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Prevalence, risk factors, and symptom bother of nocturia: a population‑based survey in China

By Y. Wang, H. Hu, K. Xu, X. Zhang, X. Wang, Y. Na, and X. Kang.

World Journal of Urology, 2014, DOI 10.1007/s00345-014-1411-5 [Epub ahead of print]

Editor’s comments:
The Authors conducted a population-based, cross-sectional survey over a period of 4 months (October 2012–January 2013) among adults aged ≥18 in five geographical regions of China, to evaluate the prevalence, risk factors, and symptom bother of nocturia in Chinese adults.

A structured questionnaire was used to receive information on the following aspects: sociodemographic characteristics, general health and past diseases, and the Chinese version of the International Consultation on Incontinence Questionnaire-Male/Female Lower Urinary Tract Symptoms Long Form was administered to obtain information on frequency of nocturia and the degree of symptom bother.

3,023 subjects out of 4,723 completed the interviews (64% response rate). Prevalence of nocturia was very similar between males and females: 58.2% of men and 56.9% of women were affected by nocturia when defined as voiding once or more per night, and 23.4% of men and 26.0% of women for voiding twice or more per night. The prevalence of nocturia increased constantly with advancing age in both genders with either definition. In addition, the prevalence of nocturia also increased with higher body mass index (BMI), alcohol consumption, smoking, hypertension, cardiovascular disease, and diabetes mellitus in both genders. In men, advanced age, LUTS with benign prostatic enlargement and BMI were more frequently associated with nocturia ≥1 void/night. In women, advanced age, higher parity and smoking were potential risk factors for nocturia ≥1 void/night. Vaginal delivery was related to nocturia ≥2 voids/night. The degree of bother reported in the survey increased with the higher frequency of nocturia, but was not affected by genders. The Authors explained the increasing frequency of nocturia with advancing age by age-related irreversible structural and functional changes in the bladder and urethra that lead to a reduced bladder capacity, uninhibited contractions, and increased post-void residual urine volume. With regard to the geographic distribution of the symptom, nocturia was reported most frequently in northeast China independent of definitions for both genders followed by northwest China, whereas other regions reported a relatively low prevalence. This could be due to differences in the diet habit, climate or perception of symptoms. In conclusion, the results of this survey are similar to those observed in other surveys but they represent the first, large epidemiologic study conducted among both genders and all adult age groups in China.

ABSTRACT

Purpose:

To evaluate the prevalence, risk factors, and symptom bother of nocturia in Chinese adults.

Methods:
A population-based, cross-sectional survey was conducted among individuals aged ≥18 years in five geographical regions of China, via a stratified sampling approach. A structured questionnaire was used to obtain information on sociodemographic characteristics, general health, and past disease, and the International Consultation on Incontinence Questionnaire-Male/Female Lower Urinary Tract Symptoms Long Form was administered to estimate the prevalence of nocturia and rate their symptom bother. The current International Continence Society definition of nocturia (≥1 void/night) was used, and a secondary analysis was conducted with the threshold of two or more voids per night.

Results:
Of the 4,723 subjects contacted, 3,023 completed the interviews (64 % response rate). After being weighted by age and genders, 57.5 % participants reported voiding once or more per night and 24.7 % twice or more per night. Advanced age, higher body mass index, smoking, hypertension, and diabetes mellitus were associated risk factors in both genders. Lower urinary tract symptoms suggestive of benign prostatic enlargement increased the occurrence of nocturia in men, and higher parity and vaginal delivery were correlated with nocturia in women. Degree of bother increased with the higher frequency of nocturia, but was not affected by genders.

Conclusions:
The prevalence of nocturia is quite high in China and increases with advancing age. Nocturia bothers sufferers greatly, and many known risk factors are associated with this bothersome condition. Experiencing two or more nightly voids is more clinically relevant.