The Boston Area Community Health (BACH) study is filling knowledge gaps in the epidemiology of urologic problems - especially variations in prevalence and risk factors by race/ethnicity, gender, age, and socioeconomic status. A random population sample of 5,506 adults (3,205 females, 2,301 males;1,770 Black, 1,877 Hispanic, 1,859 White) was successfully recruited (2002-2005). A 2-hour in-person interview obtained information on urologic symptoms, sociodemographics, measured anthropometries, health status and pharmaceutical usage (both prescribed and OTC), lifestyles and psychosocial factors, and health care utilization. A venous blood sample (20 ml) was obtained from a majority (70%) of subjects. Paper topics were identified and prioritized by a Scientific Advisory Committee: 43 posters and abstracts have been presented at national and international meetings;6 peer-reviewed papers have appeared/been accepted;13 submitted and under review;8 are in active development;59 topics have been identified for future papers. We propose to transition BACH from a cross-sectional to a prospective cohort design: efforts to remain in contact with subjects and a recent (2006) highly successful attempt to re-interview 500 subjects (after 4+ years) show that over 80% (n=4.130) can be re-recruited. Prospective follow-up of well-characterized subjects provides an opportunity to address questions concerning the epidemiology of urological symptoms: natural history (progression/remission) within the same subject, longitudinal relationship with major chronic diseases, pharmacoepidemiology, the role of life experiences/events, help-seeking behavior, and formal and informal costs (bother, distress and quality of life). It will provide much needed incidence rates, an opportunity to test the robustness of baseline associations, and help unravel pathophysiologic pathways. Interviews will continue to be conducted in-person (often using the same baseline interviewer) to avoid variations due to different data gathering modes. Analyses of the baseline data have informed many novel longitudinal questions. Unique features of BACH include: a random community-based sample; inclusion of race/ethnic minorities; sufficient numbers of both males and females; the broad age-span of 30-80 years; its focus on symptoms (rather than ill-defined conditions); use of validated field instruments; its multidisciplinary orientation; its representativeness and generalizabilitv; the ready availability of biologic specimens;and the efforts to remain in current contact with all BACH subjects. This study will examine the """"""""urologic iceberg"""""""" - the incidence of urologic symptoms in the population, risk factors, changes over time, impact on quality of life, use of health care, and the emerging burden of symptoms suggestive of urologic disease.
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