PHOENIX, AZ USA (UroToday.com) - BACH (Boston Area Community Health Study) is a unique resource as it is the largest perspective epidemic urologic study of urologic symptoms in the world, designed to address major knowledge gaps in male and female urology.
It is a population-based longitudinal survey of racially and ethnically diverse men and women from Boston, Massachusetts. A total of 5,502 subjects (3,201 women) were enrolled at baseline (between 2002 and 2005) and data collection for the first BACH follow-up was completed in July of 2010. A total of 4,145 BACH subjects (2,535 women) had subsequent follow-up visits (greater than 80% response rate). BACH’s key design feature includes a large sample size, permitting sub-group analysis use of population-based probability of sampling to ensure generalizability of results. It also includes prospective data collection. BACH enrolled both men and women with a broad age span from 30 to 79 years of baseline. It is diverse racially, ethnically, and socially. Unlike other studies, it is symptom-based rather than variable diagnosis-based and includes definitions of urologic symptoms and in-home data collection for blood sampling and anthropometric measurements.
Urinary symptoms affect woman of all age and race/ethnicities. 18.8% of women reported moderate to severe LUTS at baseline, 10.9% of weekly or daily UI. 20.8% were classified as OAB and 2.4% as having painful bladder syndrome. Rates of improvement in about 20% were seen for the more common urologic clusters of symptom patterns, particularly for those women who had reported more frequent severe symptoms at baseline. Also shown is that symptom progression occurred in approximately 20% of women with symptoms of OAB, UTIs and LUTS which is comparable with similar percentages who reported lessening or omission of symptoms over time. Analysis conducted by BACH investigators has shown that age, comorbidities and lifestyle factors are all key determinants of progression and remission of urologic symptoms in women.
Weight loss over five years was strongly associated with less improvement in remission in this sample of women. There is increasing overall evidence of the role of modifiable risk factors, as measured in BACH, in the prevalence and incidence of urologic symptoms in women. Dr. Rosen noted that these findings have important public health and clinical implications. So based on this BACH data, with the future prevalence of urologic disease symptoms and the growing epidemic of obesity in men and women, there will be a steady increase in the prevalence of urologic problems in women, many of whom will require medical or lifestyle interventions. Based on BACH estimates, Dr. Rosen anticipates a 34% increase in the prevalence of most urologic conditions by 2025. He feels that attention is urgently needed to address lifestyle and public health implications.
[refs: , Link CL, Tennstedt SL, Mollon P, Aiyer LP, Chapple CR, Wein AJ, Rosen RC. Urological symptom clusters and health-related quality-of-life: results from the Boston Area Community Health Survey. BJU Int. 2009 Jun;103(11):1502-8.
Kupelian V, McVary KT, Kaplan SA, Hall SA, Link CL, Aiyer LP, Mollon P, Tamimi N, Rosen RC, McKinlay JB. Association of lower urinary tract symptoms and the metabolic syndrome: results from the Boston Area Community Health Survey. J Urol. 2009 Aug;182(2):616-24; discussion 624-5
Rosen RC, Coyne KS, Henry D, Link CL, Cinar A, Aiyer LP, Mollon P, Kaplan SA, Roehrborn CG, Thompson C. Beyond the cluster: methodological and clinical implications in the Boston Area Community Health survey and EPIC studies. BJU Int. 2008 May;101(10):1274-8.
Presented by Raymond C. Rosen, PhD at the Society for Urodynamics and Female Urology (SUFU) 2011 Winter Meeting - March 1 - 5, 2011 - Arizona Biltmore, Phoenix, Arizona, USA
Reported for UroToday by Diane K. Newman, RNC, MSN, CRNP, FAAN and Continence Nurse Practitioner Specialist - University of Pennsylvania Medical Center.
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