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Meta-Analysis
. 2016 Jul 13;11(7):e0158992.
doi: 10.1371/journal.pone.0158992. eCollection 2016.

Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis

Gregor John  1 , Claire Bardini  2 , Christophe Combescure  3 , Patrick Dällenbach  4
Affiliations
Meta-Analysis

Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis

Gregor John et al. PLoS One. .

Abstract

Background: The association between urinary incontinence (UI) and increased mortality remains controversial. The objective of our study was to evaluate if this association exists.

Methods: We performed a systematic review and meta-analysis of observational studies comparing death rates among patients suffering from UI to those without incontinence. We searched in Medline, Embase and the Cochrane library using specific keywords. Studies exploring the post-stroke period were excluded. Hazard ratios (HR) were pooled using models with random effects. We stratified UI by gender and by UI severity and pooled all models with adjustment for confounding variables.

Results: Thirty-eight studies were retrieved. When compared to non-urinary incontinent participants, UI was associated with an increase in mortality with pooled non adjusted HR of 2.22 (95%CI 1.77-2.78). The risk increased with UI severity: 1.24 (95%CI: 0.79-1.97) for light, 1.71 (95%CI: 1.26-2.31) for moderate, and 2.72 (95%CI: 1.90-3.87) for severe UI respectively. When pooling adjusted measures of association, the resulting HR was 1.27 (95%CI: 1.13-1.42) and increased progressively for light, moderate and severe UI: 1.07 (95%CI: 0.79-1.44), 1.25 (95%CI: 0.99-1.58), and 1.47 (95%CI: 1.03-2.10) respectively. There was no difference between genders.

Conclusion: UI is a predictor of higher mortality in the general and particularly in the geriatric population. The association increases with the severity of UI and persists when pooling models adjusted for confounders. It is unclear if this association is causative or just reflects an impaired general health condition. As in most meta-analyses of observational studies, methodological issues should be considered when interpreting results.

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Conflict of interest statement

Competing Interests: All authors declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1. Flow chart of identified references to retrieved studies in the systematic review.
*Three longitudinal cohorts gave multiple publications on the association between urinary incontinence and mortality, at different time points.
Fig 2
Fig 2. Forest plot of unadjusted HR of death for urinary incontinence.
* Estimated from the ratio of logarithms of event-free proportions from the published proportion of death in the exposed and unexposed groups. † HR could be estimated from the Kaplan-Meier curve for one study UI: urinary incontinence.
Fig 3
Fig 3. Unadjusted HRs of studies (white circles) and pooled HRs (black boxes) of death for urinary incontinence by (published) UI severity.
Circle-sizes are inversely proportional to studies' standard error. UI severity subgroups are bounded by solid lines. UI: urinary incontinence.
Fig 4
Fig 4. Forest plot of adjusted HR of death for urinary incontinence.
Adjusted HR was published by gender (*) or severity of UI subgroups (†) only. A summarized HR was obtained through a meta-analysis of all subgroups for each of those studies. UI: urinary incontinence.
Fig 5
Fig 5. Adjusted HRs (white circles) and pooled HRs (black boxes) of death for urinary incontinence by (published) UI severity.
Circle-sizes are inversely proportional to studies' standard error. UI severity subgroups are bounded by solid lines. UI: urinary incontinence.
Fig 6
Fig 6. Funnel plot for unadjusted (panel A) or adjusted (panel B) HR of death.
Panel A: With The Trim and Fill approach, no missing study was detected. Panel B: With The Trim and Fill approach, one missing study was detected on the left part of the funnel plot (white dot).
See this image and copyright information in PMC

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