Research

www. AJOG.org

UROGYNECOLOGY

The incidence of urinary incontinence across Asian,
black, and white women in the United States
Mary K. Townsend, ScD; Gary C. Curhan, MD, ScD; Neil M. Resnick, MD; Francine Grodstein, ScD
OBJECTIVE: We calculated incidence rates of urinary incontinence by

incontinence frequency and type over 4 years in Asian, black, and white
women in the United States.
STUDY DESIGN: Prospective analyses included 76,724 participants

aged 37–79 years in the Nurses’ Health Study cohorts with no incontinence at baseline.
RESULTS: The 4-year incidence of incontinence at least monthly was

higher in white women (7.3/100 person-years) compared with Asian (5.7/
100 person-years; P ⫽ .003) and black women (4.8/100 person-years;

P ⬍ .001). The incidence of at least weekly stress incontinence was significantly lower in black compared with white women (0.1 vs 0.8 per 100 person-years; P ⬍ .001). The difference between black and white women in
the incidence of any incontinence and stress incontinence remained significant after adjusting for known risk factors (P ⬍ .001 for both).
CONCLUSION: Urinary incontinence incidence differs by race. Studies

to confirm these results and better understand underlying mechanisms
are needed.
Key words: epidemiology, incidence, race, urinary incontinence

Cite this article as: Townsend MK, Curhan GC, Resnick NM, et al. The incidence of urinary incontinence across Asian, black, and white women in the United
States. Am J Obstet Gynecol 2010;202:378.e1-7.

G

rowing scientific evidence indicates that the burden of urinary incontinence (UI) may vary across racial
groups. Several cross-sectional studies,1-7 including our own,8,9 have reported a lower prevalence of overall incontinence in black and Asian women
compared with white women, and cross-

From the Channing Laboratory (Drs
Townsend, Curhan, and Grodstein) and the
Renal Division (Dr Curhan), Department of
Medicine, Brigham and Women’s Hospital,
Harvard Medical School, and the
Department of Epidemiology, Harvard
School of Public Health (Drs Townsend,
Curhan, and Grodstein), Boston, MA; and
the Division of Geriatric Medicine,
Department of Medicine, University of
Pittsburgh School of Medicine, Pittsburgh,
PA (Dr Resnick).
Received June 22, 2009; revised Aug. 31,
2009; accepted Nov. 9, 2009.
Reprints: Mary K. Townsend, ScD, Channing
Laboratory, 181 Longwood Ave., Boston, MA
02115. mary.townsend@channing.harvard.
edu.
This study was supported by Grants DK62438,
CA87969, and CA50385 from the National
Institutes of Health. Dr Townsend is supported
by the Yerby Postdoctoral Fellowship Program.
0002-9378/$36.00
© 2010 Mosby, Inc. All rights reserved.
doi: 10.1016/j.ajog.2009.11.021

378.e1

sectional studies have consistently found
a higher prevalence of stress incontinence in white vs black women.2-4,6,10,11
In addition, biologic data suggest that
differences in pelvic floor anatomy between white and black women may explain differences in UI prevalence.12
However, because prevalence is a function of both incidence and duration of incontinence, these differences in prevalence
may or may not reflect incontinence incidence. Better characterization of racial
variations in incontinence incidence could
help further understanding of the natural
history and the cause of incontinence and
incontinence types. However, few prospective studies have examined incontinence incidence in different racial groups,
and, among the limited studies,3,13 only 1
collected data on incontinence type.3
Thus, we examined incontinence incidence rates, by incontinence frequency
and type, in Asian, black, and white female
health professionals enrolled in 2 large US
prospective cohort studies, the Nurses’
Health Study (NHS) and the Nurses’
Health Study II (NHSII).

M ATERIALS AND M ETHODS
The NHS and NHSII
The NHS was initiated in 1976, when
121,700 female nurses aged 30 –55 years
completed a mailed questionnaire about

American Journal of Obstetrics & Gynecology APRIL 2010

their medical history and health behaviors.14 In 1989, the NHSII was established, when 116,430 female nurses aged
25– 42 years returned a similar mailed
questionnaire. Return of the questionnaire implied informed consent. Updated information on participants is obtained using biennial questionnaires.
During each questionnaire cycle, a fulllength questionnaire is sent for initial
mailings, after which an abbreviated version is sent to nonresponders to maximize participation. The Institutional Review Board of Brigham and Women’s
Hospital approved these studies.

Study population
Questions about urinary incontinence
were included on the full-length questionnaires mailed in 2000, 2002, and
2004 for the NHS and 2001, 2003, and
2005 for the NHSII. In the NHS, 83,996
women answered the incontinence questions on the 2000 questionnaire. Responders were identical to the entire
NHS cohort in mean age, mean body
mass index (BMI), and parity. In addition, the racial distribution of responders was very similar to the entire cohort
(0.7% vs 0.8% Asian; 1.2% vs 1.5%
black; 94% vs 92% white, respectively).
In the NHSII, responders to the incontinence questions in 2001 (n ⫽ 85,503)
were identical to the entire NHSII cohort

only black or African American. once per month.932). In the NHSII.19 BMI (continuous). or white women who were at risk for incident incontinence at baseline and received at least 1 follow-up questionnaire. response to this question was highly reproducible among these nurses. Race-specific incidence rates per 100 person-years were obtained by dividing the total number of incident cases over the 4-year follow-up period by the total observed person-years and multiplying by 100 within each racial category. including mean age.17 For these analyses. NHSII.724 women (NHS. Because we allowed women missing incontinence information on either the first or second follow-up questionnaire (but not both) to remain in the study population. or white (NHS. NHSII. Measurement of UI Participants in the NHS and NHSII were asked on the baseline and follow-up questionnaires.8% black. and frequent incontinence was defined as incontinence occurring at least once per week. we defined baseline as 2000 in the NHS and 2001 in the NHSII. less than once per month. current). lifting things. 19 cases identified late in the questionnaire cycle did not receive a questionnaire) and completed by 79%. parity. n ⫽ 38. At the first follow-up. or only white. and women who selfidentified as 2 or more races or as a race other than Asian. laughing. 1–2.8 Incident incontinence during follow-up was defined as incontinence occurring at least once per month. respectively) and racial distribution (95% vs 94% white. current user. women missing information on race (NHS.org in mean age and BMI and highly similar to the entire cohort in parity (18% vs 15% nulliparous. 1. incontinence type was assessed on a supplementary questionnaire mailed to women with frequent incontinence.16 To assess associations between race and incontinence incidence adjusting for potential confounding factors. a woman at risk for incident incontinence at baseline who reported no incontinence at follow-up 1 and was missing incontinence information at follow-up 2 contributed persontime during the first follow-up period only.807. parity (0. how often have you leaked or lost control of your urine?” Response options were never. In reliability testing. all multivariable models included the following covariates.7% Asian. were similar in incident cases with frequent incontinence who did and those who did not provide incontinence type information. frequent) and incontinence type (stress. NHSII. about once per week. n ⫽ 2920. type 2 diabetes. n ⫽ 753). and the racial distribution. the same supplementary questionnaire was mailed to 98% of cases (n ⫽ 1222. urgency. In each cohort. In addition. respectively). we excluded 2007 women missing information on BMI or parity. We classified women as Asian. un- APRIL 2010 American Journal of Obstetrics & Gynecology 378. data on incontinence type were collected directly from the main questionnaire. cigarette smoking (never. or 94% of all Asian. Urgency incontinence was defined as primarily leaking accompanied by an urge to urinate or a sudden feeling of bladder fullness. Among incident cases. Stress incontinence was defined as leaking primarily with coughing or sneezing. This method allowed us to account for changes in follow-up status and take advantage of all available data.4% vs 1.16 Thus. n ⫽ 47). n ⫽ 1047. occasional incontinence was defined as incontinence occurring 1–3 times per month.923). to calculate multivariable-adjusted hazards ratios (HRs) and 95% CIs. identified as incontinence risk factors in previous studies among these women:9.AJOG. continuous). postmenopausalnever user.792. or white if they marked their race as only Asian.e2 . black. past. we used Cox proportional hazards models. for example. Important incontinence risk factors. or exercise. Incontinence type was classified as “other” when leaking occurred in circumstances other than those described previously. and thus information on incontinence type was available from 99% of women with frequent incontinence. the supplementary questionnaire was mailed to a random sample of 80% of the cases (n ⫽ 2171) and completed by 84% of these. “During the last 12 months. NHSII. we defined incontinence type only among cases with frequent incontinence. brisk walking. controlled for age in months. black. n ⫽ 37. Measurement of UI type We believed that women with at least weekly incontinence were likely better able to describe the precipitants of their incontinence than women with less fre- quent incontinence. physical activity (metabolic equivalent hours/week. 3⫹ births). we excluded prevalent cases of incontinence at least once per month or incontinence of more than a few drops less than once per month at baseline (NHS. 2–3 times per month. past user. Research Statistical analysis We calculated race-specific incontinence incidence rates and their 95% confidence intervals (CIs) by incontinence frequency (any.Urogynecology www. occasional. Thus. Therefore. For these analyses. mean BMI. we excluded women missing incontinence information on both the first and second follow-up questionnaires (NHS. and postmenopausal hormone use (premenopausal. mixed).18. we calculated incidence rates using observed person-years of follow-up. 1. Women of both Hispanic and non-Hispanic ethnicity were included within each racial category (only 1% of women reported Hispanic ethnicity).15 Because of the large number of incident cases with frequent incontinence in the NHS. which assume a uniform population throughout the study period. In addition to age. NHSII. analyses included 76. Measurement of race Women were asked to indicate their race and ethnicity on the NHS and NHSII questionnaires. respectively. n ⫽ 430. and almost every day. We used the score statistic to test whether rates of incontinence in black and Asian women were significantly different from rates in white women. as opposed to cumulative incidence proportions. n ⫽ 43. black. Incontinence type was classified as mixed when women reported that stress and urgency incontinence symptoms were equally common. For the second follow-up period. n ⫽ 2848). n ⫽ 40.3% vs 1. because these are such important covariates.

............................................. body mass index............................................. we used the ␹2 test to compare 378........ .............. 9 black......................001).......................................................................................2)....................................... % ..........2 3..................................01) and black women (P ⬍ ....................................................2 35....................................... Diabetes................................................................. Missing ........................................6 (5................. When considering separately those with occasional (1–3 times/month) and frequent (at least weekly) incontinence...8 (17................................. White women were the most likely to be current smokers...........8 5................ .................... %b ..... 2 black........................................................................... Never 21...........................1 Past 28...........8 14...............................................5 47...........................................................................................9 7..................................................4 3.............. Rates of frequent incontinence were significantly lower in black (P ⫽ ... known hormone use status).................................. ................5 (7............................................ rates of incontinence were generally highest in white women and lowest in black women... despite the age differences between the cohorts..............................................9 6........................ ..........................................................................................5 60. walking 1 block........................1 ...............3 Past 28........................................................................................9 53.........7 0............................1) 65.1 29...9 (6...................... ........................................................................................................7 27....... compared with white women..........................................................................................................................4) ..........................................3 3⫹ 49........5 (26................................................5) 28....................4 6.....................................................................................................0 0................ 0 4............................................................5 56............................................................................................................2 57................ 2 a .......................................................4 26...4 2...... SD.........................................................................................1 40................................................................1 5.............................................................................................................................0 (4... rates of occasional incontinence were significantly lower in Asian (P ⫽ .........2) 14.............1 (18........0 25................AJOG............................4 45.................... Current .......... y [mean (SD)] 66...0 2..........5) Physical activity.................................9 1...................... the NHS participants were aged 54 –79 years. Nurses’ Health Study........... Cigarette smoking............6 51.. For this analysis............. All covariates were updated to reflect participant status as of the beginning of each 2-year risk period.................................3 8.....................................................................................1 26................................................................. but not Asian women (P ⫽ ..................3 9........................ the NHSII participants were aged 37–54 years....................................................................5 66..................................................................................................................................................002)........................................org TABLE 1 Characteristics of study participants at risk for incident urinary incontinence in 2000 NHS and 2001 NHSII NHS NHSII Variable Asian (n ⴝ 287) Black (n ⴝ 590) White (n ⴝ 37.e3 the proportion of Asian or black vs white women with persistent incident UI......................................................................................................... We also conducted a secondary analysis among the subset of women with UI data at both follow-up periods (n ⫽ 10.................................... or Parkinson’s disease)......1 15.......... In the combined cohorts.............850) to explore potential racial differences in the persistence of incontinence at the second follow-up among women with incident UI at follow-up 1...7) BMI.......................................................................................3) 47...........................6 21.................. standard deviation a Body mass index is missing for 95 women in the NHS (1 Asian................................819) Age................................6 12..............................8 5............................................... BMI..7 Missing 5.......................5 2.................6 7.........................1 51..................1 50...............................................3) 19................. 92 white) and 343 women in the NHSII (7 Asian................................ % ...................4) 65.....1 9.......................3 21............0 (4....9 40.....................................................4 (6............................2) 18......................Research Urogynecology www...... Premenopausal.....................................5) 29......3 7.........................................6 89.......................................................9 41............................... multiple sclerosis..................7 (4.........................................................................4 (5.....9 2.....................1) 23....... Incidence of urinary incontinence in 3 groups of US women........9 74............ kg/m [mean (SD)] 23.................................................................. compared with white women....8 6.........................................3 72........................... major neurologic disease (defined as stroke.........................2) 26...................................................................................8 33......................................................................................................................................... Specifically.................................3) 25.................................................9 1......... bathing.................... NHS...................................2 18......................................................................................................................1 (22.............................................. or dressing) did not affect the HRs and thus were not included in models................................... In both cohorts.......................................... .......................... hysterectomy..................................................................................................9 41...................... Am J Obstet Gynecol 2010.........................................................................................................915) Asian (n ⴝ 565) Black (n ⴝ 548) White (n ⴝ 36.................... in 2001.............. R ESULTS Baseline characteristics In 2000...............................................................................3 (3...................9) 23............................ b Calculated among postmenopausal women only.............9 17.............................2 .001) compared with white women.............................. metabolic equivalent.............. Postmenopausal hormone use......................................................8 18.......... MET-h/ wk [mean (SD)] 20........................................... Parity................................. ............... we found that patterns of incontinence American Journal of Obstetrics & Gynecology APRIL 2010 rates across racial groups were similar (Table 2)................................ and functional limitation (defined as a significant limitation in climbing 1 flight of stairs..........................................................1) 20.............................................................................. and..8 (14...................................................................... 327 white).......................................... Incidence rates by incontinence frequency When considering each cohort separately over the 4-year follow-up period......................................................................2 (4...............2 (21.............................................9 22........ Additional control for hypertension................................................................5 0.....7 7..........6 26......................................................................... Never 67.5 Current 43.................................................................................................................9 1................8 30......9 61........................0) 46..................................... % ...................7 18.1 (6.....................................................6 2.................6 44.......................................................................1 17................................................ diuretic use...4 16......................3 25............................3 74......5) 46........................003) and black women (P ⬍ ....................................................................................... Asian women had the lowest mean BMI and black women were the most likely to have been diagnosed with type 2 diabetes (Table 1)........................................................................ MET..........1 23..... Townsend................................................................................................... rates of incontinence at least monthly were significantly lower in Asian (P ⫽ ............................................................... ............0 1–2 40.........................5 (3...............................7 .... % ................

.................. d d Asian 2709 155 5....7) 48 1...............................6) ................................8–4....................................... 0...1 (7......................... Incidence rates of frequent incontinence by incontinence type Within each cohort....................8–5.....04 vs white women).................................5–1..515 8.3–2................2) 7054 5............... When we compared rates of specific incontinence types between racial groups.org Research TABLE 2 Unadjusted incidence rates of urinary incontinence over 4 years by incontinence frequency and racea Anyb Race Person-y Cases Occasionalb IR (95% CI) Cases Frequentb IR (95% CI) Cases IR (95% CI) NHS ..................... rates of stress incontinence were significantly higher in white vs black women....1 (2...................................................7) ........................................................7) 41 4......1) 70 3....................5 (6.............................................................3 (7................AJOG...68) for occasional incontinence............................ incident rates............. The incidence rates of stress..2–7......................... To assess whether differences in risk factors across races might explain these differences in UI rates..................................................05......... the multivariable-adjusted HRs comparing black women to white women were 0...........4–5........................................................................ C OMMENT These data add to growing evidence from biologic and epidemiologic studies that risk of UI varies by race.....7 (4....................... d Unadjusted incidence rate significantly different vs white women: 0....0 (1................................................ In the combined cohorts...............1–2............ stress incontinence was the most common incontinence type among white and Asian women (Table 3)....................................09 vs white women) and 48% of black women (P ⫽ .....538 7..39 – 0.................01 ⱕ P ⬍ ....... ... 0.............. results were similar to those in the primary analysis (data not shown)....................................................8 (1............. results of validation studies indicate that classification of incontinence by type is more vulnerable to misclassification................8) White 254..3–5......................................................... remained significantly lower in black compared with white women after multivariable adjustment..............8) 28 1............3 (2.......2) 18 1...6–7.................................. c Asian 1716 94 5......................................................................21-23 We attempted to minimize this error by only considering incontinence type among APRIL 2010 American Journal of Obstetrics & Gynecology 378. NHSII .0) 52 1.......................2) White 130.... CI.....................80........... Our study has several limitations.............. Specifically...........................................................1 (2...... IR..................................................................................... .............................................................e4 ......... incontinence incidence appeared lower in Asian compared with white women.........35)....................... b Any incontinence is defined as incontinence at least monthly...........................4–4..................5) 126 3........................3) 5375 2........................................................................4) 13................................ 0............................8 (2............... In our prospective study........304 8023 6.........................001 ⱕ P ⬍ ........6) 6109 4. Also.... 95% CI........... urgency..............6–1..................5) 3461 2...0 (3..............................................6–4......0–2........................................ The accuracy of self-reported incontinence compared with clinically diagnosed incontinence has been established... and mixed incontinence did not differ significantly between white and Asian women............163 5. we found that the incidence rate of stress incontinence was significantly lower in black women compared with white women (P ⬍ ..................1 (0........................01) and statistically significant for occasional incontinence (HR..........1–6...........................15...........4) 20 2...............................9–4.......................... urgency incontinence was the most common type in black women....52 (95% CI..............64) for any incontinence.................................. ................................................................................................................................................6) 107 4.....................4 (1..................................4 (5............... Townsend............................. 0........0) 1914 1.................................................................................................... Occasional incontinence is defined as incontinence 1–3 times per month................9–8............................5 (4...............3) Black 3742 178 4.................. all incontinence information was self-reported.73–1.................................................................................... confidence interval.......1–5..............................................0–1......... c Asian 993 61 6. the overall incidence of incontinence was significantly higher in white women compared with black women............................................... The multivariableadjusted HR comparing Asian women to white women was borderline significant for any incontinence (HR.......... 95% CI. 0..............................................68) for frequent incontinence..........2) ....8–6............ 59% of white women with incident UI at follow-up 1 continued to report incontinence at follow-up 2 compared with 49% of Asian women (P ⫽ ... Finally.......................................... Combined .........................................Urogynecology www.................01...........1–5......................... c Unadjusted incidence rate significantly different vs white women: 0................1–2............... In a secondary analysis to explore potential differences in the persistence of incident incontinence across races.... in contrast to white or Asian women...... we controlled for several UI risk factors..................................4) 56 3................... For example.................................................... 0.............................................................................................................................. First...................... 95% CI..............................8 (4.....142 10...........................................1–2.. and this difference could not be explained by differences in several health and lifestyle factors related to incontinence................................4 (2.............55 (95% CI....... and.....1 (4...................2 (5.........................................47– 0... Am J Obstet Gynecol 2010.................................001... Frequent incontinence is defined as incontinence at least weekly.........446 18...................................................................................................................7 (2......... and 0................6) 66 3................... 0....... In multivariable-adjusted analyses............. as well as both occasional and frequent incontinence...66 – 0....20 However.. Incidence of urinary incontinence in 3 groups of US women..9 (4...7 (1.......................................1 (4...98)......................06 – 0....... rates of incontinence overall.............................................2) 34 1..........................................6) White 124.................... 0............9–5....................... a Incidence/100 person-y.............4 (3.......3–6...............001 in the combined cohorts)...47– 0................................ the difference in stress incontinence incidence comparing black women to white women remained significant after adjusting for potential confounding factors (HR..................................................................9) Black 2047 104 5.......5 (1......................................................................... urgency incontinence was the most common type among black women within each cohort.................86....................................................................... 0. e d ................................................6–2............................. e e d ................4–6........ e Unadjusted incidence rate significantly different vs white women: P ⬍ ..4 (2......... e e d ...........6 (1......2) Black 1695 74 4............................56 (95% CI....... In contrast.......... 0..................2–4................................................................................................................................

...99)......................... access to health care..................9) 9 0........................... Asian 2687 27 1.001 ⱕ P ⬍ ...2–0...............4) 11 0....5 (0....... the incidence of incontinence was not significantly different comparing Chinese or Japanese women to white women..........6) 676 0...3– 0...748 919 0..................... 0.. this homogeneity 378.............. suggesting that our classification method functions reasonably well..................................................5) Black 3720 5 0........ our study population included health professionals with similar education...................................... lower volume at strong desire to void......... Reports of a smaller levator ani muscle....... Women with incident frequent incontinence with missing information on incontinence type or whose incontinence type was unclassifiable were excluded from these analyses.......................................... and health knowledge..........................Research Urogynecology www............................................................................5 (0.... Asian 1703 17 1......................... confidence interval....................................... Frequent incontinence is defined as incontinence at least weekly.......................1-6..............3) 336 0............. with adjusted odds ratios (ORs) for any incontinence ranging from 0..................................................................................7) Black 2031 2 0.................5 (0..................... after adjusting for potential confounding factors.......... However...............32-34 In addition........................ the majority of cross-sectional studies have found a lower prevalence of incontinence in black women compared with white American Journal of Obstetrics & Gynecology APRIL 2010 women...................................0 (0......... women who remained in the cohort over the 5-year follow-up period were less likely to be black and more likely to report incontinence than those who dropped out..................................................2–0........................0) 2 0.......................................... c ........ this may be particularly important if previous studies of racial differences in incontinence may have been biased by cultural differences in reporting of incontinence............................................................... and lower cystometric capacity in 60 South Indian Asian compared with 247 white women...............01.........2–0..................4 (0.... CI..............................5................................org TABLE 3 Unadjusted incidence rates of frequent urinary incontinence over 4 years by incontinence type and racea Stress Race Person-y Cases Urgency IR (95% CI) Cases Mixed IR (95% CI) Cases IR (95% CI) NHS ..................................4–0.........6) White 123...........................................5) 8 0......................................................4–0......................................................5 (0...............................................3 However............................................ which could have led to an overestimation of incontinence incidence in black women.........8–0..................................................... Similar to our findings......0–0..........26............ In addition.. c ......................................................................... and further research on pelvic floor structure and function in Asian women is needed........... .............2–0...............................1–0............4) 4 0.2–0.........24................... have consistently found a lower prevalence of stress incontinence in black vs white .........................................................2 (0.........8....8 (0.......... including those with urodynamic data.1–0.3 (0................................................................... Consequently....... our estimates regarding specific incontinence types among black and Asian women were based on smaller numbers and should be interpreted more cautiously............................................................................... ..............2 (0.......... incident rates..0–0................. and it is possible that incidence rates among the different ethnicities are not homogeneous..........6) 4 0............. ...........................25 Second................. a Incidence/100 person-y................................................................ Asian 984 10 1..0 (0......................9) 951 0................0–0............................. Less is known regarding potential differences in pelvic floor function between Asian and non-Asian women.. Third... there was a nonsignificant increase in incontinence risk in black vs white women (OR.0–0................................ c Unadjusted incidence rate significantly different vs white women: P ⬍ .................... 95% CI................ we observed expected relations between risk factors and specific incontinence types.....................2 (0... and we did not collect data on other ethnic groups................. white women comprise ⬎90% of the NHS and NHSII cohorts.....................................4 (0.....................1–0.... 1 study found lower residual volume..............................4) 7 0....................0–0..........................................33..27 smaller pelvic floor cross-sectional area. Townsend............................ women of different ethnicities are included within each of our racial categories.2...........................................................................................................3) .......................... Combined .......180 2083 0.....................................3 (0................................................................................5–0......5–0................ NHSII .................................... in contrast to our results.....5) White 252..................001......9) 4 0............................................................................................................................0 (0..........................4 (0..432 1164 0.................. b Unadjusted incidence rate significantly different vs white women: 0.......9 In a prospective analysis of 2702 women aged 42–52 years in the Study of Women’s Health Across the Nation (SWAN) study... Prevalence studies of incontinence type..................... only 1% of the participants reported they were Hispanic or Latina..................8) 290 0.1 (0.............. However........................................................................................................................7–0.................................................................2–0.......................... Incidence of urinary incontinence in 3 groups of US women..................................AJOG................................ which may reduce generalizability to broader populations of women................................................4 (0..........28 and lower urethral closure pressure29..30 in white compared with black women support our observation of higher incontinence incidence in general and higher stress incontinence incidence in particular in white women..................................................................................................................................... in the SWAN study.....................................................5–1.7) 13 0...............................................................1 (0........................................0 (0...................................................................................... 1.....................1 (0......7) Black 1689 3 0.............4) 1012 0........ Am J Obstet Gynecol 2010.........................3 (0...........................e5 likely increases the internal validity of our findings...6–1.......... However..1–1....................................9–1.........................................4–1...........................................31 Whether these differences might be related to differences in incontinence incidence is unclear.......................... who may be better able to identify the primary circumstances in which leaking occurs.................4) ..........9 (0...................................................................................................................0–0...................2) 5 0........5 (0..............8) White 128.....5) 0 0........................ and....89 –1..........................................................................7 (0................................................. IR.0) 661 0................9......................................3–0.......... in previous analyses in these cohorts...................... several crosssectional studies observed a 30% lower prevalence of at least weekly incontinence in Asian women compared with white women after multivariable adjustment........3 (0... women with at least weekly incontinence............3) 19 0.....................2 (0........................ Finally..6) .................................................................. b ...........................

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London: Chapman and Hall. Harlow SD. Grodstein F. Tennstedt SL. the cumulative incidence of urgency incontinence was significantly higher in black vs white women after adjusting for potential confounders (OR. Urinary incontinence and pelvic floor dysfunction in Asian-American women. et al.14 – 0. Townsend MK. Lifford K. 18. Curhan GC. Townsend MK. Differences in prevalence of urinary incontinence by race/ethnicity. Obstet Gynecol 2008. J Urol 2006. Kenton K. Branch LG. Resnick NM.3 In contrast to our results.3 similar to our findings. The Nurses’ Health Study: 20-year contribution to the understanding of health among women. Hoyte L. Cundiff G. 56%. Urinary incontinence predictors and life impact in ethnically diverse perimenopausal women. Brubaker L. Obstet Gynecol 2007. Grodstein F.4 and no difference in prevalence. 3. Goode PS. Burgio KL. detrusor instability. Diokno A. 17. Obstet Gynecol 2004. Grodstein F. Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults: the Boston Area Community Health (BACH) Survey.2. The analysis of survival data.68).56: 285-90.Urogynecology www. van den Eeden SK. Waetjen LE. Gutman R. J Am Geriatr Soc 2008. and incident urinary incontinence in older women. Physical activity and urinary incontinence among healthy. and dual incontinence in older African-American and white men and women. Architectural differences in the bony pelvis of women with and without pelvic floor disorders.07– 0. 6. Danforth KN. Townsend MK. Establishing the prevalence of incontinence study: racial differences in women’s patterns of urinary incontinence.91.140:567-71. may contribute to discrepant findings across studies. fecal. are needed to better understand racial differences in incontinence incidence. Am J Obstet Gynecol 2003. Patel DA. Markland AD. Racial differences in pelvic morphology among asymptomatic nullipa- APRIL 2010 American Journal of Obstetrics & Gynecology 378. 21. 95% CI. among 66 Asian women (mean age. waist circumference. 5. older women. et al. J Urol 2008.179:656-61. Kirschner-Hermanns R. VanRooyen J. black. Hsu JW. Brown JS.10 a lower prevalence in black women. Bratt H. Correlates of urinary. For example. 194:339-45.99). Normolle DP.100:1230-8. Am J Epidemiol 2008. Colditz GA.179:1449-53. Foster RT. 95% CI.165:309-18.10. Shott S. Goode PS. Am J Epidemiol 2007. 12. 20. Resnick NM. Skurnick J. 1. 2. Seim A. Trowbridge ER. Clearly.111:678-85. 23.159:1903-8. Thom DH.29.28 – 0.109:721-7. 4. Pannu HK. Future prospective studies with data on pelvic floor structure and function may be useful to further explore these apparent racial diff ferences in incontinence risk. J Urol 2008. 1. et al. Grodstein F. Nager CW.36 In the prospective SWAN study.6:49-62.e6 . several have observed a similar pattern in the frequency of specific incontinence types among Asian women as our study.11. Resnick N.3– 0. Herzog AR. 14%. Redden DT. Obstet Gynecol 2003.167:390-9. Factors associated with prevalent and incident urinary incontinence in a cohort of midlife women: a longitudinal analysis of data: study of women’s health across the nation. in the SWAN study. Vanvik A. Burgio KL. 95% CI. Of the few cross-sectional studies that have examined incontinence type in Asian women.179:1455-60. Population based study of incidence and predictors of urinary incontinence in black and white older adults.org women. Handa VL.175: 259-64.3 Because urgency incontinence is generally less common than stress or mixed incontinence among younger women. 9. race.48:339-43. 25. 55 years) who underwent urodynamic testing. the incidence of urgency incontinence in the SWAN study was significantly lower in Chinese (OR. Diokno AC. with multivariable-adjusted ORs for stress incontinence ranging from 0. results from cross-sectional studies that have examined differences between black and white women in general populations have not been consistent.154:1727-30. We found that white women were more likely to develop incontinence than black and Asian women and black women were less likely to develop stress incontinence than white women. et al. Fretts R. Jakab M. Rothman KJ. Shah AD. 19. 1984. J Urol 1988. Association of age. the multivariable-adjusted odds of incident stress incontinence was 56% lower in black vs white women (OR. genuine stress incontinence was the most common diagnosis (genuine stress incontinence.102:1283-90. Oakes D. Resnick NM. Risk factors for urinary incontinence among middleaged women. and particularly those with data on Asian women.37. Cao G. Postmenopausal hormone therapy and risk of developing urinary incontinence. Brock BM. Hermstad R. urge and mixed urinary incontinence. Modern epidemiology. Obesity 2008. Kanaya AM.97) than in white women after multivariable adjustment.103:254-60. 15. In conclusion. Fenner DE.16:881-6. 0. Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey. 22. and the incidence of stress incontinence was similar to that in white women for both Chinese and Japanese women. and white adult women. et al. compliance and initial outcome of therapeutic options chosen by female patients with urinary incontinence.181:193-7. Danforth KN. Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. Accuracy of survey questions for geriatric urinary incontinence. and obstetric history with urinary symptoms among women in the Nurses’ Health Study.144:715-23. Greenland S. J Urol 1995. Hunskaar S. Bradley CS. 11. Yuhico M Jr. J Womens Health 1997. Cox DR. Resnick NM. Steers WD. 8.3 In the SWAN study. Dooley Y. Obstet Gynecol 2002. Am J Obstet Gynecol 2006. 14. 12%). 7. Resnick NM.AJOG. Curhan GC. Lifford K. Lukacz ES. Danforth KN.6. 24.189:428-34. For urgency incontinence. mixed incontinence. J Urol 2008. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Liao S. J Urol 2009. and the frequencies of all incontinence types were similar to those in white women. Ragins AI. Huang AJ.22– 2. Grodstein F. 0. 0. Thomas J. Hankinson SE. J Clin Epidemiol 1995. our data indicate that the incidence of UI varies among Asian.72) and Japanese women (OR. Curhan GC.195:1331-7.

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