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Association Between Socioeconomic Status (SES) and Lower Urinary Tract Symptom (LUTS) Severity Among Black and White Men

Journal of General Internal Medicine volume 26, pages 1305–1310 (2011)Cite this article

ABSTRACT

BACKGROUND

A higher prevalence of moderate or severe lower urinary tract symptoms (LUTS) has been reported among African Americans, but the separate effects of race and socioeconomic status (SES) on LUTS severity are unclear.

OBJECTIVE

We investigated the roles of education, income, marital status, and source of health insurance on LUTS reporting among black and white U.S. men.

DESIGN

A prospective cohort within the Southern Community Cohort Study

MAIN MEASURES

The International Prostate Symptom Score (IPSS) was completed during follow-up by 2488 white men and 4188 black men. Multivariable linear and logistic regression methods were used to compare IPSS scores and LUTS severity by race and SES after adjusting for age, duration of follow-up, benign prostatic hyperplasia (BPH) treatment, source of recruitment, smoking status, BMI, mode of follow-up ascertainment, and prior diagnosis of hypertension, diabetes, or hypercholesterolemia.

KEY RESULTS

Overall IPSS scores and the prevalence of moderate/severe LUTS were not significantly associated with race. Instead, higher IPSS scores were significantly associated (p < 0.05) with a lower income, marital status, and source of insurance. Education was also marginally associated with IPSS scores (p = 0.06) among black men. Furthermore, moderate/severe LUTS onset was significantly associated with a household income less than $15,000/year (OR = 1.56 (1.23, 1.96)) and having private health insurance (OR = 0.79 (0.67, 0.93)).

CONCLUSIONS

Social or behavioral factors related to SES affect LUTS reporting, and suggests a potential affect on BPH diagnosis.

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References

  1. Kirby RS. The natural history of benign prostatic hyperplasia: what have we learned in the last decade? Urology. 2000;56(5 Suppl 1):3–6.

    PubMed  Article  CAS  Google Scholar 

  2. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol. 2005;173(4):1256–1261.

    PubMed  Article  Google Scholar 

  3. Crawford ED, Wilson SS, McConnell JD, Slawin KM, Lieber MC, Smith JA, et al. Baseline Factors as Predictors of Clinical Progression of Benign Prostatic Hyperplasia in Men Treated With Placebo. J Urol. 2006;175(4):1422–1427.

    PubMed  Article  CAS  Google Scholar 

  4. Johnson TV, Abbasi A, Ehrlich SS, Kleris RS, Schoenberg ED, Owen-Smith A, et al. Patient misunderstanding of the individual questions of the American Urological Association symptom score. J Urol. 2008;179(6):2291–2294.

    PubMed  Article  Google Scholar 

  5. Johnson TV, Schoenberg ED, Abbasi A, Ehrlich SS, Kleris R, Owen-Smith A, et al. Assessment of the performance of the American Urological Association symptom score in 2 distinct patient populations. J Urol. 2009;181(1):230–237.

    PubMed  Article  Google Scholar 

  6. Platz EA, Smit E, Curhan GC, Nyberg LM, Giovannucci E. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men. Urology. 2002;59(6):877–883.

    PubMed  Article  Google Scholar 

  7. Kristal AR, Arnold KB, Schenk JM, Neuhouser ML, Weiss N, Goodman P, et al. Race/ethnicity, obesity, health related behaviors and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. J Urol. 2007;177(4):1395–1400.

    PubMed  Article  Google Scholar 

  8. Sarma AV, Wei JT, Jacobson DJ, Dunn RL, Roberts RO, Girman CJ, et al. Comparison of lower urinary tract symptom severity and associated bother between community-dwelling black and white men: the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men’s Health Study. Urology. 2003;61(6):1086–1091.

    PubMed  Article  Google Scholar 

  9. Fowke JH, Signorello LB, Chang SS, Matthews CE, Buchowski MS, Cookson MS, et al. Effects of Obesity and Height on PSA and Percent Free PSA Levels Among African-American and Caucasian Men. Cancer. 2006;107(10):2361–2367.

    PubMed  Article  CAS  Google Scholar 

  10. Fowler JE, Bigler SA, Farabaugh PB, Wilson SS. Prostate cancer detection in Black and White men with abnormal digital rectal examination and prostate specific antigen less then 4 ng./ml. J Urol. 2000;164(6):1961–3.

    Article  Google Scholar 

  11. Fowler JE Jr, Bigler SA, Kilambi NK, Land SA. Relationships between prostate-specific antigen and prostate volume in black and white men with benign prostate biopsies. Urology. 1999;53(6):1175–1178.

    PubMed  Article  Google Scholar 

  12. Signorello LB, Hargreaves MK, Blot WJ. The Southern Community Cohort Study: investigating health disparities. J Health Care Poor Underserved. 2010;21(1 Suppl):26–37.

    PubMed  Article  Google Scholar 

  13. Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148(5):1549–1557.

    PubMed  CAS  Google Scholar 

  14. Burgess DJ, Powell AA, Griffin JM, Partin MR. Race and the validity of self-reported cancer screening behaviors: development of a conceptual model. Prev Med. 2009;48(2):99–107.

    PubMed  Article  Google Scholar 

  15. Platz EA, Kawachi I, Rimm EB, Willett WC, Giovannucci E. Race, ethnicity and benign prostatic hyperplasia in the health professionals follow-up study. J Urol. 2000;163(2):490–495.

    PubMed  Article  CAS  Google Scholar 

  16. Kupelian V, Wei JT, O’Leary MP, Kusek JW, Litman HJ, Link CL, 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.

    PubMed  Article  Google Scholar 

  17. Fowke JH, Murff HJ, Signorello LB, Lund L, Blot WJ. Race and socioeconomic status are independently associated with benign prostatic hyperplasia. J Urol. 2008;180(5):2091–2096.

    PubMed  Article  Google Scholar 

  18. Bailey LR, Roodi N, Verrier CS, Yee CJ, Dupont WD, Parl FF. Breast cancer and CYP1A1, GSTM1, GSTT1 polymorphisms; evidence of a lack of association in Caucasions and African Americans. Cancer Res. 1998;58:65–70.

    PubMed  CAS  Google Scholar 

  19. Bennett CL, Price DK, Kim S, Liu D, Jovanovic BD, Nathan D, et al. Racial variation in CAG repeat lengths within the androgen receptor gene among prostate cancer patients of lower socioeconomic status. J Clin Oncol. 2002;20(17):3599–3604.

    PubMed  Article  CAS  Google Scholar 

  20. Devgan S, Henderson BE, Yu M, Shi C-Y, Pike M, Ross R, et al. Genetic variation in 3beta-hydroxysteroid dehydrogenase Type II in three racial/ethinic groups: Implications for prostate cancer risk. The Prostate. 1997;33:9–12.

    PubMed  Article  CAS  Google Scholar 

  21. Hoke GP, McWilliams GW. Epidemiology of benign prostatic hyperplasia and comorbidities in racial and ethnic minority populations. Am J Med. 2008;121(8 Suppl 2):S3–10.

    PubMed  Article  Google Scholar 

  22. Badia X, Rodriguez F, Carballido J, Garcia LM, Unda M, Dal-Re R, et al. Influence of sociodemographic and health status variables on the American Urological Association symptom scores in patients with lower urinary tract symptoms. Urology. 2001;57(1):71–77.

    PubMed  Article  CAS  Google Scholar 

  23. MacDiarmid SA, Goodson TC, Holmes TM, Martin PR, Doyle RB. An assessment of the comprehension of the American Urological Association Symptom Index. J Urol. 1998;159(3):873–874.

    PubMed  Article  CAS  Google Scholar 

  24. Master VA, Johnson TV, Abbasi A, Ehrlich SS, Kleris RS, Abbasi S, et al. Poorly numerate patients in an inner city hospital misunderstand the American Urological Association symptom score. Urology. 2010;75(1):148–152.

    PubMed  Article  Google Scholar 

  25. Klag MJ, Whelton PK, Coresh J, Grim CE, Kuller LH. The association of skin color with blood pressure in US blacks with low socioeconomic status. JAMA. 1991;265(5):599–602.

    PubMed  Article  CAS  Google Scholar 

  26. Blanchard K, Proverbs-Singh T, Katner A, Lifsey D, Pollard S, Rayford W. Knowledge, attitudes and beliefs of women about the importance of prostate cancer screening. J Natl Med Assoc. 2005;97(10):1378–1385.

    PubMed  Google Scholar 

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Acknowledgements

Supported by RO1CA092447 and N01-DK-7-0003 from the National Institutes of Health and the Urologic Diseases of America Project.

Conflict of interest

None disclosed.

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Affiliations

  1. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Jay H. Fowke PhD, Lisa B. Signorello ScD & William J. Blot PhD

  2. International Epidemiology Institute, Rockville, MD, USA

    Heather Munro MS, Lisa B. Signorello ScD & William J. Blot PhD

  3. Department of Surgical Urology, Vanderbilt University Medical Center, Nashville, TN, 37203, USA

    Jay H. Fowke PhD & David F. Penson MD

  4. VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA

    David F. Penson MD

Authors
  1. Jay H. Fowke PhD
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  2. Heather Munro MS
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  3. Lisa B. Signorello ScD
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  4. William J. Blot PhD
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  5. David F. Penson MD
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the Urologic Diseases of America Project

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Correspondence to Jay H. Fowke PhD.

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Fowke, J.H., Munro, H., Signorello, L.B. et al. Association Between Socioeconomic Status (SES) and Lower Urinary Tract Symptom (LUTS) Severity Among Black and White Men. J GEN INTERN MED 26, 1305–1310 (2011). https://doi.org/10.1007/s11606-011-1776-8

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  • DOI: https://doi.org/10.1007/s11606-011-1776-8

KEY WORDS

  • benign prostatic hyperplasia
  • lower urinary tract symptoms
  • race
  • socio-economic status