女性尿失禁亚型与身体功能受限的关联分析：基于NHANES横断面数据

Association between urinary incontinence subtypes and physical functional limitation among women: cross-sectional data from NHANES

摘要

目的 分析女性尿失禁（UI）亚型与身体功能受限的关系，并采用美国国家健康与营养调查（NHANES）2021-2023年数据进行独立时间验证。方法 选取NHANES 2005-2018年具有UI问卷和身体功能问卷资料的20岁及以上成年女性的资料作为研究对象，根据漏尿诱因分为压力性尿失禁（SUI）、急迫性尿失禁（UUI）、混合性尿失禁（MUI）及其他/未分类UI。以身体功能受限为主要结局，以严重身体功能受限和行动能力受限作为次要结局。采用复杂抽样加权logistic回归评估UI频率、亚型与结局的关联；模型3在社会人口学、身体质量指数（BMI）、吸烟、合并症和调查周期基础上进行完全校正，模型4进一步校正抑郁症状。结果 共纳入8266名女性参与者，其中4270名存在UI，7045名进入模型3分析。主要结局分析显示，模型完全校正后（模型3），任意UI与身体功能受限相关（OR=1.386，95%CI:1.183～1.625），且UI频率越高，身体功能受限风险越大（P_趋势＜0.001）。与无UI者相比，SUI与身体功能受限的关联无统计学意义（OR=1.025，95%CI:0.813～1.292），UUI（OR=1.542，95%CI:1.215～1.957）和MUI（OR=1.871，95%CI:1.474～2.375）与身体功能受限均显示独立关联。进一步校正抑郁症状后（模型4），UUI和MUI与身体功能受限的关联仍存在。次要结局分析中，UUI和MUI与严重身体功能受限、行动能力受限的关系仍较稳定。NHANES 2021-2023年验证分析显示，MUI与任意身体功能困难及行走/上下楼困难的关联最强，UUI次之，整体方向与主要结局分析一致。结论 女性UI与身体功能受限有关，但不同亚型的关联强度并不相同。UUI和MUI患者更可能合并身体功能下降，临床评估时宜在判断UI亚型的同时关注行动能力及跌倒风险。

Abstract

Objective To examine the subtype-specific associations between urinary incontinence (UI) and physical functional limitation among women, and to validate the findings using an independent National Health and Nutrition Examination Survey (NHANES) 2021-2023 cycle. Methods The data of adult women aged 20 years or older with available UI and physical functioning questionnaires from NHANES 2005-2018 were included as the research subjects. UI was classified as stress UI (SUI), urgency UI (UUI), mixed UI (MUI) or other/unspecified UI. The primary outcome was physical functional limitation, and the secondary outcome was severe functional limitation and mobility limitation. Complex sampling-weighted logistic regression was adopted to assess the associations of UI frequency and subtypes with clinical outcomes. Model 3 was fully adjusted for sociodemographic factors, body mass index (BMI), smoking status, comorbidities, and survey wave. Model 4 was further adjusted for depressive symptoms. Results A total of 8266 women were included in the main descriptive analysis, including 4270 women with UI, and 7045 entered Model 3. Any UI was associated with physical functional limitation in the fully adjusted model (OR=1.386, 95%CI:1.183-1.625). A significant increasing trend was observed across UI frequency categories (P_{for trend}<0.001). Compared with women without UI, SUI was not significantly associated with physical functional limitation (OR=1.025, 95%CI:0.813-1.292), whereas UUI (OR=1.542, 95%CI:1.215-1.957) and MUI (OR=1.871, 95%CI:1.474-2.375) were associated with higher odds of the outcome. UUI and MUI remained significant after further adjustment for depressive symptoms in Model 4. The association pattern was consistent for secondary outcomes. In NHANES 2021-2023, MUI showed the strongest association with physical functioning difficulty and walking/climbing difficulty, followed by UUI. Conclusion The association between UI and physical functional limitation differs by UI subtypes. Patients with UUI and MUI are more likely to experience physical function decline. Clinical assessments should evaluate mobility and fall risk alongside the classification of UI subtypes.

关键词

尿失禁 / 压力性尿失禁 / 急迫性尿失禁 / 混合性尿失禁 / 身体功能受限 / NHANES

Key words

urinary incontinence / stress urinary incontinence / urgency urinary incontinence / mixed urinary incontinence / physical functional limitation / NHANES

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