The purpose of this study was to investigate the prevalence and risk factors of overactive bladder (OAB) in young adults and to explore the influence of OAB on mental health.
Between October 2019 and January 2020, 14,010 anonymous questionnaires were distributed to freshmen at 2 universities in Henan, China. The students came from all over the country. The questionnaire included general items and information necessary to calculate the overactive bladder symptom score, the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) score, Self-Esteem Scale (SES) score, and Self-Rating Depression Scale (SDS) score. The relationships between the prevalence of OAB and its risk factors were evaluated.
The overall prevalence of OAB was 6.0%, with 4.3% of participants characterized as having dry OAB and 1.7% as having wet OAB. The prevalence of mild OAB was 5.5%, and that of moderate OAB was 0.5%; no severe OAB was observed. Higher prevalence rates of OAB were found among women, respondents with constipation, and respondents with primary nocturnal enuresis (PNE) (P <0.05). Compared to healthy controls, the OAB group exhibited a higher mean SDS score (52.12±8.986 vs. 47.71±9.399, P<0.001) and mean PSQI score (5.28±2.486 vs. 4.27±2.431, P<0.001), but a lower mean SES score (27.78±3.599 vs. 29.57±4.109, P<0.001).
OAB significantly affects the mental health of young adults. Female sex, constipation, and PNE are risk factors for OAB.
Overactive bladder (OAB) is a common urological abnormality that is defined by the International Continence Society (ICS) as “urgency, with or without urge incontinence, usually with frequency and nocturia” in the absence of “proven infection or other obvious pathology” [
The etiology and risk factors of OAB have not been fully clarified, although age, sex and body mass index (BMI) are reported risk factors for OAB [
measures in the future.
The purpose of this study was to investigate the prevalence and risk factors of OAB among university students in mainland China. Since university students are a key group of young adults, this study provides important information for further understanding the epidemiology of OAB in young adults in mainland China.
Between October 2019 and January 2020, a survey of 14,010 junior university students was administered at two universities medical university in China using an anonymous questionnaire after obtaining informed consent. The participants originated from areas throughout the country, and they were instructed to avoid taking medication or consuming coffee in the 3 days prior to participation. In addition, all participants underwent a physical examination, including a routine urine examination. The inclusion criteria of the OAB group were as follows: (1) fulfillment of the diagnostic criteria for primary OAB, which include symptoms of urgency, frequent urination, and nocturia, with or without urgent urinary incontinence; and (2) an urgency score of ≥2 and a total score of ≥3 on the overactive bladder symptom score (OABSS). The exclusion criteria were a congenital history of urinary tract abnormality, pelvic surgery, neurogenic disease, or present urinary tract infection (UTI). The presence of UTI was assessed via urine testing, which is part of the routine physical examination conducted at the time of entry to the university. The study was performed according to the Declaration of Helsinki and approved by the Ethics Committee of Xinxiang Medical University (XYLL-2018237).
The contents of the questionnaire included: (1) basic information (such as sex, date of birth, place of origin, height, and weight); (2) history of primary nocturnal enuresis (PNE; intermittent incontinence while asleep in a child >5 years of age, at least twice a month [
The PSQI was developed to evaluate subjective sleep disturbance over the prior month, with a higher score indicating poorer sleep quality. The Chinese version of the PSQI was translated and validated by Zhu et al. [
The diagnostic criteria for OAB used in this study were an urgency score of at least 2 and a total OABSS score of at least 3. Dry OAB was defined as OAB without urgent urinary incontinence (as indicated by an urgent urinary incontinence OABSS score of 0), while wet OAB referred to OAB with urgent urgency incontinence (as indicated by an urgent urinary incontinence OABSS score of at least 1). A total OABSS score of 5 or lower was considered to indicate mild OAB, a score between 6 and 11 indicated moderate OAB, and a score of 12 or higher indicated severe OAB.
After verification by the research group staff, the data were imported into the IBM SPSS Statistics ver. 21.0 (IBM Co., Armonk, NY, USA) for statistical analysis. Count data were expressed as percentages, and measurement data were expressed as means±standard deviations. The chi-square test was used to analyze the factors related to OAB, and logistic regression was used for the multivariate analysis. The U-test was used to compare the SDS, SES, and PSQI scores between the OAB and nonOAB groups. A P-value of <0.05 indicated a statistically significant difference. The Bonferroni method was used to correct the test standard (P/α), and comparisons were performed among age groups and BMI groups.
The data for 93.4% (13,083 of 14,010) of the participants (4,192 males and 8,891 females; age, 19±1.3 years) were included in the final statistical analysis.
The overall prevalence of OAB was 6.0% (788 of 13,083), with dry OAB accounting for 4.3% (562 of 13,083) and wet OAB accounting for 1.7% (226 of 13,083) of cases. The prevalence of mild OAB was 5.5% (726 of 13,083), and that of moderate OAB was 0.5% (62 of 13,083); no severe OAB was observed. The prevalence rates of OAB among male and female participants were 4.7% (196 of 4,192) and 6.7% (592 of 8,891), respectively, and the difference was significant. The prevalence of OAB was 5.8% (101 of 1,739) among 18-year-olds, 6.0% (227 of 3,766) among 19-year-olds, 6.0% (188 of 3,108) among 20-year-olds, 6.0% (130 of 2,164) among 21-year-olds, and 6.2% (142 of 2,306) among the 22-year-old participants. No correlation was observed between prevalence rate and age (χ2=0.224, P>0.05) (
The prevalence of OAB with respect to sex, constipation, and PNE is shown in
The variables found to be meaningful in the chi-square analysis were included in the regression analysis model, and the results showed that female sex (odds ratio [OR], 1.374; 95% confidence interval [CI], 1.159–1.630), constipation (OR, 1.460; 95% CI, 1.236–1.724), and PNE (OR, 2.490, 95% CI, 1.530–4.053) were risk factors for OAB occurrence (
Based on the U-test, the SES score of the OAB group was lower than that of the healthy group, while the SDS and PSQI scores were higher than those of the healthy group, as shown in
OAB severely affects quality of life due to frequent toilet use, forced reduction of water consumption, and fear of participating in social activities [
The prevalence of OAB in our study differed from the results of other studies [
A study by Wang et al. [
Zhang et al. [
Many studies have not presented a classification of the severity of OAB [
The prevalence of OAB may vary by sex. The EPIC study indicated that the prevalence of OAB was slightly higher among women than among men [
The relationship between OAB and BMI has long been controversial. Many studies of adults have indicated that a high BMI is related to a higher likelihood of developing OAB [
Research has shown that constipation is a risk factor for OAB [
The incidence of acute cystitis is known to increase in young women after the age of 19 to 20 years, and cystitis may be a cause of OAB in adolescents. Unfortunately, this was not considered in our survey due to the difficulty of confirming acute cystitis in this large investigation. Consequently, we excluded individuals with acute UTI, some of whom may have had acute cystitis [
The results of this study support the view that OAB has negative effects on psychology, such as reducing sleep quality and increasing the incidence of depression and self-abasement [
In the present study, many risk factors were found for the prevalence of OAB among young adults, with no clear mechanisms. Therefore, researchers must continue to investigate the potential mechanisms behind these relationships. Although the participants originated from around the country, this was not a cross-sectional study, and the information obtained from the survey on the prevalence and risk factors of OAB among young adults may not represent the complete situation of OAB among young adults in China. This survey required respondents to recall and list the symptoms of the disease, which may have promoted recall bias. Additionally, the continuous presence of OAB in an individual over time must be documented. Thus, in this study, we reported only the sensation of urgency in a young sample population and additionally did not evaluate sexual function in the population with OAB. Therefore, multicenter surveys and additional samples are necessary to clarify the potential risk factors and underlying mechanisms of OAB.
In conclusion, OAB is common among Chinese university students and affects their mental health significantly. Female sex, constipation, and PNE were risk factors for OAB.
Henan Province Medical Science Provincial-ministerial Construction Project (No: SBGJ2018059); National Nature Science Foundation of China (No. U1904208).
The study was performed according to the Declaration of Helsinki and approved by the Ethics Committee of Xinxiang Medical University (XYLL-2018237).
No potential conflict of interest relevant to this article was reported.
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Prevalence of overactive bladder (OAB) in the different age groups.
Univariate analysis of the prevalence of and risk factors for OAB among 13,083 university students
Variable | Cases (n) | OAB frequency and prevalence (%) | χ2 | P-value |
---|---|---|---|---|
Sex | 19.788 | < 0.001 | ||
Male | 4,192 | 196 (4.7) | ||
Female | 8,891 | 592 (6.7) | ||
Place of residence | 0.200 | 0.655 | ||
City | 4,902 | 276 (5.6) | ||
Countryside | 8,181 | 476 (5.8) | ||
Age (yr) | 0.224 | 0.994 | ||
18 | 1,739 | 101 (5.8) | ||
19 | 3,766 | 227 (6.0) | ||
20 | 3,108 | 188 (6.0) | ||
21 | 2,164 | 130 (6.0) | ||
22 | 2,306 | 142 (6.2) | ||
Constipation | 36.763 | < 0.001 | ||
No | 10,475 | 565 (5.4) | ||
Yes | 2,608 | 223 (8.6) | ||
BMI (kg/m2) | 0.311 | 0.856 | ||
< 25 | 12,127 | 728 (6.0) | ||
25-30 | 860 | 53 (6.2) | ||
≥ 30 | 96 | 7 (7.3) | ||
PNE | 18.304 | < 0.001 | ||
No | 12,947 | 768 (5.9) | ||
Yes | 136 | 20 (14.7) |
OAB, overactive bladder; BMI, body mass index; PNE, primary nocturnal enuresis.
Logistic regression analysis of the influencing factors of OAB prevalence
Variable | β | SE | P-value | OR (95% CI) |
---|---|---|---|---|
Sex | 0.318 | 0.087 | < 0.001 | 1.374 (1.159–1.630) |
Constipation | 0.379 | 0.085 | < 0.001 | 1.460 (1.236–1.724) |
PNE | 0.912 | 0.249 | < 0.001 | 2.490 (1.530–4.053) |
OAB, overactive bladder; SE, standard error; OR, odds ratio; CI, confidence interval; PNE, primary nocturnal enuresis.
Effect of OAB on self-esteem, depression and sleep quality
Score | OAB | Non-OAB | Z value | P-value |
---|---|---|---|---|
SES | 27.78 ± 3.599 | 29.57 ± 4.109 | 5.891 | < 0.001 |
SDS | 52.12 ± 8.986 | 47.71 ± 9.399 | 0.939 | < 0.001 |
PQSI | 5.28 ± 2.486 | 4.27 ± 2.431 | 0.068 | < 0.001 |
OAB, overactive bladder; SES, self-esteem scale; SDS, self-rating depression scale; PSQI, Pittsburgh sleep quality index.