Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis

Abstract

BackgroundThe association between urinary incontinence (UI) and increased mortality remains controversial. The objective of our study was to evaluate if this association exists.MethodsWe performed a systematic review and meta-analysis of observational studies comparing death rates among patients suffering from UI to those without incontinence. We searched in Medline, Embase and the Cochrane library using specific keywords. Studies exploring the post-stroke period were excluded. Hazard ratios (HR) were pooled using models with random effects. We stratified UI by gender and by UI severity and pooled all models with adjustment for confounding variables.ResultsThirty-eight studies were retrieved. When compared to non-urinary incontinent participants, UI was associated with an increase in mortality with pooled non adjusted HR of 2.22 (95%CI 1.77–2.78). The risk increased with UI severity: 1.24 (95%CI: 0.79–1.97) for light, 1.71 (95%CI: 1.26–2.31) for moderate, and 2.72 (95%CI: 1.90–3.87) for severe UI respectively. When pooling adjusted measures of association, the resulting HR was 1.27 (95%CI: 1.13–1.42) and increased progressively for light, moderate and severe UI: 1.07 (95%CI: 0.79–1.44), 1.25 (95%CI: 0.99–1.58), and 1.47 (95%CI: 1.03–2.10) respectively. There was no difference between genders.ConclusionUI is a predictor of higher mortality in the general and particularly in the geriatric population. The association increases with the severity of UI and persists when pooling models adjusted for confounders. It is unclear if this association is causative or just reflects an impaired general health condition. As in most meta-analyses of observational studies, methodological issues should be considered when interpreting results.

Urinary Incontinence and Indwelling Urinary Catheters as Predictors of Death after New-Onset Stroke: A Report of the South London Stroke Register

“…The factors of adjustment were chosen from previous publications or when they were associated with mortality in univariate analyses. [5,6] Continuous variable were introduced as categorical or dichotomous variable when not linear in the Cox model. Furthermore, the proportion of UI, the proportion of IUC, and one-year mortality decreased over the study period (Table e-1).…”

“…The respective figure for IUC was 729 deaths among patients with IUC (62.3%) compared to 470 among patients without IUC (18.2%, p <0.001). UI and IUC were both associated with death in unadjusted survival analysis: hazard ratio (HR) 6 Mortality in continent and incontinent patients was higher among those receiving an IUC (Figure 1). Compared to patients without UI or IUC, patients with IUC (HR 3.42; 95% CI 2.35-4.97), patients with UI but no IUC (HR 4.70; 95% CI 3.88-5.70), and patients with UI and IUC (HR 10.24; 95% CI 8.72-12.03) were at higher risk of death.…”

“…[1,3] UI has been reported to be an independent predictor of institutionalization, severe disability, and death in the post-stroke period. [1,[4][5][6] Indwelling urinary catheters (IUC) are often used after the occurrence of an acute stroke (in almost 25% of patients), but are only seldom reported in studies. [7] IUC is responsible for most of the urinary track infections among hospitalized patients, with a risk of approximately 5% per day.…”

Cluster analysis of multiple chronic conditions associated with urinary incontinence among women in the USA

“…Urinary incontinence (UI) occurs in up to one-third of adult women, with urgency type UI (UUI), specifically, increasing greatly with age [1][2][3][4][5][6][7]. UI may also be associated with increased mortality even after adjusting for chronic conditions [8]. Treatment options for UI include nonpharmacological and pharmacological interventions that rarely ameliorate all symptoms [9].…”

Understanding help-seeking in older people with urinary incontinence: an interview study

“…) and is a predictor of higher mortality, especially among older people (John et al 2016). The study reported here aims to explore help-seeking behaviour in older people with UI.…”