Abstract
Introduction and Hypothesis
To examine the current prevalence and trends of OAB among US adult women and correlations between OAB and potential risk factors.
Methods
The study used the nationally representative data from NHANES. Seven cycles’ data on OAB from 2005–2020 were analyzed. The weighted prevalence and corresponding 95% confidence intervals of OAB in these seven cycles were calculated. The temporal trends in OAB were investigated by linear regression. Multivariate-adjusted weighted logistic regression analysis was performed to determine the correlation between OAB and several participants’ factors.
Results
The overall prevalence of OAB had a significant increase from 18.7% in the 2005–2006 cycle to 22.1% in the 2017–2020 cycle (difference 3.4% [95% CI 2.11–4.69%)]; Ptrend < 0.001). For subgroup analysis, the prevalence of OAB experienced a significant increase among women: aged ≥ 60 years, non-Hispanic White, non-Hispanic Black, or body mass index ≥ 30 kg/m2. Older age, non-Hispanic Black, lower educational level, higher family poverty ratio, obesity, hypertension, diabetes, depression, sleep disorder, other chronic comorbidities, less intense recreational activity, poorer health condition, history of pregnancies, and use of female hormone were independent risk factors of OAB.
Conclusions
The contemporary prevalence of OAB was high, affecting 22.1% of US women, and the estimated overall prevalence showed an upward trend from 2005 to 2020.
Keywords: Overactive bladder, Prevalence, Trends, National Health and Nutrition Examination Survey, Risk factors, Women
Introduction
Overactive bladder (OAB) is a widespread condition that affects millions of individuals globally, with a higher prevalence among women [1]. It can have a significant impact on physical and psychological health, and quality of life [2]. Additionally, OAB caused a substantial economic burden, with estimated costs of 7 billion euros in Europe and 66 billion USD in the United States (US) annually, these costs include expenses related to urgency urinary incontinence (UUI) and nursing home admissions [3].
OAB is a condition characterized by urinary urgency, increased frequency during the day and night (nocturia), accompanied by UUI or not, and without urinary tract infection [4]. The overall prevalence of OAB varies across different countries and studies. In the EPIC study performed in five western countries, the prevalence was estimated to be 13% [5]. Population-based studies have reported the prevalence ranging between 7% and 27% in men, 9% and 43% in women [6]. In China, the estimated prevalence in adult women is 6% based on the OAB symptom score questionnaire (OABSS) [7], while in Austria it is 16.8% [8] and in Europe and Canada it is 12.8% [5]. The difference in OAB prevalence rate may be related to the geographic distribution, method of epidemiological investigation, study designs, different OAB definitions, response rates, and study population. About two decades ago, the National Overactive Bladder Evaluation (NOBLE) program was performed to investigate the overall prevalence and burden of OAB in the US by telephone questionnaires and the study reported an overall prevalence of 16.9% in US women [9]. Nevertheless, the current incidence and trends of OAB in US women are unclear.
The risk factors of OAB remain uncertain; age, socioeconomic status, lifestyles, nutritional status, and comorbidities may be associated with the incidence of OAB [10]. To address these gaps, we used nationally representative data from the National Health and Nutrition Examination Survey (NHANES) to evaluate the contemporary prevalence and trends in OAB from 2005–2020 among US women and to further determine the associations between sociodemographic features, BMI, chronic comorbidities, gynecologic factors, lifestyles, and OAB.
Patients and Methods
Study Design
The NHANES is a program of surveys conducted by the National Center for Health Statistics (NCHS) to collect health-related data from the civilian noninstitutionalized population in the US. These surveys use a complex and multistage probability sample design to establish a representative sample of the population. The aim is to obtain comprehensive information on health and nutrition status through interviews and examinations. The detailed information of study design, protocol, and data collection for NHANES are described in existing publications [11]. From 1999 to March 2020, there were ten cycles for NHANES surveys, consisting of nine 2-year cycles spanning from 1999 to 2016 and one combined cycle from 2017 to March 2020, which was impacted by the COVID-2019 pandemic [12]. For this study, the NHANES protocol obtained approval from the NCHS Research Ethics Review Board, and all participants provided written consent. The present study included adult women aged ≥ 20 years and who had complete data for OAB associated symptoms, including UUI and nocturia, from 2005–2020. The unweighted total female response rates ranged from 52.4% to 80.9% for the interviewed samples and from 48.2% to 77.8% for the examined samples [13].
Assessment and Definitions of OAB
The data on OAB associated symptoms including UUI and nocturia were collected using the Kidney Conditions-Urology (KIQ_U) questionnaire in the mobile examination center (MEC). Two questions were asked to assess the severity of UUI: 1. “During the past 12 months, have you leaked or lost control of even a small amount of urine with an urge or pressure to urinate and you couldn’t get to the toilet fast enough?” 2. “How frequently does this occur?” And another question was asked to assess the severity of nocturia: “During the past 30 days, how many times per night did you most typically get up to urinate, from the time you went to bed at night until the time you got up in the morning?”.
To further identify OAB, we used the established OABSS questionnaire developed by Blaivas et al. [14]. The method for conversion of NHANES symptom frequencies to OABSS are shown in Table 1. Finally, we combined the UUI score and nocturia score and total score of ≥ 3 indicated a diagnosis of OAB disorder.
Table 1.
Conversion of NHANES symptom frequencies to OABSS
| NHANES symptom frequencies | OABSS |
|---|---|
| UUI | UUI score |
| Never | 0 |
| Less than once a month | 1 |
| A few times a month | 1 |
| A few times a week | 2 |
| Every day or night | 3 |
| Nocturia | Nocturia score |
| 0 | 0 |
| 1 | 1 |
| 2 | 2 |
| 3 | 3 |
| 4 | 3 |
| 5 or more | 3 |
NHANES national health and nutrition examination survey, OABSS overactive bladder symptom score, UUI urgency urinary incontinence
Correlates of OAB
We extracted data on age (20–39 years, 40–59 years, and ≥ 60 years), race/ethnicity (Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian and other), education (< high school, high school and > high school), family poverty ratio (< 1.3, 1.3–3.5 and ≥ 3.5), body mass index (BMI; < 25 kg/m2, 25–30 kg/m2, ≥ 30 kg/m2), smoking, hypertension, diabetes, depression, sleep time, sleep disorder, chronic conditions (including asthma, arthritis, congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, stroke, thyroid problem, any liver condition and cancer), recreational activity (mild, moderate, and vigorous), diet, health condition, food security, health insurance, and reproductive information such as parity (0, 1, 2, 3+), menopausal status and history of female hormone use.
Statistical Analysis
Statistical analysis was performed with R version 4.3.1. Descriptive statistics were conducted to show the demographic characteristics and other participants’ features in each cycle. Estimates on weighted average level (95% confidence interval (CI)) of OABSS and weighted prevalence (95% CI) of OAB were calculated in each cycle. The linear regression analyses were performed to assess the crude linear trends in the prevalence of OAB. The estimate β can be interpreted as the average change in every 2 years. Absolute differences (95% CI) in the prevalence of OAB between the initial cycle and the final cycle were calculated. Weighted logistic regressions were used to explore the risk factors of OAB. All statistical tests were two sided; P < 0.05 was considered statistically significant.
Results
Participant Characteristics
Of the 76,496 individuals who participated in NHANES from 2005 to 2020, we excluded 33,084 participants who were younger than 20 years, 21,027 who were men, and 3328 who had incomplete information of UUI and/or nocturia. The final study population included 19,057 female adults aged ≥ 20 years and who had complete data. The average age was 48.2 years, 34.8% were aged 20–39 years, 37.3% were aged 40–59 years, and 27.9% were aged ≥ 60 years. Of the 19,057 participants, 7.6% were Mexican American; 5.3% were other Hispanic American; 11.7% were non-Hispanic Black; 68.5% were non-Hispanic White; and 6.9% were other races/ethnicities. Detailed data on demographic characteristics and other participants’ features are shown in Table 2.
Table 2.
Baseline characteristics of the study population in the NHANES, 2005 to 2020a
| Characteristic | 2005–2006 | 2007–2008 | 2009–2010 | 2011–2012 | 2013–2014 | 2015–2016 | 2017–2020 |
|---|---|---|---|---|---|---|---|
| Number | 2235 | 2632 | 2671 | 2319 | 2624 | 2531 | 4045 |
| Weighted (N) | 99,348,610 | 101,051,849 | 97,690,639 | 102,952,866 | 108,917,653 | 110,461,599 | 117,090,681 |
| Age, y | |||||||
| 20–39 | 36.5 | 35.6 | 34.7 | 33.9 | 34.5 | 33.6 | 34.4 |
| 40–59 | 39.4 | 38.7 | 38.2 | 36.6 | 36.4 | 35.7 | 34.3 |
| ≥ 60 | 24.1 | 25.7 | 27.1 | 29.5 | 29.1 | 30.7 | 31.3 |
| Race/ethnicity | |||||||
| Mexican American | 7.0 | 7.5 | 7.5 | 6.5 | 8.4 | 8.6 | 7.7 |
| Other Hispanic | 3.4 | 4.9 | 5.0 | 6.2 | 5.7 | 5.9 | 7.5 |
| Non-Hispanic White | 72.6 | 70.6 | 69.5 | 68.1 | 66.9 | 65.1 | 64.0 |
| Non-Hispanic Black | 11.5 | 11.9 | 11.7 | 12.1 | 11.6 | 11.7 | 11.7 |
| Non-Hispanic Asian | / | / | / | 4.6 | 5.0 | 5.1 | 5.5 |
| Otherb | 5.5 | 5.2 | 6.3 | 2.6 | 2.4 | 3.7 | 3.5 |
| Education | |||||||
| < High school | 15.9 | 19.3 | 18.4 | 14.9 | 14.3 | 12.6 | 9.8 |
| High school | 24.7 | 24.4 | 22.2 | 19.2 | 20.3 | 19.9 | 25.8 |
| > High school | 59.4 | 56.3 | 59.4 | 66.0 | 65.4 | 67.5 | 64.4 |
| Family poverty ratio | |||||||
| < 1.3 | 17.9 | 21.9 | 22.2 | 24.7 | 25.6 | 22.0 | 20.2 |
| 1.3–3.5 | 37.9 | 34.5 | 37.4 | 35.7 | 35.2 | 38.0 | 35.7 |
| ≥ 3.5 | 44.2 | 43.6 | 40.4 | 39.7 | 39.2 | 40.0 | 44.1 |
| BMI, kg/m2 | |||||||
| < 25 | 38.1 | 35.0 | 34.5 | 32.7 | 32.5 | 30.7 | 29.3 |
| 25–30 | 26.2 | 29.7 | 28.6 | 30.1 | 27.3 | 27.1 | 27.9 |
| ≥ 30 | 35.7 | 35.3 | 36.9 | 37.2 | 40.3 | 42.2 | 42.7 |
| Smoke | |||||||
| Current | 20.4 | 19.8 | 18.7 | 15.9 | 18.4 | 16.2 | 15.0 |
| Former | 21.8 | 20.8 | 21.3 | 22.2 | 19.6 | 21.6 | 21.0 |
| Never | 57.8 | 59.3 | 60.0 | 61.9 | 62.0 | 62.3 | 64.1 |
| Hypertension | |||||||
| Yes | 31.3 | 32.4 | 30.9 | 32.9 | 36.5 | 33.9 | 31.6 |
| No | 68.7 | 67.6 | 69.1 | 67.1 | 63.5 | 66.1 | 68.4 |
| Diabetes | |||||||
| Yes | 8.0 | 8.8 | 8.4 | 9.7 | 10.0 | 10.1 | 9.9 |
| No | 92.0 | 91.2 | 91.6 | 90.3 | 90.0 | 89.9 | 90.1 |
| Depression | |||||||
| Yes | 6.4 | 10.4 | 9.7 | 9.9 | 11.5 | 9.4 | 10.3 |
| No | 93.6 | 89.6 | 90.3 | 90.1 | 88.5 | 90.6 | 89.7 |
| Sleep time, h | |||||||
| < 7 | 33.1 | 36.5 | 34.3 | 35.4 | 34.8 | 15.5 | 20.2 |
| ≥ 7 | 66.9 | 63.5 | 65.7 | 64.6 | 65.2 | 84.5 | 79.8 |
| Sleep disorder | |||||||
| Yes | 28.9 | 28.5 | 30.4 | 32.0 | 32.9 | 34.3 | 33.9 |
| No | 71.1 | 71.5 | 69.6 | 68.0 | 67.1 | 65.7 | 66.1 |
| Chronic diseasesc | |||||||
| Any | 54.0 | 54.7 | 53.8 | 53.4 | 57.7 | 58.0 | 56.9 |
| No | 46.0 | 45.3 | 46.2 | 46.6 | 42.3 | 42.0 | 43.1 |
| Recreational activity | |||||||
| Mild | 33.7 | 51.9 | 50.9 | 46.9 | 48.3 | 46.5 | 47.4 |
| Moderate | 33.3 | 28.7 | 31.9 | 33.1 | 30.4 | 28.9 | 28.3 |
| Vigorous | 33.1 | 19.4 | 17.2 | 20.0 | 21.2 | 24.6 | 24.2 |
| Health diet | |||||||
| Yes | 73.7 | 73.4 | 75.0 | 75.6 | 75.9 | 71.9 | 70.5 |
| No | 26.3 | 26.6 | 25.0 | 24.4 | 24.1 | 28.1 | 29.5 |
| Health condition | |||||||
| Good | 83.6 | 80.9 | 82.8 | 82.0 | 80.3 | 81.1 | 81.1 |
| Not good | 16.4 | 19.1 | 17.2 | 18.0 | 19.7 | 18.9 | 18.9 |
| Food security | |||||||
| Yes | 91.3 | 89.5 | 87.1 | 84.9 | 84.8 | 81.1 | 82.7 |
| No | 8.7 | 10.5 | 12.9 | 15.1 | 15.2 | 18.9 | 17.3 |
| Health insurance | |||||||
| Yes | 84.3 | 84.1 | 82.1 | 83.6 | 84.4 | 88.4 | 89.8 |
| No | 15.7 | 15.9 | 17.9 | 16.4 | 15.6 | 11.6 | 10.2 |
| Pregnanciesd | |||||||
| 0 | 16.3 | 16.8 | 18.0 | 19.9 | 18.6 | 17.7 | 19.4 |
| 1 | 12.9 | 13.1 | 12.2 | 14.4 | 12.9 | 10.8 | 11.5 |
| 2 | 20.7 | 22.5 | 24.3 | 21.6 | 21.5 | 23.0 | 21.6 |
| 3 + | 50.1 | 47.6 | 45.5 | 44.1 | 47.1 | 48.4 | 47.5 |
| Female hormone usee | |||||||
| Ever | 26.8 | 22.5 | 20.3 | 21.9 | 22.0 | 20.9 | 18.3 |
| Never | 73.2 | 77.5 | 79.7 | 78.1 | 78.0 | 79.1 | 81.7 |
| Menopausef | |||||||
| Yes | 42.8 | 44.6 | 46.3 | 49.1 | 46.8 | 49.6 | 48.8 |
| No | 57.2 | 55.4 | 53.7 | 50.9 | 53.2 | 50.4 | 51.2 |
Data were expressed as %. NHANES National Health and Nutrition Examination Survey, BMI body mass index
(a) All estimates were weighted to be nationally representative. No. of participants for some variables may not sum up to equal the unweighted and weighted number due to missing data
(b) “Other” includes race and ethnicity other than non-Hispanic White, non-Hispanic Black, non-Hispanic Asian (2011 onward) and Hispanic, including multiracial
(c) Chronic diseases included asthma, arthritis, congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, stroke, thyroid problem, any liver condition and cancer
(d) Pregnancies includes live births, miscarriages, stillbirths, tubal pregnancies and abortions, tubal pregnancies and abortions
(e) Female hormone means estrogen or progesterone
(f) Menopause means no period in the past 12 mo due to menopause or having had a hysterectomy
Prevalence and Trends of OAB
From the 2005–2006 cycle to the 2017–2020 cycle, the overall OABSS increased significantly from 1.38 to 1.56 (difference, 0.18 [95% CI 0.11–0.25)]; Ptrend < 0.001) (Table 3 and Fig. 1A). The overall prevalence of OAB increased significantly from 18.7% to 22.1% (difference 3.4% [95% CI 2.11−4.69%)]; Ptrend < 0.001) (Table 3 and Fig. 1B). Additionally, an increasing trend was observed among women aged ≥ 60 years: from 31.5% to 37.1% (difference 5.6% [95% CI 3.78−7.42%)]; Ptrend < 0.001) (Fig. 2A); non-Hispanic White women: from 17.6 to 21.1% (difference 3.5% [95% CI 2.16−4.84%)]; Ptrend = 0.01); non-Hispanic Black women: from 25.7% to 32.6% (difference 6.9% [95% CI 4.07−9.73%]; Ptrend = 0.02) (Fig. 2B); or obese women (BMI ≥ 30 kg/m2): from 23.8% to 28.9% (difference 5.1% [95% CI (1.81−8.39%]; Ptrend = 0.04) (Fig. 2C). Detailed data are shown in Table 3.
Table 3.
Weighted trends in OAB prevalence among US women, NHANES 2005 to 2020a
| 2005–2006 | 2007–2008 | 2009–2010 | 2011–2012 | 2013–2014 | 2015–2016 | 2017–2020 | βb | Pb | Differencec | |
|---|---|---|---|---|---|---|---|---|---|---|
| OABSS score | 1.38 (1.29–1.46) | 1.34 (1.28–1.41) | 1.40 (1.33–1.47) | 1.47 (1.36–1.58) | 1.50 (1.41–1.58) | 1.52 (1.42–1.63) | 1.56 (1.50–1.63) | 0.04 | 0.00 | 0.18 (0.11–0.25) |
| OAB prevalence | 18.7 (17.1–20.3) | 18.4 (16.9–19.9) | 18.9 (17.4–20.4) | 20.1 (18.5–21.7) | 20.2 (18.6–21.7) | 21.3 (19.7–22.9) | 22.1 (20.9–23.4) | 0.62 | 0.00 | 3.4 (2.11–4.69) |
| Age, y | ||||||||||
| 20–39 | 11.3 (9.3–13.4) | 8.5 (6.6–10.4) | 10.1 (8.1–12.0) | 10.3 (8.1–12.5) |
9.0 (6.8–11.2) |
11.5 (9.3–13.7) | 11.3 (9.5–13.0) | 0.17 | 0.49 | 0.00 (−1.09 to 1.09) |
| 40–59 | 17.7 (14.8–20.6) | 18.7 (16.1–21.3) | 16.8 (14.4–19.3) | 19.2 (16.5–22.0) | 20.2 (17.6–22.8) | 18.9 (16.3–21.5) | 19.4 (17.3–21.5) | 0.32 | 0.15 | 1.7 (0.66–2.74) |
| ≥ 60 | 31.5 (27.9–35.1) | 31.7 (28.7–34.6) | 33.1 (30.0–36.2) | 32.4 (29.1–35.6) | 33.5 (30.5–36.4) | 34.8 (31.6–38.0) | 37.1 (34.6–39.6) | 0.84 | 0.00 | 5.6 (3.78–7.42) |
| Race/Ethnicity | ||||||||||
| Mexican American | 19.2 (15.6–22.8) | 16.8 (13.4–20.2) | 20.7 (17.1–24.4) | 18.9 (13.5–24.3) | 20.2 (16.0–24.5) | 20.5 (16.9–24.1) | 18.9 (15.3–22.4) | 0.21 | 0.45 | −0.3 (−1.54 to 0.94) |
| Other Hispanic | 23.5 (13.5–33.5) | 22.8 (18.2–27.4) | 16.8 (12.5–21.0) | 24.8 (19.4–30.2) | 19.8 (14.9–24.7) | 25.9 (21.4–30.5) | 25.2 (21.0–29.2) | 0.51 | 0.46 | 1.7 (−1.34 to 4.74) |
| Non-Hispanic White | 17.6 (15.4–19.8) | 17.5 (15.4–19.6) | 16.8 (14.7–18.8) | 18.6 (16.0–21.2) | 18.4 (16.2–20.6) | 19.6 (16.9–22.3) | 21.1 (19.0–23.2) | 0.58 | 0.01 | 3.5 (2.16–4.84) |
| Non-Hispanic Black | 25.7 (21.8–29.6) | 26.4 (22.7–30.1) | 32.6 (28.3–36.9) | 31.1 (27.5–34.7) | 31.3 (27.3–35.3) | 33.1 (29.1–37.1) | 32.6 (29.8–35.4) | 1.17 | 0.02 | 6.9 (4.07–9.73) |
| Non-Hispanic Asian | 12.9 (9.1–16.8) | 10.0 (6.5–13.6) | 13.4 (9.2–17.6) | 14.9 (11.7–18.1) | 0.94 | 0.41 | 2.0 (−1.26 to 5.26) | |||
| BMI, kg/m2 | ||||||||||
| < 25 | 11.8 (9.5–14.2) | 19.6 (16.9–22.4) | 10.8 (8.6–13.0) | 14.0 (11.5–16.6) | 13.5 (11.2–15.9) | 13.9 (11.3–16.5) | 13.4 (11.3–15.5) | −0.14 | 0.82 | 1.6 (−0.99 to 4.19) |
| 25–30 | 20.9 (17.8–24.1) | 16.8 (14.2–19.4) | 17.8 (15.1–20.5) | 17.2 (14.3–20.2) | 18.9 (16.0–21.8) | 17.5 (14.6–20.3) | 20.3 (17.9–22.7) | 0.02 | 0.94 | −0.6 (−2.07 to 0.87) |
| ≥ 30 | 23.8 (21.0–26.7) | 18.9 (16.5–21.3) | 26.8 (24.2–29.4) | 26.8 (24.0–29.7) | 26.3 (23.7–28.9) | 29.3 (26.7–32.0) | 28.9 (26.9–31.0) | 1.27 | 0.04 | 5.1 (1.81–8.39) |
Data were expressed as mean (95% CI) or % (95% CI). OAB overactive bladder, NHANES National Health and Nutrition Examination Survey, OABSS overactive bladder symptom score, BMI body mass index, CI confidence interval
(a) All estimates were weighted to be nationally representative
(b) The estimate β and P for trend were calculated using linear regression that included the NHANES 2-year cycle as a continuous variable. The estimate β can be interpreted as the average change in level every 2 years
(c) A decrease corresponds to difference below zero
Fig. 1.
Crude overall weighted OABSS score (A) and trends in OAB prevalence (B) among US women, NHANES 2005–2020. OABSS overactive bladder symptom score, OAB overactive bladder, NHANES national health and nutrition examination survey
Fig. 2.
Crude weighted trends in OAB prevalence according to age, race, and ethnicity and weight status among US women, NHANES 2005–2020. OAB overactive bladder, NHANES national health and nutrition examination survey
Correlates of OAB
In multivariate logistic regression analysis, the prevalence of OAB was higher for those aged ≥ 60 years (OR 2.82; 95% CI 2.37–3.36) or aged 40 to 59 years (OR 1.56; 95% CI 1.37–1.79) when compared with women aged 20 to 39 years (Table 4 and Fig. 2A). Other Hispanic (OR 1.32; 95% CI 1.06–1.63) and non-Hispanic Black women (OR 1.89; 95% CI 1.57–2.27) had a higher prevalence of OAB than Mexican American women (Fig. 2B). In addition, being obese (OR 1.45; 95% CI 1.28–1.66) was significantly correlated with OAB (Fig. 2C). Moreover, all women who had hypertension (OR 1.14; 95% CI 1.02–1.28), diabetes (OR 1.21; 95% CI 1.05–1.40), depression (OR 1.62; 95% CI 1.40–1.88), sleep disorder (OR 1.20; 95% CI 1.06–2.36), chronic conditions (OR 1.22; 95% CI 1.10–1.36), poorer health condition (OR 1.44; 95% CI 1.26–1.64), one pregnancy (OR 1.29; 95% CI 1.04–1.61), or three or more pregnancies (OR 1.37; 95% CI 1.12–1.69) or used female hormone (OR 1.16; 95% CI 1.00–1.35) had a significantly higher prevalence of OAB. For those who had high school (OR 0.73; 95% CI 0.64–0.83) or higher than high school educational level (OR 0.58; 95% CI 0.48–0.69), family poverty ratio between 1.3 and 3.5 (OR 0.86; 95% CI 0.76–0.97) or ≥ 3.5 (OR 0.58; 95% CI 0.48–0.69) or had vigorous recreational activity (OR 0.74; 95% CI 0.61–0.89) had a significantly lower prevalence of OAB (Table 4).
Table 4.
Weighted logistic regression models of OAB among women, NHANES 2005 to 2020a
| Characteristics | OR (95% CI) | P |
|---|---|---|
| Age, y | < 0.001 | |
| 20–39 | 1 (Reference) | |
| 40–59 | 1.56 (1.37, 1.79) | |
| ≥ 60 | 2.82 (2.37, 3.36) | |
| Race/ethnicity | < 0.001 | |
| Mexican American | 1 (Reference) | |
| Other Hispanic | 1.32 (1.06, 1.63) | |
| Non-Hispanic White | 1.04 (0.87, 1.23) | |
| Non-Hispanic Black | 1.89 (1.57, 2.27) | |
| Otherb | 0.95 (0.73, 1.23) | |
| Education | < 0.001 | |
| < High school | 1 (Reference) | |
| High school | 0.73 (0.64, 0.83) | |
| > High school | 0.58 (0.48, 0.69) | |
| Family poverty ratio | < 0.001 | |
| < 1.3 | 1 (Reference) | |
| 1.3–3.5 | 0.86 (0.76, 0.97) | |
| ≥ 3.5 | 0.58 (0.48, 0.69) | |
| BMI, kg/m2 | < 0.001 | |
| ≤ 25 | 1 (Reference) | |
| 25–30 | 1.15 (0.98, 1.35) | |
| ≥ 30 | 1.45 (1.28, 1.66) | |
| Smoke | 0.8 | |
| Never | 1 (Reference) | |
| Former | 0.97 (0.81, 1.15) | |
| Current | 1.04 (0.88, 1.23) | |
| Hypertension | 0.025 | |
| No | 1 (Reference) | |
| Yes | 1.14 (1.02, 1.28) | |
| Diabetes | 0.006 | |
| No | 1 (Reference) | |
| Yes | 1.21 (1.05, 1.40) | |
| Depression | < 0.001 | |
| No | 1 (Reference) | |
| Yes | 1.62 (1.40, 1.88) | |
| Sleep time, h | 0.5 | |
| ≥ 7 | 1 (Reference) | |
| < 7 | 0.96 (0.85, 1.08) | |
| Sleep disorder | 0.005 | |
| No | 1 (Reference) | |
| Yes | 1.20 (1.06, 1.36) | |
| Any chronic diseasec | < 0.001 | |
| No | 1 (Reference) | |
| Yes | 1.22 (1.10, 1.36) | |
| Recreational activity | 0.007 | |
| Mild | 1 (Reference) | |
| Moderate | 0.91 (0.80, 1.04) | |
| Vigorous | 0.74 (0.61, 0.89) | |
| Healthy diet | 0.10 | |
| Yes | 1 (Reference) | |
| No | 1.09 (0.98, 1.22) | |
| Health condition | < 0.001 | |
| Good | 1 (Reference) | |
| Not good | 1.44 (1.26, 1.64) | |
| Food security | 0.2 | |
| Yes | 1 (Reference) | |
| No | 1.10 (0.94, 1.29) | |
| Health insurance | 0.6 | |
| Yes | 1 (Reference) | |
| No | 0.96 (0.82, 1.13) | |
| History of pregnanciesd | 0.013 | |
| 0 | 1 (Reference) | |
| 1 | 1.29 (1.04, 1.61) | |
| 2 | 1.22 (0.99, 1.50) | |
| 3 + | 1.37 (1.12, 1.69) | |
| Female hormone usee | 0.043 | |
| No | 1 (Reference) | |
| Yes | 1.16 (1.00, 1.35) | |
| Menopausef | 0.2 | |
| No | 1 (Reference) | |
| Yes | 1.10 (0.96, 1.28) | |
| Cycle | 0.073 | |
| 2005–2006 | 1 (Reference) | |
| 2007–2008 | 0.82 (0.64, 1.05) | |
| 2009–2010 | 0.88 (0.70, 1.12) | |
| 2011–2012 | 0.95 (0.75, 1.20) | |
| 2013–2014 | 0.92 (0.74, 1.14) | |
| 2015–2016 | 1.03 (0.81, 1.33) | |
| 2017–2020 | 1.11 (0.89, 1.38) | |
OAB overactive bladder, NHANES National Health and Nutrition Examination Survey, OR odds ratio, CI confidence interval, BMI body mass index
(a) All estimates were weighted to be nationally representative
(b) “Other” includes race and ethnicity other than non-Hispanic White, non-Hispanic Black, non-Hispanic Asian and Hispanic, including multiracial
(c) Chronic diseases included asthma, arthritis, congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, stroke, thyroid problem, any liver condition and cancer
(d) Pregnancies includes live births, miscarriages, stillbirths, tubal pregnancies and abortions, tubal pregnancies and abortions
(e) Female hormone means estrogen or progesterone
(f) Menopause was defined as no menstruation in the past 12 months due to menopause or having had a hysterectomy
Discussion
A nationally representative population of US women were included in the present study. Our data showed that the contemporary overall prevalence of OAB was 22.1% in the 2017–2020 cycle. It had a significant increasing trend from 2005–2020. Additionally, significant increases of OAB prevalence were observed in older women, non-Hispanic White and Black women, and obese women. In addition, lower educational level, lower family poverty ratio, hypertension, diabetes, depression, sleep disorder, comorbidities, less intense recreational activity, poorer health condition, history of pregnancies, and use of female hormone made women more likely to report OAB.
About two decades ago, the National Overactive Bladder Evaluation (NOBLE) program was formed to investigate the overall prevalence and burden of OAB in the US by telephone questionnaires, and the study reported an overall prevalence of 16.9% for US women [9]. Our study showed that the prevalence of OAB in the 2005–2006 cycle was 18.7%, slightly higher than the NOBLE study. Another study published in 2013 reported the prevalence of OAB was around 20% in US women [6], which was consistent with the prevalence of 20.2% in the 2013–2014 cycle of this study. Although two prior studies revealed the overall incidence of UUI increased significantly from 2005 to 2018 [15] and revealed the overall incidence of nocturia increased significantly from 2005 to 2016 [16] in US women, the authors did not evaluate the prevalence of OAB, thus the contemporary incidence and current trends in OAB remain unclear among US women. The present study indicated an increase in the incidence of OAB, particularly in older women. As the US population aged, the proportion of women aged ≥ 60 years increased significantly from 2005 to 2020 (Ptrend < 0.001) in our study, as an older age was one of the well-known risk factors of OAB [17] and this may be one of the reasons contributing to a significant increase of OAB prevalence.
The prevalence and trends of OAB were found to be associated with some sociodemographic features. Non-Hispanic Black women had a higher prevalence of OAB, this was consistent with the results of a racially diverse population study [10]. Although the specific reasons for racial differences in OAB remained unclear, they were likely multifactorial. Non-Hispanic Black women may have a biological susceptibility to developing OAB, and there are anatomical differences in urethral sphincter morphology, closure pressure, and levator hiatal dimensions between Black women and women of other races [18]. Furthermore, racial minorities in the US tend to have lower educational levels, engage in physically demanding jobs, earn lower incomes, and experience higher stress levels. In addition, a higher educational level and lower family poverty ratio was significantly correlated with lower prevalence of OAB [7, 9, 10]. The disparity may be attributed to the fact that these individuals tend to have better health-seeking behaviors and adopt healthier lifestyles. Conversely, individuals with lower education and income levels may have a higher prevalence of smoking, poor diet, increased physical labor, and exposure to toxins, which increases their susceptibility to developing OAB.
Consistent with previous analysis [17, 19], our data implied that a higher BMI was an independent risk factor of OAB. This was probably because a higher BMI can subject the pelvic floor to elevated levels of intra-abdominal and intravesical pressure, which may cause chronic stretching of the pudendal nerve, resulting in nerve injury and dysfunction of the pelvic floor [20]. In addition, a higher BMI is significantly correlated to diabetes and neurological conditions, such as diabetic autonomic neuropathy, which can contribute to the onset and development of OAB [21]. Additionally, previous research has suggested that weight loss can substantially improve OAB symptoms, which further demonstrated the correlation between BMI and OAB. Fortunately, BMI can be managed through interventions by engaging in regular exercise and maintaining a balanced nutrition, thus we can control our weight to reduce the risk of OAB as well as other associated problems [22].
Chronic comorbidities, such as hypertension, diabetes, stroke, or cancer, were all associated with a higher prevalence with OAB, probably by compromising pelvic floor vascular, nerve and muscle function [23–25]. Animal studies showed that spontaneously hypertensive rats have subnormal bladder capacities and micturition volumes [26]. Stroke and diabetes may cause neurological conditions such as central nerve injury and diabetic autonomic neuropathy, which may lead to the onset of OAB [24]. Additionally, depression and sleep disorder were associated with a higher prevalence of OAB in our study. Previous studies demonstrated that OAB or its associated symptoms such as nocturia may result in poor sleep and sleep apnea [27, 28], and mental health conditions such as anxiety and depression may influence the natural history of OAB in US women veterans [29]. In fact, sleep or mental problems and OAB may be causal to each other, OAB can obviously affect mental health and sleep quality and sleep disorder or mental problems such as anxiety and depression, in turn, affect and aggravate the condition of OAB, which may be related to the dysregulation of bladder function by numerous neural pathways. This analysis also found that a higher parity was associated with increased odds of experiencing OAB [7]. A hypothetical explanation was that pregnancies may increase the sensitivity of the detrusor muscles of the bladder during the filling phase through possible neuropathic changes, yet the exact mechanisms require further investigation. Finally, our data showed that estrogen and/or progesterone use led to a higher prevalence of OAB. The exact cause of this condition is not fully understood, but it has been observed that postmenopausal hormone therapy in women is correlated with heightened bladder contractility and increased breakdown of collagen, leading to symptoms such as urgency and stress urinary incontinence, respectively [30].
The NHANES design constituted the principal strengths of this study. NHANES employed a sophisticated multistage, probability-based sampling procedure to enroll a sample that properly represented the overall United States population. Furthermore, standardized protocols ensured the quality of data collection in NHANES. However, this study had some limitations, such as the fact that confirmation of OAB relied on self-reported information with no comprehensive clinical examination, including physical assessment, urine analysis, ultrasound, or urodynamic testing. Additionally, recall biases could have influenced the self-reported data used in the study. Owing to the cross-sectional nature of the study, it was not possible to capture newly developed cases of OAB or assess the duration of OAB. Finally, the noninstitutionalized nature of participants included in the study implied that the actual prevalence of OAB may have been underestimated since individuals in hospitals or nursing homes were not represented. However, the present study provided crucial observations of contemporary epidemiology of OAB, and disparities of OAB in sociodemographic, comorbidities, lifestyle, and gynecologic factors, which may inform future studies and public health planning.
Conclusions
The contemporary prevalence of OAB was high, affecting 22.1% US women. The overall prevalence of OAB significantly increased across the past two decades, especially among women who were aged 60 years or older, non-Hispanic White and Black, and obese. Older age, non-Hispanic Black, lower educational level, higher family poverty ratio, obesity, chronic comorbidities, less intense recreational activity, poorer health condition, history of pregnancies, and use of female hormone were independent risk factors of OAB. Therefore, focused research can help prevent and remedy this growing socioeconomic and individually calamitous malady.
Data Availability
The datasets generated and/or analyzed during the current study are available in the open database NHANES website: https://wwwn.cdc.gov/nchs/nhanes/Default.aspx
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Hongbo Xie, Yunan Liang, Xin Zhao, and Huasheng Liu contributed equally to this work.
Contributor Information
Yong Xu, Email: yongxu8816@sina.com.
Hongtuan Zhang, Email: zhtlml@163.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and/or analyzed during the current study are available in the open database NHANES website: https://wwwn.cdc.gov/nchs/nhanes/Default.aspx