Markland and colleagues evaluated the prevalence of UI in men by using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2007-2008. NHANES is a cross-sectional health survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. All participants older than 20 years were asked questions about UI, and men older than 40 years were asked questions about prostate conditions during private interviews by trained interviewers. UI was identified using the 2-item incontinence severity index (ISI), which asks about frequency and amount of urinary leakage. Other questions were asked to evaluate for the type of UI (stress vs urge vs both) and for the presence or absence of prostate conditions. In addition, data on socioeconomic status and other medical issues were obtained.

A total of 5297 men completed household interviews, and 5081 men completed physical examinations, which were conducted in mobile examination centers. The overall UI rate for men in this study was 12.4%. A total of 4.5% of men evaluated had moderate to severe UI; risk factors associated with moderate to severe UI included a 10-year age increment, major depression, hypertension, and benign prostatic hyperplasia (BPH) in men older than 40 years who were asked about prostate conditions. On multivariate analysis, depression, prostate cancer, and BPH seemed to have greater associations with stress UI. Chronic illnesses and poor or fair self-rated health were significantly associated with UI on univariate analysis alone.

Viewpoint

These data are important, especially when one realizes that by 2050, more than one sixth of men in the United States will be aged 65 years or older. Age was clearly associated with UI in Markland and colleagues’ study and in other studies of both men and women.[1,2] This study suggests that moderate to severe UI is present 1 of 6 older men. Of note, race and ethnicity were not associated with UI, consistent with previous NHANES evaluations of UI in women[1] and with the Boston Area Community Health Survey[3], another population-based study.

How, if at all, should these data influence the way we currently practice medicine? Age-adjusted population counts from NHANES suggest that 22.6 million men have UI in the United States and 8.2 million men have moderate to severe UI. Markland and colleagues identified age, major depression, hypertension, and BPH as being associated with UI in men. Men with these conditions could benefit from screening for symptoms of UI, which clearly can affect quality of life.

A limitation of this study is that it was a sample of noninstitutionalized patients only; nursing home patients, who have a higher prevalence of UI, were not included. Therefore, the true prevalence of UI has probably been underestimated.