Elsevier

European Urology

Volume 65, Issue 1, January 2014, Pages 79-95
European Urology

Platinum Priority – Review – Incontinence
Editorial by Piotr Radziszewski and Bartosz Dybowski on pp. 96–98 of this issue
Global Prevalence and Economic Burden of Urgency Urinary Incontinence: A Systematic Review

https://doi.org/10.1016/j.eururo.2013.08.031Get rights and content

Abstract

Context

The prevalence and economic burden of urgency urinary incontinence (UUI) are difficult to ascertain because of overlap with data on overactive bladder and other types of incontinence.

Objective

To summarize the evidence on the global prevalence and economic burden of UUI.

Evidence acquisition

A PubMed search was performed used the following terms: (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR cost OR economic OR prevalence). A similar search was conducted using Embase. English-language articles published from 1991 through 2013 on non-neurogenic UUI were retained.

Evidence synthesis

We retained 54 articles (50 studies); 22 large-scale, population-based surveys indicated varying UUI prevalence estimates with ranges of 1.8−30.5% in European populations, 1.7−36.4% in US populations, and 1.5−15.2% in Asian populations, with prevalence dependent on age and gender. Nineteen smaller-scale studies supported these findings. Despite varying methods, 11 studies estimating the costs of UUI worldwide consistently concluded that the economic burden is substantial and will increase markedly as the population ages. In a 2005 multinational study, the annual cost-of-illness estimate for UUI in Canada, Germany, Italy, Spain, Sweden, and the United Kingdom was €7 billion. A US cost-of-illness study reported a total cost of $66 billion in 2007 US dollars. The costs of routine care and nursing home admissions for UUI were major contributors to the cost.

Conclusions

UUI affects millions of men and women worldwide. Current evidence demonstrates the substantial economic burden of UUI to patients and society. Worldwide public health and clinical management programs are needed to improve UUI awareness and highlight the need for early diagnosis and management.

Introduction

Urinary incontinence (UI) is defined by the International Continence Society (ICS) as the complaint of involuntary loss of urine, with three primary subtypes of UI identified: urgency UI (UUI), stress UI (SUI), and mixed UI (MUI; both UUI and SUI) [1], [2]. UUI is defined as involuntary loss of urine associated with urgency; SUI is defined as involuntary loss of urine associated with effort, physical exertion, sneezing, or coughing; and MUI is defined as involuntary loss of urine associated with urgency and with effort, exertion, sneezing, or coughing [1], [2].

UUI is a symptom of the overactive bladder (OAB) syndrome, defined as urinary urgency usually accompanied by frequency and nocturia, with or without UUI, in the absence of urinary tract infection or other obvious pathology [1], [2]. OAB symptoms, including UUI, can have detrimental effects on an individual's physical, mental, and social well-being and are associated with increased morbidity and mortality [3], [4], [5], [6]. The prevalence of UUI specifically has been less well studied than that of OAB, and available study results are often difficult to compare because of differing populations, UUI definitions, and methodologies. Because prevalence rates are an important factor in models used to calculate the economic costs associated with UUI, economic data also vary across studies. The purpose of this review is to summarize the published medical literature on the worldwide prevalence and economic burden of UUI to provide health care providers with a current overview of the data and to increase awareness of the toll that UUI exacts from patients and society.

Section snippets

Evidence acquisition

This systematic review was conducted based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement [7]. A PubMed search of the literature on the prevalence and economic burden of UUI was conducted on September 7, 2012, and updated March 6, 2013, using the following search terms: (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR cost OR economic OR prevalence). The search was limited

Global prevalence of urgency urinary incontinence

Twenty-one large-scale (≥5000 adults), population-based, telephone, mail, interview, and Internet surveys (22 articles) assessed the prevalence of UUI in different samples of adults from Europe, the United States, Asia, and Africa (Table 1). In large-scale studies of adults aged ≥18−20 yr, the prevalence of any UUI ranged from 1.5% to 14.3% for men and from 1.6% to 22.8% for women, whereas in studies of adults aged ≥30−40 yr, the prevalence of any UUI ranged from 1.7% to 13.3% for men and from

Conclusions

Current evidence demonstrates the substantial economic burden of UUI, which likely will increase over time in parallel with the projected 25% increase in UUI prevalence in the next decade because of the aging of the population. Data on the costs of UUI are highly dependent on the accuracy and comprehensiveness of prevalence and cost data, making it difficult to accurately estimate the economic burden of UUI. The increasing prevalence of UUI, together with the comorbidities associated with UUI,

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