title: Relationship between lifestyle and health factors and severe lower urinary tract symptoms (LUTS) in 106,435 middle-aged and older Australian men: population-based study.
abstract: BACKGROUND
  Despite growing interest in prevention of lower urinary tract symptoms (LUTS) through better understanding of modifiable risk factors, large-scale population-based evidence is limited.
  
  
  OBJECTIVE
  To describe risk factors associated with severe LUTS in the 45 and Up Study, a large cohort study.
  
  
  METHODS
  A cross-sectional analysis of questionnaire data from 106,435 men aged ≥ 45 years, living in New South Wales, Australia.
  
  
  METHODS
  LUTS were measured by a modified version of the International Prostate Symptom Score (m-IPSS). The strength of association between severe LUTS and socio-demographic, lifestyle and health-related factors was estimated, using logistic regression to calculate odds ratios, adjusted for a range of confounding factors.
  
  
  RESULTS
  Overall, 18.3% reported moderate, and 3.6% severe, LUTS. Severe LUTS were more common among men reporting previous prostate cancer (7.6%), total prostatectomy (4.9%) or having part of the prostate removed (8.2%). After excluding men with prostate cancer or prostate surgery, the prevalence of moderate-severe LUTS in the cohort (n = 95,089) ranged from 10.6% to 35.4% for ages 45-49 to ≥ 80; the age-related increase was steeper for storage than voiding symptoms. The adjusted odds of severe LUTS decreased with increasing education (tertiary qualification versus no school certificate, odds ratio (OR = 0.78 (0.68-0.89))) and increasing physical activity (high versus low, OR = 0.83 (0.76-0.91)). Odds were elevated among current smokers versus never-smokers (OR = 1.64 (1.43-1.88)), obese versus healthy-weight men (OR = 1.27 (1.14-1.41)) and for comorbid conditions (e.g., heart disease versus no heart disease, OR = 1.36 (1.24-1.49)), and particularly for severe versus no physical functional limitation (OR = 5.17 (4.51-5.93)).
  
  
  CONCLUSIONS
  LUTS was associated with a number of factors, including modifiable risk factors, suggesting potential targets for prevention.
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia; Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Smith
authors.affiliation: Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia; School of Public Health, Sydney University, Sydney, New South Wales, Australia.
authors.forename: Marianne F
authors.initials: MF
authors.lastname: Weber
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Kay
authors.initials: K
authors.lastname: Soga
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Rosemary J
authors.initials: RJ
authors.lastname: Korda
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Tikellis
authors.affiliation: School of Public Health, Sydney University, Sydney, New South Wales, Australia.
authors.forename: Manish I
authors.initials: MI
authors.lastname: Patel
authors.affiliation: Karolinska Institute, Stockholm, Sweden.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Clements
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Terry
authors.initials: T
authors.lastname: Dwyer
authors.affiliation: Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Isabel K
authors.initials: IK
authors.lastname: Latz
authors.affiliation: The Sax Institute, Sydney, New South Wales, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Banks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires