中国成年女性尿失禁患病率的meta分析
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摘要
目的系统评价中国成年女性尿失禁的患病率,为尿失禁的防治决策提供依据。方法计算机检索CNKI、VIP、WanFang Data、CBM、PubMed、EMbase、The Cochrane Library,检索时限均从建库到2018年6月,搜集有关中国成年女性尿失禁患病情况的横断面研究。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 12.0软件进行meta分析。结果共纳入20个研究,包括90 126例患者。meta分析结果显示,成年女性尿失禁患病率为31.1%[95%CI(28.3%,34.0%)],且患病率随年龄增长而增加。亚组分析显示,压力性尿失禁是尿失禁的主要表现亚型,以轻度尿失禁为主,城市平均患病率为27.5%[95%CI(22.6%,32.4%)],农村为32.5%[95%CI(23.3%,41.7%)],南方平均患病率为30.9%[95%CI(26.8%,35.1%)],北方为31.4%[95%CI(26.0%,36.7%)];尿失禁患病率在2005～2008年开始升高,其后几年一直处于较高水平。结论我国成年女性尿失禁的患病率高达31.1%,从2005年以来一直处于较高水平,过去10余年无明显改善。成年女性尿失禁的患病率随年龄增长而增高,逐渐成为困扰女性和老年人群的健康负担。为关爱女性健康,提高女性生活质量,应重视尿失禁的发病原因并采取适当干预措施预防和治疗成年女性尿失禁。
Objectives To provide reference for decision-making on prevention and treatment of urinary incontinence by assessing the prevalence of urinary incontinence in Chinese adult women. Methods We searched CNKI,VIP, WanFang Data, CBM, PubMed, EMbase, The Cochrane Library to collect cross-sectional studies on urinary incontinence in adult women in mainland China from inception to June 2018. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using Stata12.0 software. Results A total of 20 studies were involved, including 90 126 patients. Meta-analysis showed that the prevalence of urinary incontinence in adult women was 31.1%(95%CI: 28.3% to 34.0%). The subgroup analysis showed that stress urinary incontinence was the main subtype, of which was mainly with mild incontinence, with an average prevalence rate of 27.5%(95%CI: 22.6% to 32.4%) in urban areas and 32.5%(95%CI: 23.3% to 41.7%) in rural areas; 30.9%(95%CI: 26.8% to 35.1%) in the south and 31.4%(95%CI: 26.0% to 36.7%) in the north. The prevalence rate was rising from 2005 to 2008, and it remained at a high level in the following years, and the prevalence increased with age.Conclusions The prevalence of urinary incontinence in adult women in China has been at a high level since 2005. There has been no significant improvement in the past 10 years. Therefore, we should attach great importance to it and take appropriate interventions to prevent the occurrence of urinary incontinence.
Objectives To provide reference for decision-making on prevention and treatment of urinary incontinence by assessing the prevalence of urinary incontinence in Chinese adult women. Methods We searched CNKI,VIP, WanFang Data, CBM, PubMed, EMbase, The Cochrane Library to collect cross-sectional studies on urinary incontinence in adult women in mainland China from inception to June 2018. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using Stata12.0 software. Results A total of 20 studies were involved, including 90 126 patients. Meta-analysis showed that the prevalence of urinary incontinence in adult women was 31.1%(95%CI: 28.3% to 34.0%). The subgroup analysis showed that stress urinary incontinence was the main subtype, of which was mainly with mild incontinence, with an average prevalence rate of 27.5%(95%CI: 22.6% to 32.4%) in urban areas and 32.5%(95%CI: 23.3% to 41.7%) in rural areas; 30.9%(95%CI: 26.8% to 35.1%) in the south and 31.4%(95%CI: 26.0% to 36.7%) in the north. The prevalence rate was rising from 2005 to 2008, and it remained at a high level in the following years, and the prevalence increased with age.Conclusions The prevalence of urinary incontinence in adult women in China has been at a high level since 2005. There has been no significant improvement in the past 10 years. Therefore, we should attach great importance to it and take appropriate interventions to prevent the occurrence of urinary incontinence.
引文
1 Abrams P, Cardozo L, Fall M, et al. The standardization of terminology in lower urinary tract function:report from the Standardization Sub-committee of the International Continence Society. Urology, 2003, 61(1):37-49.
2 Milsom I, Coyne KS, Nicholson S, et al. Global prevalence and economic burden of urgency urinary incontinence:a systematic review. Eur Urol, 2014, 65(1):79-95.
3周全,宋岩峰,罗龙华,等.两种闭孔路径尿道中段悬吊术治疗女性压力性尿失禁的Meta分析.中华全科医师杂志,2013, 12(2):127-129.
4 Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet, 2003, 82(3):327-338.
5朱兰,郎景和,王宏,等.北京地区成年女性尿失禁的流行病学研究.中华医学杂志,2006,(11):728-731.
6曾宪涛,刘慧,陈曦,等.Meta分析系列之四:观察性研究的质量评价工具.中国循证心血管医学杂志,2012, 4(4):297-299.
9邓丽,韦业平,张丽滢,等.南宁市成年女性尿失禁流行病学调查.广西医科大学学报,2013, 30(6):963-966.
8何本鸿,龚艳丽.利川市成年女性尿失禁流行病学调查.医学新知杂志,2006,16(6):358-359.
9刘晓旭.河北省部分地区女性尿失禁流行病学调查.石家庄:河北医科大学,2011.
10卫中庆,周文俊,喻荣彬,等.南京地区成年女性尿失禁的流行病学调查.临床泌尿外科杂志,2009, 24(1):49-52.
11丁峰.厦门社区女性盆底功能障碍性疾病流行病学研究.福州:福建医科大学,2011.
12来光华,赫小龙,张骁,等.杭州市成年女性尿失禁患病情况及对生活质量的影响.浙江预防医学,2016, 28(4):328-331.
13李亚钦,宋岩峰,何晓宇,等.福州市某社区女性居民尿失禁患病率调查.中华流行病学杂志,2004, 25(4):363.
14张素英.杭州地区成年女性尿失禁的流行病学调查.杭州:浙江大学,2009.
15曹晓静.粵东地区女性盆底功能障碍性疾病流行病学调查.北京:首都医科大学,2016.
16 Liu B, Wang L, Huang SS, et al. Prevalence and risk factors of urinary incontinence among Chinese women in Shanghai. Int J Clin Exp Med,2014, 7(3):686-696.
17初磊,王建军,樊伯珍,等.上海市成年女性尿失禁的流行病学研究.现代妇产科进展,2015, 24(6):421-424.
18陈旭.辽宁地区成年女性尿失禁流行病学调查研究.沈阳:中国医科大学,2009.
19葛静,鲁永鲜,张弈,等.北京地区成年女性尿失禁患病率及就诊率调查.中国妇产科临床杂志,2010,11(1):15-17.
20黄亮,张淞文,王涛,等.北京地区女性下尿路症状流行病学研究.中国妇幼保健,2011,26(26):4014-4018.
21蒋妍,闫璐,杜飞达,等.河北省女性尿失禁患病率调查及其影响因素分析.中华妇产科杂志,2016, 51(12):914-920.
22李易霞,马兰,何春妮,等.新疆马兰地区成年女性尿失禁的流行病学调查.中国医药导报,2012, 9(13):128-131.
23刘青,仇杰,龙丽霞,等.甘肃省女性尿失禁的流行病学调查及影响因素的多因素Logistic分析.实用妇产科杂志,2012, 28(10):830-833.
24宋迎春,张培莲,谢丽,等.西安市区成年女性尿失禁的流行病学及对生活质量影响的研究.陕西医学杂志,2014, 43(2):225-228.
25张蕾.中国成年女性下尿路症状流行病学调查及随访研究-多中心横断面及前瞻性队列研究.北京:北京协和医学院,2015.
26 Ma SS. The prevalence of adult female urinary incontinence in Hong Kong Chinese. Int Urogynecol J Pelvic Floor Dysfunct, 1997,8(6):327-331.
27 Azuma R, Murakami K, Iwamoto M, et al. Prevalence and risk factors of urinary incontinence and its influence on the quality of life of Japanese women. Nurs Health Sci, 2008,10(2):151-158.
28 Choo MS, Ku JH, Oh SJ, et al. Prevalence of urinary incontinence in Korean women:an epidemiologic survey. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18(11):1309-1315.
29 Reynolds WS, Dmochowski RR, Penson DF. Epidemiology of stress urinary incontinence in women. Curr Urol Rep, 2011, 12(5):370-376.
30 Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol,2014,123(1):141-148.
31 Hunskaar S, Lose G, Sykes D, et al. The prevalence of urinary incontinence in women in four European countries. BJU Int, 2004,93(3):324-330.
32何春妮,张淑萍,蔺玉红,等.新疆乌鲁木齐周边不同民族女性尿失禁调查分析.中国医师杂志,2009,11(10):1435-1436.
33 Tennstedt SL, Link CL, Steers WD, et al. Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults:the Boston area community health(BACH)survey. Am J Epidemiol, 2008, 167(4):390-399.
34 Fenner DE, Trowbridge ER, Patel DA, et al. Establishing the prevalence of incontinence study:racial differences in women's patterns of urinary incontinence. J Urol, 2008, 179(4):1455-1460.
35 Nygaard I, Barber MD, Burgio KL,et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA, 2008,300(11):1311-1316.
36 Goode PS, Burgio KL, Redden DT, et al. Population based study of incidence and predictors of urinary incontinence in black and white older adults. J Urol, 2008, 179(4):1449-1454.
37 Kupelian V, Wei JT, O'Leary M P, et al. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample:the Boston Area Community Health(BACH)survey. Arch Intern Med, 2006, 166(21):2381-2387.
38 Anger JT, Saigal CS, Litwin MS. The prevalence of urinary incontinence among community dwelling adult women:resultsfrom the national health and nutrition examination survey. J Urol,2006,175(2):601-604.
39 Al-Mukhtar OJ, Akervall S, Milsom I, et al. Urinary incontinence in nulliparous women aged 25-64 years:a national survey. Am J Obstet Gynecol, 2017, 216(2):141-149.
40贺媛,赵小兰,曾强.城市成人超重、肥胖、中心性肥胖的流行特征和相关危险因素分析.实用预防医学,2015,22(4):390-394.
41 Subak LL, Richter HE, Hunskaar S. Obesity and urinary incontinence:epidemiology and clinical research update. J Urol,2009,182(Suppl6):S2-S7.
42 Lawrence JM, Lukacz ES, Liu IL, et al. Pelvic floor disorders,diabetes, and obesity in women:findings from the Kaiser permanente continence associated risk epidemiology study.Diabetes Care, 2007, 30(10):2536-2541.
43 Maclennan AH, Taylor AW, Wilson DH, et al. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG, 2000, 107(12):1460-1470.
44 Romero-Talamas H, Unger CA, Aminian A, et al. Comprehensive evaluation of the effect of bariatric surgery on pelvic floor disorders. Surg Obes Relat Dis, 2016,12(1):138-143.
45 Subak LL, King WC, Belle SH, et al. Urinary incontinence before and after bariatric surgery. JAMA Intern Med, 2015, 175(8):1378-1387.
46艾聪,李光校,周波,等.中国2000年后急性心肌梗死患者抑郁患病率的Meta分析.中国循证医学杂志,2017, 17(1):47-51.
2 Milsom I, Coyne KS, Nicholson S, et al. Global prevalence and economic burden of urgency urinary incontinence:a systematic review. Eur Urol, 2014, 65(1):79-95.
3周全,宋岩峰,罗龙华,等.两种闭孔路径尿道中段悬吊术治疗女性压力性尿失禁的Meta分析.中华全科医师杂志,2013, 12(2):127-129.
4 Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet, 2003, 82(3):327-338.
5朱兰,郎景和,王宏,等.北京地区成年女性尿失禁的流行病学研究.中华医学杂志,2006,(11):728-731.
6曾宪涛,刘慧,陈曦,等.Meta分析系列之四:观察性研究的质量评价工具.中国循证心血管医学杂志,2012, 4(4):297-299.
9邓丽,韦业平,张丽滢,等.南宁市成年女性尿失禁流行病学调查.广西医科大学学报,2013, 30(6):963-966.
8何本鸿,龚艳丽.利川市成年女性尿失禁流行病学调查.医学新知杂志,2006,16(6):358-359.
9刘晓旭.河北省部分地区女性尿失禁流行病学调查.石家庄:河北医科大学,2011.
10卫中庆,周文俊,喻荣彬,等.南京地区成年女性尿失禁的流行病学调查.临床泌尿外科杂志,2009, 24(1):49-52.
11丁峰.厦门社区女性盆底功能障碍性疾病流行病学研究.福州:福建医科大学,2011.
12来光华,赫小龙,张骁,等.杭州市成年女性尿失禁患病情况及对生活质量的影响.浙江预防医学,2016, 28(4):328-331.
13李亚钦,宋岩峰,何晓宇,等.福州市某社区女性居民尿失禁患病率调查.中华流行病学杂志,2004, 25(4):363.
14张素英.杭州地区成年女性尿失禁的流行病学调查.杭州:浙江大学,2009.
15曹晓静.粵东地区女性盆底功能障碍性疾病流行病学调查.北京:首都医科大学,2016.
16 Liu B, Wang L, Huang SS, et al. Prevalence and risk factors of urinary incontinence among Chinese women in Shanghai. Int J Clin Exp Med,2014, 7(3):686-696.
17初磊,王建军,樊伯珍,等.上海市成年女性尿失禁的流行病学研究.现代妇产科进展,2015, 24(6):421-424.
18陈旭.辽宁地区成年女性尿失禁流行病学调查研究.沈阳:中国医科大学,2009.
19葛静,鲁永鲜,张弈,等.北京地区成年女性尿失禁患病率及就诊率调查.中国妇产科临床杂志,2010,11(1):15-17.
20黄亮,张淞文,王涛,等.北京地区女性下尿路症状流行病学研究.中国妇幼保健,2011,26(26):4014-4018.
21蒋妍,闫璐,杜飞达,等.河北省女性尿失禁患病率调查及其影响因素分析.中华妇产科杂志,2016, 51(12):914-920.
22李易霞,马兰,何春妮,等.新疆马兰地区成年女性尿失禁的流行病学调查.中国医药导报,2012, 9(13):128-131.
23刘青,仇杰,龙丽霞,等.甘肃省女性尿失禁的流行病学调查及影响因素的多因素Logistic分析.实用妇产科杂志,2012, 28(10):830-833.
24宋迎春,张培莲,谢丽,等.西安市区成年女性尿失禁的流行病学及对生活质量影响的研究.陕西医学杂志,2014, 43(2):225-228.
25张蕾.中国成年女性下尿路症状流行病学调查及随访研究-多中心横断面及前瞻性队列研究.北京:北京协和医学院,2015.
26 Ma SS. The prevalence of adult female urinary incontinence in Hong Kong Chinese. Int Urogynecol J Pelvic Floor Dysfunct, 1997,8(6):327-331.
27 Azuma R, Murakami K, Iwamoto M, et al. Prevalence and risk factors of urinary incontinence and its influence on the quality of life of Japanese women. Nurs Health Sci, 2008,10(2):151-158.
28 Choo MS, Ku JH, Oh SJ, et al. Prevalence of urinary incontinence in Korean women:an epidemiologic survey. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18(11):1309-1315.
29 Reynolds WS, Dmochowski RR, Penson DF. Epidemiology of stress urinary incontinence in women. Curr Urol Rep, 2011, 12(5):370-376.
30 Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol,2014,123(1):141-148.
31 Hunskaar S, Lose G, Sykes D, et al. The prevalence of urinary incontinence in women in four European countries. BJU Int, 2004,93(3):324-330.
32何春妮,张淑萍,蔺玉红,等.新疆乌鲁木齐周边不同民族女性尿失禁调查分析.中国医师杂志,2009,11(10):1435-1436.
33 Tennstedt SL, Link CL, Steers WD, et al. Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults:the Boston area community health(BACH)survey. Am J Epidemiol, 2008, 167(4):390-399.
34 Fenner DE, Trowbridge ER, Patel DA, et al. Establishing the prevalence of incontinence study:racial differences in women's patterns of urinary incontinence. J Urol, 2008, 179(4):1455-1460.
35 Nygaard I, Barber MD, Burgio KL,et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA, 2008,300(11):1311-1316.
36 Goode PS, Burgio KL, Redden DT, et al. Population based study of incidence and predictors of urinary incontinence in black and white older adults. J Urol, 2008, 179(4):1449-1454.
37 Kupelian V, Wei JT, O'Leary M P, et al. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample:the Boston Area Community Health(BACH)survey. Arch Intern Med, 2006, 166(21):2381-2387.
38 Anger JT, Saigal CS, Litwin MS. The prevalence of urinary incontinence among community dwelling adult women:resultsfrom the national health and nutrition examination survey. J Urol,2006,175(2):601-604.
39 Al-Mukhtar OJ, Akervall S, Milsom I, et al. Urinary incontinence in nulliparous women aged 25-64 years:a national survey. Am J Obstet Gynecol, 2017, 216(2):141-149.
40贺媛,赵小兰,曾强.城市成人超重、肥胖、中心性肥胖的流行特征和相关危险因素分析.实用预防医学,2015,22(4):390-394.
41 Subak LL, Richter HE, Hunskaar S. Obesity and urinary incontinence:epidemiology and clinical research update. J Urol,2009,182(Suppl6):S2-S7.
42 Lawrence JM, Lukacz ES, Liu IL, et al. Pelvic floor disorders,diabetes, and obesity in women:findings from the Kaiser permanente continence associated risk epidemiology study.Diabetes Care, 2007, 30(10):2536-2541.
43 Maclennan AH, Taylor AW, Wilson DH, et al. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG, 2000, 107(12):1460-1470.
44 Romero-Talamas H, Unger CA, Aminian A, et al. Comprehensive evaluation of the effect of bariatric surgery on pelvic floor disorders. Surg Obes Relat Dis, 2016,12(1):138-143.
45 Subak LL, King WC, Belle SH, et al. Urinary incontinence before and after bariatric surgery. JAMA Intern Med, 2015, 175(8):1378-1387.
46艾聪,李光校,周波,等.中国2000年后急性心肌梗死患者抑郁患病率的Meta分析.中国循证医学杂志,2017, 17(1):47-51.