title: Rural vs. urban disparities in association with lower urinary tract symptoms and benign prostatic hyperplasia in ageing men, NHANES 2001-2008.
abstract: OBJECTIVE
  The objective of this study was to investigate rural/urban and socio-demographic disparities in lower urinary tract symptoms and benign prostatic hyperplasia (LUTS/BPH) in a nationally representative population of men.
  
  
  METHODS
  Data on men age ≥40 years (N = 4,492) in the 2001-2008 National Health and Nutrition Examination Surveys were analysed. Self-report of physician-diagnosed enlarged prostate and/or BPH medication use defined recognised LUTS/BPH. Urinary symptoms without BPH diagnosis/medications defined unrecognised LUTS/BPH. Rural-Urban Commuting Area Codes assessed urbanisation. Unadjusted and multivariable associations (odds ratios (OR)) between LUTS/BPH and covariates were calculated using logistic regression.
  
  
  RESULTS
  Recognised and unrecognised LUTS/BPH weighted-prevalence estimates were 16.5% and 9.6%. There were no significant associations between LUTS/BPH and rural/urban status. Significant predisposing factors for increased adjusted odds of recognised and unrecognised LUTS/BPH included age, hypertension (OR=1.4;1.4), analgesic use (OR=1.4;1.4) and PSA level >4 ng/mL (OR=2.3;1.9) when adjusted for rural/urban status, race, education, income, alcohol, health insurance, health care and proton pump inhibitor (PPI) use (all p ≤ 0.1). Restricting to urban men only (N = 3,371), healthcare use (≥4visits/year) and PPI's increased adjusted odds of recognised LUTS/BPH (OR=2.0;1.6); no health insurance and <high school education decreased odds (OR=0.5;0.6) after adjusting for variables listed above, antidepressant and calcium channel blocker use (p ≤ 0.1). Also among urban men, adjusted odds of unrecognised LUTS/BPH increased for blacks (OR=1.9), Hispanic/Other (OR=1.9) and income<$34,999 (OR=1.6). Among rural men only (N = 1,121), adjusted odds of recognised and unrecognised LUTS/BPH increased for age, hypertension (OR=1.9;1.7) and analgesic use (OR=2.0;1.5) when adjusting for race, CRP, antidepressant and dyslipidaemic use (p ≤ 0.1).
  
  
  CONCLUSIONS
  Rural/urban status was not associated with significantly increased adjusted odds of either recognised or unrecognised LUTS/BPH.
authors.affiliation: New England Research Institutes, Inc., Watertown, MA, USA.
authors.forename: K B
authors.initials: KB
authors.lastname: Egan
authors.affiliation: New England Research Institutes, Inc., Watertown, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Suh
authors.affiliation: New England Research Institutes, Inc., Watertown, MA, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Rosen
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Burnett
authors.affiliation: Global Statistical Sciences and Advanced Analytics, Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: X
authors.initials: X
authors.lastname: Ni
authors.affiliation: Eli Lilly and Company USA, Indianapolis, IN, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Wong
authors.affiliation: Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: McVary
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011470:Prostatic Hyperplasia / Q000453:epidemiology*; D011788:Quality of Life; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*