Search

Abuse is associated with a wide variety of health problems, yet comprehensive population-based data are scant. Existing literature focuses on a single type of abuse, population, or lifestage. Using a racially/ethnically diverse community-based sample, we document the preva-lence of physical, emotional, and sexual abuse by lifestage and gender; assess variation in abuse by sociodemographics; establish overlap of abuses; and examine childhood abuse relationships with abuse in adulthood. Prevalence of abuse ranges from 15% to 27%; women report more adulthood emotional abuse and lifetime sexual abuse than men; reports of abuse can vary by race/ethnicity and poverty status, particularly in women; there is overlap between types of abuse; and a history of childhood abuse is associated with a greater risk of abuse as an adult. [ABSTRACT FROM AUTHOR]

Purpose: We investigate the association of different measures of adiposity (waist circumference, hip circumference, waist-to-hip ratio and body mass index) with overactive bladder (urinary frequency and urgency), whether the association varies by gender or age and whether it persists when models are adjusted for other confounders. Materials and Methods: Data were from the Boston Area Community Health epidemiological survey, a random sample of 5,503 Boston, Massachusetts, residents 30 to 79 years old with equal representation from 3 racial/ethnic groups (black, Hispanic and white). Statistical analysis involved nonparametric loess models and multivariate logistic regression. Results: We noted distinct patterns by gender for the association of various adiposity measures with overactive bladder. Waist-to-hip ratio was not significantly associated with overactive bladder in either gender. In women the prevalence of overactive bladder increased as waist (OR adjusted for other confounders 1.10/10 cm increase) or hip circumference (OR 1.12/10 cm increase) or body mass index (OR 1.03/kg/m2 increase) increased. In men the prevalence of overactive bladder decreased as adiposity increased (OR 0.65/10 cm increase in waist circumference, OR 0.71/10 cm increase in hip circumference and OR 0.87/kg/m2 in body mass index) but only to a certain point (waist circumference 100 cm, hip circumference 115 cm and body mass index 27.5 kg/m2, respectively). At that point the prevalence of overactive bladder increased with increasing adiposity (OR 1.19/10 cm increase in waist circumference, OR 1.16/10 cm increase in hip circumference and OR 1.08/kg/m2 in body mass index). Conclusions: The relationship between adiposity and overactive bladder varies by gender. [Copyright &y& Elsevier]

This article examines the sociodemographic and health characteristics of the underinsured—people who have some health insurance but are having trouble paying for health care or medications. It uses data from the Boston Area Community Health (BACH) Survey, a large (N = 5,503) community-based random sample of Boston residents aged 30 to 79 years (1,767 black, 1,877 Hispanic, and 1,859 white; 2,301 men and 3,202 women). The authors found that minorities were less likely than whites to have health insurance (for men and women, respectively, 30% and 19% of Hispanics, 16% and 9% of blacks, and 9% and 7% of whites lacked health insurance). Blacks were the most likely to be underinsured (for men and women, respectively, 18% and 20% of blacks vs. 9% and 14% of Hispanics and 8% and 12% of whites were underinsured). Those of lower and middle socioeconomic status were also more likely to be uninsured or underinsured. The health status of the uninsured was similar to that of the adequately insured, whereas those who were underinsured reported more co-morbidities and depression. The underinsured are generally older and sicker, and make greater use of the health care system, and may present a larger public health and health policy challenge than the uninsured. [ABSTRACT FROM AUTHOR]

Purpose: In this study we investigated the relationship between lower urinary tract symptoms as defined by the American Urological Association symptom index and the metabolic syndrome, and determined the relationship between individual symptoms comprising the American Urological Association symptom index and the metabolic syndrome. Materials and Methods: The Boston Area Community Health Survey used a 2-stage cluster design to recruit a random sample of 2,301 men 30 to 79 years old. Analyses were conducted on 1,899 men who provided blood samples. Urological symptoms comprising the American Urological Association symptom index were included in the analysis. The metabolic syndrome was defined using a modification of the Adult Treatment Panel III guidelines. The association between lower urinary tract symptoms and the metabolic syndrome was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. Results: Increased odds of the metabolic syndrome were observed in men with mild to severe symptoms (American Urological Association symptom index 2 to 35) compared to those with an American Urological Association symptom index score of 0 or 1 (multivariate OR 1.68, 95% CI 1.21–2.35). A statistically significant association was observed between the metabolic syndrome and a voiding symptom score of 5 or greater (multivariate adjusted OR 1.73, 95% CI 1.06–2.80) but not for a storage symptom score of 4 or greater (multivariate adjusted OR 0.94, 95% CI 0.66–1.33). Increased odds of the metabolic syndrome were observed even with mild symptoms, primarily for incomplete emptying, intermittency and nocturia. These associations were observed primarily in younger men (younger than 60 years) and were null in older men (60 years old or older). Conclusions: The observed association between urological symptoms and the metabolic syndrome provides further evidence of common underlying factors between lower urinary tract symptoms and chronic conditions outside the urinary tract. [Copyright &y& Elsevier]

Purpose: Racial/ethnic disparities in nocturia prevalence have been reported previously. We estimated nocturia prevalence rates by race/ethnicity and determined the contribution of socioeconomic status to potential differences by race/ethnicity. Materials and Methods: The Boston Area Community Health Survey used a multistage stratified design to recruit a random sample of 5,501 adults, including 2,301 men and 3,200 women, who were 30 to 79 years old. Nocturia was defined as voiding more than once per night in the last week or voiding more than once per night fairly often, usually or almost always in the last month. Self-reported race/ethnicity was defined as black, Hispanic and white. Socioeconomic status was defined as a combination of education and household income. Results: The overall prevalence of nocturia was 28.4% with a higher prevalence in black and Hispanic participants compared to white participants (38.6% and 30.7%, respectively, vs 23.2%), a trend that was consistent by gender. After adjusting for socioeconomic status the increased odds of nocturia in Hispanic men disappeared (adjusted OR 1.04, 95% CI 0.71, 1.52), while the OR in black men was attenuated but remained statistically significant (OR 1.57, 95% CI 1.12, 2.21). In women the association between race/ethnicity and nocturia was attenuated but remained statistically significant after adjusting for socioeconomic status. Conclusions: Socioeconomic status accounts for part of the racial/ethnic disparities in prevalence of nocturia. The effect of socioeconomic status was more pronounced in men and in Hispanic participants, while differences in nocturia prevalence remained significant in black men and women. [Copyright &y& Elsevier]

Purpose: We investigated the association between lower urinary tract symptoms and chronic illness, such as heart disease, diabetes, hypertension and depression, in men and women. In addition, we determined whether a dose-response relationship exists in the association between the severity and duration of urological symptoms and major chronic illnesses. Materials and Methods: The Boston Area Community Health Survey used a multistage stratified design to recruit a random sample of 5,503 adults who were 30 to 79 years old. Urological symptoms in the American Urological Association symptom index were included in analysis. Results: Statistically significant associations that were consistent by gender were observed between depression and all urological symptoms. Nocturia of any degree of severity or duration was associated with heart disease in men and with diabetes in women. In men a dose-response relationship was observed for the association of symptom severity and/or the duration of urinary intermittency and frequency with heart disease, and for the association of urinary urgency with diabetes. In women a history of heart disease was associated with a weak stream and straining, while a history of hypertension was associated with urgency and a weak stream. Conclusions: Results indicate a dose-response relationship in the association of the severity and duration of urological symptoms with major chronic illnesses. An association between urinary symptoms and depression was observed in men and women. In contrast, the association between lower urinary tract symptoms and heart disease, diabetes or hypertension varied by gender, suggesting different mechanisms of association in men and women. [Copyright &y& Elsevier]

Purpose: We estimated the prevalence of symptoms suggestive of painful bladder syndrome defined as pain increasing as the bladder fills and/or pain relieved by urination for at least 3 months, and its association with sociodemographics (gender, age, race/ethnicity and socioeconomic status), lifestyle (smoking, alcohol consumption, physical activity) and psychosocial variables (sexual, physical, emotional abuse experienced as a child or as an adult, worry, trouble paying for basics, depression). Materials and Methods: The data used come from the Boston Area Community Health Survey, an epidemiological study of 5,506 randomly selected adults 30 to 79 years old of 3 race/ethnic groups (black, Hispanic, white). Results: The overall prevalence of symptoms suggestive of painful bladder syndrome was 2% (1.3% in men and 2.6% in women) with increased prevalence in middle-aged adults and those of lower socioeconomic status. Symptoms suggestive of painful bladder syndrome were more common in those who experienced abuse, in those who were worried about someone close to them and in those who were having trouble paying for basics. This pattern held even after adjusting for depression. Conclusions: Painful bladder syndrome is associated with a number of lifestyle and psychosocial correlates. This suggests that the treatment of patients with painful bladder syndrome (physical symptoms) may benefit from a multifaceted approach of combining medical, psychological and cognitive treatment. [Copyright &y& Elsevier]

Purpose: The etiology of painful bladder syndrome is currently unknown. We investigated the relationship between medical factors and symptoms suggestive of painful bladder syndrome in a population based random sample. Materials and Methods: Data were collected from the Boston Area Community Health Survey, an epidemiological study conducted from 2002 to 2005 in a racially and ethnically diverse population (30 to 79 years old) from Boston, Massachusetts. The operational definition of painful bladder syndrome was symptom based. Those reporting pain increasing as the bladder fills and/or pain relieved by urination (fairly often/usually/almost always) for 3+ months were considered to have symptoms suggestive of painful bladder syndrome. We used multivariate logistic regression to estimate odds ratios and 95% confidence intervals (adjusted for demographics, anthropometric and other factors) for the association of comorbidities, surgery and medication use with painful bladder syndrome symptoms. Results: The prevalence of painful bladder syndrome symptoms was 1.3% in men and 2.6% in women. In men only depression was associated in a multivariate model (OR 4.96; 95% CI 1.65, 14.92). In women associations were observed for depression (OR 3.35; 95% CI 1.93, 5.81), history of urinary tract infections (OR 2.17; 95% CI 1.49, 4.96), chronic yeast infections (OR 3.11; 95% CI 1.29, 7.51), hysterectomy (OR 2.82; 95% CI 1.20, 6.62), calcium channel blockers (OR 4.59; 95% CI 2.71, 9.72) and cardiac glycosides (OR 10.28; 95% CI 1.46, 72.35), while thyroid medications and statins were inversely associated (OR 0.13; 95% CI 0.03, 0.47 and OR 0.24; 95% CI 0.08, 0.76; respectively). Conclusions: Gynecologic factors and certain medications may be associated with the painful bladder syndrome in women. Our results for medications suggest potentially modifiable risk factors. [Copyright &y& Elsevier]

Purpose: We explored the association of lower urinary tract symptoms and erectile dysfunction in a racially and ethnically diverse random sample of men. Materials and Methods: The Boston Area Community Health Survey used a stratified, 2-stage cluster sample to recruit 2,301 men representative of Boston. Data were obtained on symptoms suggestive of a number of urogynecologic conditions, comorbidities, and lifestyle and psychosocial factors. Results: The percent of men reporting moderate/severe lower urinary tract symptoms, as measured by the American Urological Association symptom index, ranged from 8% in those 30 to 39 years old to 26% in those 70 to 79 years old. The prevalence of erectile dysfunction was high and it increased dramatically with age with 10% of 30 to 39-year-old and 59% of 70 to 79-year-old men reporting mild-moderate/moderate/severe symptoms. A strong association was observed between the American Urological Association symptom index and erectile dysfunction after adjusting for age. However, after adjusting for other symptoms and comorbidities evidence of this association became weak. Much stronger associations were seen with incontinence, which is not included in the American Urological Association symptom index, and symptoms suggestive of prostatitis. When considering the American Urological Association symptom index symptoms separately, only nocturia increased the severity of erectile dysfunction. Stratified analyses demonstrated similar associations across race/ethnicity groups. Conclusions: Lower urinary tract symptoms and erectile dysfunction are common conditions in older men in the community. This study provides evidence to suggest that the previously observed association between erectile dysfunction and lower urinary tract symptoms may be primarily due to nocturia, incontinence and symptoms suggestive of prostatitis. [Copyright &y& Elsevier]

The article presents a study which investigated whether levels of circulating androgens and their carrier protein, sex hormone-binding globulin (SHBG), varied by statin exposure among a sample of men from a population-based epidemiologic study, the Boston Area Community Health Survey. According to some data, statins were among the most commonly used prescription medications in the U.S. and may affect cancer risk and/or disease severity. The study's findings suggest that the prevalence of statin use was 12.4% and 95% confidence interval.

Purpose: The prevalence of painful bladder symptoms is poorly defined, especially in racial and ethnic minority groups. We estimated the prevalence of painful bladder symptoms in a community based sample, assessed symptom variation by age, gender, race/ethnicity and socioeconomic status, and estimated their impact on quality of life. Materials and Methods: A population based cross-sectional survey of individuals was done in the Boston area using a multistage stratified cluster sample. A 2-hour in person interview performed by a bilingual interviewer was done, generally in the home of the subject. The research design was for equal numbers of subjects in each of 24 design cells, as defined by age (30 to 39, 40 to 49, 50 to 59 and 60 to 79 years), gender and race/ethnicity (black, Hispanic and white). The sample of 5,506 subjects was recruited from April 2002 through June 2005. Multiple definitions of painful bladder symptoms were used based on consensus statements, research definitions and published articles. The effect of gender, age, race/ethnicity and socioeconomic status on symptom prevalence was assessed. Results: The prevalence of painful bladder syndrome symptoms was 0.83% to 2.71% in women and 0.25% to 1.22% in men depending on the definition used. Multivariate analyses revealed that symptoms were significantly more common in women, middle-aged individuals (40 to 59 years old) and lower socioeconomic status groups. For most definitions there were no variations by race or ethnicity. The presence of symptoms was associated with a significant adverse impact on quality of life. Conclusions: Painful bladder symptoms are more common than suggested by coded physician diagnoses. Although most bladder pain research cohorts have included predominantly white women, these population based findings indicate no racial/ethnic disparity and limited gender disparity in the prevalence of painful bladder symptoms. This suggests that the burden of painful bladder syndrome may be greater in nonwhite individuals and men than previously suspected. [Copyright &y& Elsevier]

Purpose: We examined the association of nocturia with age, race/ethnicity, gender, cardiac disease, diabetes, body mass index and diuretic use. Materials and Methods: Data were obtained from the Boston Area Community Health study, which used a multistage, stratified, cluster random sample design to recruit 5,506 adults at ages 30 to 79 years from Boston. Nocturia was defined as fairly often or more frequently arising up to urinate more than once nightly in the last month and/or going to the bathroom more than once nightly in the last week. Observations were weighted inversely proportional to their probability of selection into the study. Analyses were performed using SUDAAN®. Results: Nocturia was present in 1,872 respondents (28.4%). In a multivariate model the odds of nocturia increased with age (p <0.001), were higher for minority vs white respondents (black and Hispanic respondents OR 1.89, 95% CI 1.53, 2.32 and OR 1.60, 95% CI 1.26, 2.04, respectively), were lower for men (OR 0.79, 95% CI 0.65, 0.97), increased with increasing body mass index (p <0.001) and were higher if the respondent had type II diabetes (OR 1.67, 95% CI 1.20, 2.33) or cardiac disease (OR 1.37, 95% CI 1.01, 1.87), or used diuretics (OR 1.38, 95% CI 1.08, 1.75). Nocturia was associated with decreased physical and mental health scores. Conclusions: Nocturia is common and associated with decreased quality of life. When planning treatment, clinicians should consider causes of nocturia outside of the lower urinary tract. [Copyright &y& Elsevier]

Purpose: We examined care seeking and treatment for urine leakage in the Boston Area Community Health Survey, a racially and ethnically diverse, community based study of urological and gynecological symptoms and their correlates. Materials and Methods: Boston Area Community Health Survey used a multistage, stratified cluster design to enroll 5,506 black, Hispanic and white adults. Subjects were 30 to 79 years old and residents of Boston, Massachusetts. Data were obtained during a 2-hour in home interview. Analyses for this report include the 331 women and 128 men who reported weekly incontinence, defined as urine leakage that occurred 1 or more times weekly in the last year. Results: Of women 45% and 22% of men with weekly incontinence reported ever having sought care for it. Of those who sought care 60% reported receiving treatment and half of those who were treated continued to have daily leakage. Of treated women 50% and 40% of treated men reported moderate to great frustration with continued urine leakage. Conclusions: This study demonstrates that the majority of men and women who experience weekly urinary incontinence do not seek care for it, many who sought treatment believe that none was provided and many who received treatment continue to have troubling symptoms. The public should be educated to seek care for urine leakage, health care providers should take the initiative to ask their patients about urinary symptoms and more attention should be given to ensuring that, when treatment is given, it is appropriate and effective. [Copyright &y& Elsevier]

Purpose: In this study we investigated the relationship between lower urinary tract symptoms as defined by the American Urological Association symptom index and the metabolic syndrome, and determined the relationship between individual symptoms comprising the American Urological Association symptom index and the metabolic syndrome. Materials and Methods: The Boston Area Community Health Survey used a 2-stage cluster design to recruit a random sample of 2,301 men 30 to 79 years old. Analyses were conducted on 1,899 men who provided blood samples. Urological symptoms comprising the American Urological Association symptom index were included in the analysis. The metabolic syndrome was defined using a modification of the Adult Treatment Panel III guidelines. The association between lower urinary tract symptoms and the metabolic syndrome was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. Results: Increased odds of the metabolic syndrome were observed in men with mild to severe symptoms (American Urological Association symptom index 2 to 35) compared to those with an American Urological Association symptom index score of 0 or 1 (multivariate OR 1.68, 95% CI 1.21–2.35). A statistically significant association was observed between the metabolic syndrome and a voiding symptom score of 5 or greater (multivariate adjusted OR 1.73, 95% CI 1.06–2.80) but not for a storage symptom score of 4 or greater (multivariate adjusted OR 0.94, 95% CI 0.66–1.33). Increased odds of the metabolic syndrome were observed even with mild symptoms, primarily for incomplete emptying, intermittency and nocturia. These associations were observed primarily in younger men (younger than 60 years) and were null in older men (60 years old or older). Conclusions: The observed association between urological symptoms and the metabolic syndrome provides further evidence of common underlying factors between lower urinary tract symptoms and chronic conditions outside the urinary tract. [Copyright &y& Elsevier]