Association of urologic symptoms and chronic illness: contribution of symptom severity and duration

1
Association of urologic symptoms and chronic
illness contribution of symptom severity and
duration

• Varant Kupelian, Ph.D.

New England Research Institutes, Watertown, MA
02472 USA vkupelian_at_neriscience.com NIDDK
DK-56842, Pfizer
2
Background

• Lower urinary tract symptoms (LUTS) are common in
  both aging men and women
• Increasing evidence suggesting and association
  between LUTS and chronic illnesses
• Beyond the bladder hypothesis
• (Fitzgerald et al Eur Urol 2007)
• The effect of symptom severity and duration not
  investigated previously

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Objectives

• Investigate the association between LUTS and
  chronic illnesses
• Heart disease
• Type 2 diabetes
• Hypertension
• Depressive Symptoms
• Determine whether a dose-response relationship
  exists in the association of severity and
  duration of urologic symptoms with chronic
  illnesses

4
Methods

• Urologic Symptoms (AUA symptom index)
• Incomplete emptying
• Intermittency
• Weak stream
• Straining
• Frequency
• Urgency
• Nocturia
• Overall LUTS AUA-SI 8 (Moderate or Severe)

5
Methods

• Severity assessed on six point scale
• No symptom ? reference category
• Rarely
• Sometimes
• Fairly often
• Usually
• Almost Always

Mild
Severe
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Methods

• Duration of symptoms
• No Symptom ? reference category
• lt3 months
• 3-6 months
• 7-12 months
• 1-5 years
• 6 years

lt1 year
1year
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Methods

• Self-report of chronic illnesses
• Heart disease myocardial infarction, angina,
  congestive heart failure, coronary artery bypass
  or stent
• Type 2 diabetes
• Hypertension
• Depressive symptoms reporting 5 out of 8
  symptoms on the CES-D scale

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Analysis

• Odds ratios (OR) and 95 confidence intervals
  (95CI) estimated using logistic regression
• Analysis conducted separately for men and women
• 2301 men
• 3202 women
• Combining severity and duration into a 5 category
  variable not feasible because of small numbers

reference category
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Prevalence of Chronic Illnesses
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Prevalence of Urologic Symptoms
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Severity and Duration of Symptoms
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LUTS (AUA-SI 8) and Chronic Illnesses
adjusted for age, race/ethnicity, BMI, physical
activity, smoking, alcohol consumption, comorbid
conditions
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LUTS and Depressive Symptoms

• Robust and consistent association between all
  seven urologic symptoms and depressive symptoms.
• Associations stronger with increased severity of
  symptoms
• Men ORs for severe symptoms ranged 2.3 to 7.3
• Women ORs for severe symptoms ranged 1.6 to 4.2
• Duration of symptoms did not influence the LUTS
  and depressive symptoms associations.

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Men Nocturia and Heart Disease
ORs adjusted for age, race/ethnicity, BMI,
physical activity, smoking, alcohol consumption,
comorbid conditions
15
Men Intermittency, Frequency, and Heart Disease
16
Men Urgency and Type 2 Diabetes
ORs adjusted for age, race/ethnicity, BMI,
physical activity, smoking, alcohol consumption,
comorbid conditions
17
Women LUTS and Heart Disease
ORs adjusted for age, race/ethnicity, BMI,
physical activity, smoking, alcohol consumption,
comorbid conditions
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Women Weak Stream, Urgency, and Heart Disease
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Women Nocturia and Type 2 Diabetes
ORs adjusted for age, race/ethnicity, BMI,
physical activity, smoking, alcohol consumption,
comorbid conditions
20
Women LUTS Hypertension
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Summary
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Conclusions

• Dose-response relationship observed in the
  association of severity and duration of many
  urologic symptoms and chronic illnesses
• Robust association between LUTS and depressive
  symptoms consistent by gender
• Association of specific symptoms and heart
  disease, diabetes, and hypertension different by
  gender.
• May indicate different underlying biologic
  mechanism by gender