Increase in Urinary Voiding Dysfunctions Predicted Globally
October 1, 2011 — Both the incidence and prevalence of urinary and bladder conditions are predicted to increase worldwide between 2008 and 2018, according to a study published online January 13 and in the October print issue of BJU International.
The number of people experiencing lower urinary tract symptoms (LUTS), overactive bladder (OAB), urinary incontinence (UI), and LUTS suggestive of bladder outlet obstruction (LUTS/BOO) is expected to climb by approximately 20% worldwide, with Africa, South America, and Asia facing the steepest increases.
The highest prevalence for all for all of these conditions, however, is expected to remain in Europe, followed by North America, reports Debra E. Irwin, PhD, from the Department of Epidemiology, University of North Carolina, Chapel Hill, and colleagues.
"For Africa, these increases are primarily attributed to the substantial size growth (29.3%) that is predicted within its general population between 2008 and 2018, with little overall population aging expected," they write. In contrast, the European increases are largely driven by the overall aging of the general population (namely, an "8.0% increase in the number of individuals aged ≥45 years between 2008 and 2018"), whereas the Asian and South American increases are affected by both population growth (rise of 17.8% and 18.6%, respectively, between 2008 and 2018) and aging (16.1% and 13.5% increases in the number of individuals ≥45 years of age, respectively, during the same time), the authors report.
The study calculated incidence and prevalence of urinary voiding dysfunctions among individuals aged 20 years or more, using data from the US Census Bureau International Data Base as well as the EPIC study, a population-based cross-sectional telephone survey of more than 19,000 men and women in 5 countries.
The researchers used the data to calculate "current" (2008) worldwide incidences and prevalences of each condition, using definitions from the International Continence Society, and then estimated how these figures would change by 2018.
They estimated that worldwide, the number of people experiencing LUTS would increase by 18.4% by 2018, to 2.3 billion, with the highest increase in incidence predicted for Africa (30.1%), South America (20.5%), and Asia (19.7%).
For OAB, the authors estimated a worldwide increase of 20.1% by 2018, to a total of 546 million people, with the highest increases once again seen in Africa (31.1%), South America (22.4%), and Asia (22.1%).
There is a projected 21.6% increase in the number of people who will experience any type of UI by 2018 (growing to 423 million people), with the increase once again the heaviest for Africa (30.8%), South America (24.7%), and Asia (24.4%).
A similar pattern is predicted for LUTS/BOO, with a predicted increase of 18.5% in the number of people affected by 2018 (to a total of 1.1 billion), with Africa facing a 30.2% increase and South America and Asia facing increases of 20.6% and 19.7%, respectively.
In terms of prevalence, all conditions are predicted to increase by 2018, with the highest rates in Europe and North America.
Worldwide, the prevalence of LUTS is expected to increase from 45.2% in 2008 to 45.8% in 2018, rising to 48.4% and 47.0% in Europe and North America, respectively.
For OAB, the worldwide prevalence is expected to rise from 10.7% to 10.9%, rising to 12.3% and 11.6% in Europe and North America, respectively.
The worldwide prevalence of UI is expected to rise from 8.2% to 8.5%, rising to 10.0% in Europe and 9.2% in North America.
Finally, for LUTS/BOO, the worldwide prevalence is expected to rise from 21.5% to 21.8% by 2018, rising to 23.0% in Europe and 22.4% in North America.
Although these prevalence increases "appear to be small, they translate into a substantial number of affected individuals given the size of the worldwide and regional general populations," the authors note.
Overall, the estimates have "significant implications for public health and clinical practice," they add. "These conditions are under-reported, underdiagnosed and undertreated; and are associated with significant direct and indirect costs."
They add: "[W]e believe that there is a clear and urgent need to improve the awareness, prevention, diagnosis and management of these conditions. International and national programmes that increase public awareness, educate clinicians and at-risk or affected populations, and implement public campaigns designed to diminish or eliminate social stigma will be a significant step toward reaching this objective."
The analysis is "innovative" and "provides valuable information for public-health studies and policy development related to these important clinical conditions," Tomas L. Griebling, MD, from the Department of Urology and the Landon Center on Aging at the University of Kansas in Kansas City, writes in an editorial. "The findings also highlight the critical need for better continence promotion and education worldwide," adds Dr. Griebling. "[T]here are significant geographic differences in social and cultural implications of urinary incontinence and other urological conditions. These issues also deserve additional attention in future research."
He also points out that the study has inherent limitations, which are also outlined by the authors, in that it relies on assumptions based on epidemiological data and population growth statistics.
The study was supported by Pfizer, Inc. All study authors have disclosed financial relationships, including employment and consultation, with Pfizer, Inc.