title: Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history.
abstract: OBJECTIVE
  Urinary incontinence (UI) is common and the relationship among its subtypes complex. Our objective was to describe the natural history and predictors of the incontinence subtypes stress, urgency, and mixed, in middle-aged and older US women. We tested our hypothesis that UI subtype history predicted future occurrence, evaluating subtype incidence/remission over multiple time points in a stable cohort of women.
  
  
  METHODS
  We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women aged ≥50 in the 2004-2010 Health and Retirement Study. Mixed, stress, and urgency incontinence prevalence (2004, 2006, 2008, 2010) and 2-year cumulative incidence and remissions (2004-2006, 2006-2008, 2008-2010) were estimated. Patient characteristics and incontinence subtype status 2004-2008 were entered into a multivariable, transition model to determine predictors for incontinence subtype occurrence in 2010.
  
  
  RESULTS
  The prevalence of each subtype in this population (median age 63-66) was 2.6-8.9 %. Subtype incidence equaled 2.1-3.5 % and remissions for each varied between 22.3 and 48.7 %. Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, and functional limitations. Compared with white women, black women had decreased odds of incident stress incontinence and Hispanic women had increased odds of stress incontinence remission. The age range 80-90 and severe obesity predicted incident mixed incontinence. Functional limitations predicted mixed and urgency incontinence. The strongest predictor of incontinence subtype was subtype history. The presence of the respective incontinence subtypes in 2004 and 2006 strongly predicted 2010 recurrence (odds ratio [OR] stress incontinence = 30.7, urgency OR = 47.4, mixed OR = 42.1).
  
  
  CONCLUSIONS
  Although the number of remissions was high, a previous history of incontinence subtypes predicted recurrence. Incontinence status is dynamic, but tends to recur over the longer term.
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, MSC10-5580 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA. ykomesu@salud.unm.edu.
authors.forename: Yuko M
authors.initials: YM
authors.lastname: Komesu
authors.affiliation: University of New Mexico Clinical and Translational Science Center, Albuquerque, NM, USA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Schrader
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, MSC10-5580 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
authors.forename: Loren H
authors.initials: LH
authors.lastname: Ketai
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, MSC10-5580 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, MSC10-5580 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
authors.forename: Gena C
authors.initials: GC
authors.lastname: Dunivan
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012075:Remission, Spontaneous; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D053202:Urinary Incontinence, Urge / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data
keywords: Incidence; Mixed urinary incontinence; Predictors; Stress urinary incontinence; Urgency urinary incontinence