This is the final resubmission of a competing renewal to examine risk factors for urinary incontinence. Estimates in middle-aged and older women indicate that 30-40% have urinary incontinence (UI);in those over 60 years, 12% report daily episodes of leaking urine. The costs of UI are approximately $20 billion/year, with much of that burden (e.g., pads, extra washing/dry cleaning) paid for by individuals, including older women on limited incomes. In the first funding period, we began studies of UI prevalence and incidence among 237,000 women in the Nurses'Health Study and Nurses'Health Study II. We examined the descriptive epidemiology of UI, noting significant differences in prevalence by race/ethnicity, and detected several important risk factors for UI development, including type 2 diabetes and use of exogenous hormones. In this revision, we propose to extend our research on key previous findings. Specifically, we propose to carefully investigate differences in UI incidence, UI type, and UI progression across racial/ethnic groups;this will be critical to better understanding the etiology of UI and better addressing UI in clinical and public health practice (e.g., targeting high/low risk patients). In addition, we propose to specifically explore risk factors for UI development in women with type 2 diabetes - identifying risk factors in this group could have broad implications for the prevention of UI among the growing number of women with diabetes. Given interesting recent evidence that use of postmenopausal hormone therapy may increase risk of developing UI, we also propose novel and detailed analyses of the relation between oral contraceptives and UI in premenopausal women. Finally, we propose to initiate research on diet and UI in older women;women with incontinence are often given advice to reduce certain foods, such as caffeine, and acidic fruit/vegetables. Yet, recommending lower intake of healthy foods such as fruit/vegetables, especially in older women, may be harmful to the public health, and there are virtually no epidemiologic data supporting such recommendations. With extensive information on diet over many years, we are uniquely positioned to address these issues. Data collection methods in the Nurses'Health Study and Nurses'Health Study II are identical, including biennial questionnaires requesting extensive information on health and lifestyle since 1976, and 1989, respectively. Follow-up remains high in both cohorts. Overall, this is an exciting and unique opportunity to significantly expand the scope of knowledge regarding risk factors for incontinence, a common condition in women. By taking advantage of the previously collected data, we can accomplish these goals at extremely modest cost.

Public Health Relevance

Estimates in middle-aged and older women indicate that 30-40% have urinary incontinence (UI);in those over 60 years, 12% experience daily episodes of leaking urine. In this competing renewal, we propose to take advantage of the Nurses'Health Study and Nurses'Health Study II to explore the relations of race/ethnicity, type 2 diabetes, exogenous hormones, and diet to urinary incontinence in women aged 37-88 years.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Study Section
Kidney, Nutrition, Obesity and Diabetes (KNOD)
Program Officer
Kusek, John W
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Brigham and Women's Hospital
United States
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Townsend, Mary K; Minassian, Vatché A; Okereke, Olivia I et al. (2014) Urinary incontinence and prevalence of high depressive symptoms in older black versus white women. Int Urogynecol J 25:823-9
Minassian, Vatche A; Devore, Elizabeth; Hagan, Kaitlin et al. (2013) Severity of urinary incontinence and effect on quality of life in women by incontinence type. Obstet Gynecol 121:1083-90
Matthews, Catherine A; Whitehead, William E; Townsend, Mary K et al. (2013) Risk factors for urinary, fecal, or dual incontinence in the Nurses' Health Study. Obstet Gynecol 122:539-45
Townsend, Mary K; Resnick, Neil M; Grodstein, Francine (2012) Caffeine intake and risk of urinary incontinence progression among women. Obstet Gynecol 119:950-7
Devore, Elizabeth E; Townsend, Mary K; Resnick, Neil M et al. (2012) The epidemiology of urinary incontinence in women with type 2 diabetes. J Urol 188:1816-21
Townsend, Mary K; Devore, Elizabeth E; Resnick, Neil M et al. (2012) Acidic fruit intake in relation to incidence and progression of urinary incontinence. Int Urogynecol J :
Jura, Ying H; Townsend, Mary K; Curhan, Gary C et al. (2011) Caffeine intake, and the risk of stress, urgency and mixed urinary incontinence. J Urol 185:1775-80
Townsend, Mary K; Jura, Ying H; Curhan, Gary C et al. (2011) Fluid intake and risk of stress, urgency, and mixed urinary incontinence. Am J Obstet Gynecol 205:73.e1-6
Townsend, Mary K; Curhan, Gary C; Resnick, Neil M et al. (2011) Original research: rates of remission, improvement, and progression of urinary incontinence in Asian, Black, and White women. Am J Nurs 111:26-33; quiz 34-5
Townsend, Mary K; Curhan, Gary C; Resnick, Neil M et al. (2010) The incidence of urinary incontinence across Asian, black, and white women in the United States. Am J Obstet Gynecol 202:378.e1-7

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