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Trends and Prevalence of Nocturia Among US Adults, 2005-2016 - Beyond the Abstract

Nocturia is defined as a person waking up and urinating one or more times per night, regardless of poor sleep.1 Previous studies have demonstrated that the number of nocturia episodes potentially increases risk for several adverse clinical outcomes, and in particular, two and more episodes of nocturia have been shown to be associated with a higher risk of mortality, recurrent falls, polypharmacy, insomnia, decreased functional capacity, frailty, urinary incontinence, and depression.2 Because of all these negative correlations, it is suggested that nocturia may be an indicator of poor health rather than a simple lower urinary tract symptom. Therefore, it is important to examine in detail the contemporary prevalence of nocturia and the secular trend over time to provide information about the general health status of the societies and developing appropriate management strategies.

In our recent study, we aimed to investigate the frequency trends of nocturia in the United States between 2005 and 2016 by using NHANES data according to different age groups. We found that from 2005 to 2016, the secular trend in the prevalence of ≥1 nocturia episode increased in both men and women in general, which was significant among those under the age of 60 years. Additionally, the prevalence of ≥2 nocturia episodes tended to increase only in men aged 40-59 years.3

We think our results are very important in many ways. First, the increase in the frequency of nocturia in these age groups may lead to an increase in health expenditures by reducing the productivity of the people who are actively working.4 Second, since there is a significant association between nocturia and depression in both men and women, this result suggests that in the US, nocturia should be considered in the prevention of depression and negative outcomes due to depression, which is one of the most important and increasing health problems of today.5 Third, in a study conducted using NHANES data to investigate the effect of nocturia on mortality risk, it was reported that ≥2 nocturia episodes increased the risk of mortality by 1.54 times in men and 1.28 times in women.6 However, interestingly, the magnitude of the nocturia and mortality association was greater in those younger than 65 years with attenuated associations in the 65 years or older age group. There was a significant trend in an increased risk of death due to increased night void events. Finally, according to NHANES data, the prevalence of obesity, hypertension, diabetes mellitus, unhealthy lifestyle behaviors, and sodium consumption has increased over the years.7-10 This may account for the upward trend of nocturia in the middle-aged and younger aged groups, indicating that these cardiovascular risk factors are not being effectively controlled in the US.

Our study also showed that the prevalence of those who had nocturia for at least one time was more than 80% and the prevalence of those who had nocturia for at least two times was around 50%, but no change was observed in the nocturia prevalence trend in those ≥60 years of age.3 In fact, even if it seems that there is no increase in the nocturia trend over the age of 60, these rates are already very high, because serious complications such as nocturia-related hip fractures, falls and reduced functionality are more common in older subjects and often require hospitalization.2,3
Future studies are needed to determine the reasons for these trends and high ratios. Because increased nocturia episodes can be a clinical marker of poor health status, nocturia assessment is very important for clinical practice; thus, evaluation of nocturia and nocturia frequency should be a part of patients' assessments, and impactful strategies should be implemented to reduce nocturia episodes and improve its related negative outcomes.

Written by: Pinar Soysal, MD, Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey; Chao Cao, MPH, Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri; Ahmet Turan Isik, MD, PhD, Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; Nicola Veronese, MD, Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy; Lee Smith, MD, MSc, The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, England

References:

  1. Haylen, B. T., D. De Ridder, R. M. Freeman, S. E. Swift, B. Berghmans, J. Lee, A. Monga et al. "An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction." Journal of the Association of Chartered Physiotherapists in Womens Health 110 (2012): 33.
  2. Dutoglu, Ekrem, Pinar Soysal, Lee Smith, Ferhat Arik, Ugur Kalan, Rumeyza Turan Kazancioglu, and Ahmet Turan Isik. "Nocturia and its clinical implications in older women." Archives of gerontology and geriatrics 85 (2019): 103917.
  3. Soysal, Pinar, Chao Cao, Tianlin Xu, Lin Yang, Ahmet Turan Isik, Rumeyza Turan Kazancioglu, Qinran Liu et al. "Trends and prevalence of nocturia among US adults, 2005–2016." International Urology and Nephrology (2019): 1-9.
  4. Holm‐Larsen, Tove. "The economic impact of nocturia." Neurourology and urodynamics 33, no. S1 (2014): S10-S14.
  5. Liu, Ying, Candice Collins, Kesheng Wang, Xin Xie, and Ronghai Bie. "The prevalence and trend of depression among veterans in the United States." Journal of affective disorders 245 (2019): 724-727.
  6. Kupelian, Varant, Mary P. Fitzgerald, Steven A. Kaplan, Jens Peter Norgaard, Gretchen R. Chiu, and Raymond C. Rosen. "Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey." The Journal of urology 185, no. 2 (2011): 571-577.
  7. Moon, Shinje, Hye Soo Chung, Jae Myung Yu, Kwang Jin Ko, Don Kyoung Choi, Ohseong Kwon, Young Goo Lee, and Sung Tae Cho. "The association between obesity and the nocturia in the US population." International neurourology journal 23, no. 2 (2019): 169.
  8. Ryu, Seungho, Emily Frith, Zeljko Pedisic, Minsoo Kang, and Paul D. Loprinzi. "Secular trends in the association between obesity and hypertension among adults in the United States, 1999–2014." European journal of internal medicine 62 (2019): 37-42.
  9. Brouillard, Adam M., Aldi T. Kraja, and Michael W. Rich. "Trends in Dietary Sodium Intake in the United States and the Impact of USDA Guidelines: NHANES 1999-2016." The American journal of medicine 132, no. 10 (2019): 1199-1206.
  10. Yang, Lin, Chao Cao, Elizabeth D. Kantor, Long H. Nguyen, Xiaobin Zheng, Yikyung Park, Edward L. Giovannucci, Charles E. Matthews, Graham A. Colditz, and Yin Cao. "Trends in sedentary behavior among the US population, 2001-2016." Jama 321, no. 16 (2019): 1587-1597.
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