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Obstetrics & Gynecology 2002;99:572-575
© 2002 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Prevalence of Urinary Incontinence Symptoms Among Black, White, and Hispanic Women

Eddie H. M. Sze, MD, Wendy P. Jones, MD, Jennifer L. Ferguson, MD, Cynthia D. Barker, MD and Jeanette M. Dolezal, PhD

From the Department of Obstetrics and Gynecology and Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina.

Address reprint requests to: Eddie H. M. Sze, MD, Yale University School of Medicine, Department of Obstetrics and Gynecology, 333 Cedar Street, P.O. Box 208063, New Haven, CT 06520; E-mail: eddie.sze{at}yale.edu.


   ABSTRACT
TOP
ABSTRACT
MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
OBJECTIVE: To compare the prevalence of urinary incontinence symptoms among black, white, and Hispanic women.

METHODS: Women attending our gynecologic clinic were asked to complete a survey. The survey asked: "Do you lose urine when you cough, sneeze, lift, jump, or get up from a bed or chair? Do you wear a pad or protective undergarment because you lose urine when you cough, sneeze, lift, jump, or get up from a bed or chair? Do you urinate more than once every hour during the day? Does the urge to urinate wake you from your sleep more than twice most nights? Do you lose urine less than 5 minutes after you feel the urge to urinate more than once per week?"

RESULTS: Seven hundred ninety-nine black, 932 white, and 639 Hispanic women completed the survey. More white women reported urinary incontinence than did black or Hispanic women (41% versus 31% versus 30%, P < .001) because of their higher prevalence of stress incontinence symptoms (39% versus 27% versus 24%, P < .001). The percentage of women who had urge incontinence symptoms was very similar between the three groups (19% versus 16% versus 16%, P = .214). More black and white women reported mixed incontinence than Hispanic women (14% versus 15% versus 9%, P < .001). More black women had frequency and nocturia than the other two groups (31% and 35% versus 19% and 19% versus 25% and 26%, P < .001).

CONCLUSION: The prevalence of incontinence symptoms is significantly different among black, Hispanic, and white women.

Studies have shown that urinary incontinence affects approximately 11–63% of women in the United States.1 These data are obtained primarily from studying white women. There is very little information regarding the prevalence of this condition in black and Hispanic women. Three recent studies from urogynecologic referral clinics found that black and Hispanic women who had stress and/or urge incontinence had different distribution of presenting symptoms than white women.2–4 Two epidemiologic studies revealed that elderly or pregnant black women were less likely to experience urinary incontinence than their white counterparts.5,6 These findings gave us little information about the prevalence of this condition among the general black or Hispanic populations. The aim of our study was to compare the prevalence of urinary incontinence symptoms among black, white, and Hispanic women.


   MATERIALS AND METHODS
TOP
ABSTRACT
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
This study was approved by the University Medical Center Institutional Review Board. Women attending the Brody Medical School Clinic and the Office of East Carolina University Women’s Physicians for gynecologic care between May 2000 and June 2001 were asked to complete a survey. Women referred to the urogynecologic and obstetric clinics were excluded from the study. The survey was composed in English and designed to screen for women with severe incontinence symptoms. A small pilot study involving 12 English-speaking women was conducted before the initiation of the survey to ensure that the questions were clear, precise, and asked for information that was easy to recall. The Linguistic Department at East Carolina University then translated the English version into Spanish. Twelve Hispanic translators and medical students who were fluent in both English and Spanish validated the translated survey. They all confirmed that the survey was easy to understand and accurately translated.

In addition to three demographic questions (age, parity, and race), the survey also asked: "Do you lose urine when you cough, sneeze, lift, jump, or get up from a bed or chair? Do you wear a pad or protective undergarment because you lose urine when you cough, sneeze, lift, jump, or get up from a bed or chair? Do you urinate more than once every hour during the day? Does the urge to urinate wake you from your sleep more than twice most nights? Do you lose urine less than 5 minutes after you feel the urge to urinate more than once per week?" In this study, the severity of urine loss associated with intra-abdominal pressure increase was not quantified. It was gauged by whether the woman needed to wear a pad or protective undergarment.

To determine the effect of age and parity on the prevalence of urinary incontinence symptoms, we divided women in each racial group into nine age-parity strata. Age was stratified as less than 30 years, 30–50 years, and older than 50 years to represent early and late reproductive age and postmenopausal women, respectively. Parity was stratified as zero (nullipara), one (primipara), and more than one (multipara). The prevalence of urge and stress incontinence symptoms was compared within each of the nine age-parity strata for statistical significance between the three racial groups.

All data were entered into a computer database system for storage and analysis. Statistical analysis was performed using Epi Info 6.04b (USD, Stone Mountain, GA) and Microsoft Office 1997 (Microsoft Corp., Redmond, WA). Categoric data were analyzed for significance using the {chi}2 test (3 x 2 contingency table). Quantitative data were analyzed with analysis of variance. Based on a conservative estimate of 20% white women experiencing involuntary urine loss, power analysis indicated that 219 women would be needed in each group to detect a 10% difference in the prevalence of incontinence symptoms among black, white, and Hispanic women with an {alpha} error of 5% and a ß error of 20%.


   RESULTS
TOP
ABSTRACT
 MATERIALS AND METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
A total of 2370 women completed the survey from May 2000 to June 2001. Seven hundred ninety-nine (34%) of the women surveyed were black, 932 (39%) were white, and 639 (27%) were Hispanic (Table 1Go). The average age of white women was significantly higher than their black and Hispanic counterparts (43.1 years versus 38.2 years versus 32.3 years, P < .001). Hispanic women had higher mean parity than white and black women (2.5 versus 1.7 versus 1.9, P < .001). A significantly larger percentage of white women reported urinary incontinence than did black or Hispanic women (41% versus 31% versus 30%, P < .001) (Table 1Go). This was largely attributable to the higher prevalence of stress incontinence symptoms among white women (39% versus 27% versus 24%, P < .001). The percentage of women who had urge incontinence symptoms was very similar between the three groups (19% versus 16% versus 16%, P = 214). More black and white women reported mixed incontinence than Hispanic women (14% versus 15% versus 9%, P <.001). More black women had frequency and nocturia than the other two groups (31% versus 19% versus 25%, P < .001, and 35% versus 19% versus 26%, P < .001).


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  		Table 1. Demographic Characteristics and Distribution of Urinary Incontinence Symptoms
 
Within the nine age-parity strata, the following comparisons of stress and urge incontinence symptoms were statistically significant: 1) Nulliparous Hispanic women under 30 years were significantly more likely to have stress and/or urge incontinence symptoms than either black or white women of similar age and parity ({chi}2 = 12.13, degrees of freedom = 2, P = .002); 2) Parous (parity greater than or equal to 1) white women between 30 and 50 years of age were significantly more likely to have stress incontinence symptoms than either black or Hispanic women of similar age and parity ({chi}2 for primiparous women = 7.13, degrees of freedom = 2, P = .028; {chi}2 for multiparous women = 20.25, degrees of freedom = 2, P < .001); 3) Multiparous black women between 30 and 50 years were significantly more likely to have weekly urge incontinence symptoms than either Hispanic or white women of similar age and parity ({chi}2 = 9.57, degrees of freedom = 2, P = .008); and 4) Multiparous black and white women between 30 and 50 years were significantly more likely to have stress and/or urge incontinence symptoms than Hispanic women of similar age and parity ({chi}2 = 9.04, degrees of freedom = 2, P = .011).


   DISCUSSION
TOP
ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
Studies have shown that lower urinary tract symptoms are a sensitive approach to detect urinary incontinence.7–9 These symptoms, however, are relatively non-specific in diagnosing whether the involuntary urine loss is caused by stress, urge, or mixed incontinence.7–9 Our study was not designed to estimate the prevalence of each type of incontinence among black, white, and Hispanic women. Our aim was to compare the prevalence of incontinence symptoms among these three racial groups. Data from our study clearly showed that the prevalence of incontinence symptoms was significantly different among black, white, and Hispanic women. In addition, our age-parity stratified data also showed that young, nulliparous Hispanic women appeared to be more likely to report urinary incontinence, whereas older, parous black and white women were more likely to have urge and stress incontinence symptoms, respectively.

Our study population included women from different socioeconomic, educational, and racial backgrounds. The resident clinic at East Carolina University Brody Medical School sees primarily women who are unemployed or employed in low-paying jobs, such as migrant farm workers, and have either Medicaid or no medical insurance. Most have a high school education or less. In contrast, the Office of East Carolina University Women’s Physicians sees mainly blue- and white-collar workers or their spouses and professionals with commercial insurance. Most have a college or graduate degree. We believe that our survey conducted at these two clinics provides us with a diverse sample of women. However, it is still important to remember that the survey population was not randomly selected, which might have an effect on the study outcome.

A woman’s race was defined by her identification with a specific group. In obstetric and gynecologic studies, race is usually identified either by sight or by the individual herself as in our study. Investigators have noted that regardless of the method of identification, the selection process will invariably mix some races.10 We do not know how or if it is possible to control for this variable.

Investigators believe that there is a difference in the susceptibility to develop urinary incontinence among women of different races. Recent studies have shown that this condition is prevalent even among women previously considered to be relatively immune to this condition.11–13 Our study showed that 30% of black and Hispanic women reported involuntary urine loss despite having a lower prevalence of incontinence symptoms than white women. We do not know whether this lower prevalence of incontinence symptoms among black and Hispanic women is due to genetic predisposition or some other factors. Regardless, the high prevalence of incontinence symptoms among women of different races found in this and other studies clearly illustrates that health care providers should routinely screen all women for urinary incontinence.1,11–16


   Footnotes
 
PII S0029-7844(01)01781-1

Received September 18, 2001. Received in revised form November 26, 2001. Accepted December 11, 2001.


   REFERENCES
TOP
ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
1. Locher JL, Burgio KL. Epidemiology of incontinence. In: Ostergard DR, Bent AE, eds. Urogynecology and urodynamics: Theory and practice. Baltimore, MD: Williams & Wilkins; 1996:67–73.

2. Bump RC. Racial comparisons and contrasts in urinary incontinence and pelvic organ prolapse. Obstet Gynecol 1993;81:421–5.[Abstract]

3. Peacock LM, Wiskind AK, Wall LL. Clinical features of urinary incontinence and urogenital prolapse in a black innercity population. Am J Obstet Gynecol 1994;171: 1464–71.[Medline]

4. Mattox TF, Bhatia NN. The prevalence of urinary incontinence or prolapse among white and Hispanic women. Am J Obstet Gynecol 1996;174:646–8.[Medline]

5. Fultz NH, Herzog AR, Raghunathan TE, Wallace RB, Diokno A. Prevalence and severity of urinary incontinence in older African American and Caucasian women. J Gerontol 1999;54A:M299–303.

6. Burgio KL, Locher JL, Zyczynski H, Hardin JM, Singh K. Urinary incontinence during pregnancy in a racially mixed sample: Characteristics and predisposing factors. Int Urogynecol J 1996;7:69–73.

7. Cundiff GW, Harris RL, Coates KW, Bump RC. Clinical predictors of urinary incontinence in women. Am J Obstet Gynecol 1997;177:262–6.[Medline]

8. Sandvik H, Hunskaar S, Vanvik A, Bratt H, Seim A. Diagnostic classification of female urinary incontinence: An epidemiological survey corrected for validity. J Clin Epidemiol 1995;48:339–43.[Medline]

9. Ouslander J, Staskin D, Raz S, Su H, Hepps K. Clinical versus urodynamic diagnosis in an incontinent geriatric female population. J Urol 1987;137:68–71.[Medline]

10. Osborne NG, Feit MD. The use of race in medical research. JAMA 1992;267:275–80.[Medline]

11. Brieger GM, Yip SK, Hin LY, Chung TKH. The prevalence of urinary dysfunction in Hong Kong Chinese women. Obstet Gynecol 1996;88:1041–4.[Abstract]

12. Ma SSY. The prevalence of adult female urinary incontinence in Hong Kong Chinese. Int Urogynecol J 1997;8: 327–31.

13. Brieger GM, Mongelli M, Hin LY, Chung TKH. The epidemiology of urinary dysfunction in Chinese women. Int Urogynecol J 1997;8:191–5.

14. Lara C, Nacey J. Ethnic differences between Maori, Pacifc Island, and European New Zealand women in prevalence and attitudes to urinary incontinence. N Z Med J 1994; 107:374–6.[Medline]

15. Kato K, Dondo A, Okamura K, Takaba H. Prevalence of urinary incontinence in working women. Nippon-Hinyokika Gakkai-Zassh 1986;77:1502–5.

16. Takai K, Miyashita A, Mochizuki K. Actual conditions of female stress incontinence. Jpn J Clin Urol 1987;41:393–6.




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