Healthcare-seeking with bothersome lower urinary tract symptoms among men in the Danish population: the impact of lifestyle and socioeconomic status

Figures & data

Figure 1. Flowchart of the study cohort (2012).

Table 1. Characteristics of Danish men participating in the Danish Symptom Cohort (2012) with SES and lifestyle factors and stratified by symptom type.

	Respondents	Difficulty in emptying the bladder	Nocturia	Frequent urination	Incontinence^a
	n (%)	n (%)	n (%)	n (%)	n (%)
Respondents
Overall	21,838 (100.0%)	3159 (14.5%)	10,865 (49.8%)	2413 (11.0%)	1411 (6.5%)
Symptoms and GP contact
GP contact with LUTS^b		952 (30.1%)	1825 (16.8%)	682 (28.3%)	407 (28.8%)
Reporting LUTS as bothersome^c		1637 (51.8%)	3716 (34.2%)	1438 (59.6%)	905 (64.1%)
GP contact with bothersome LUTS		631 (38.5%)	1071 (28.8%)	541 (37.6%)	315 (34.8%)
Age (years)
<40	5082 (23.3%)	335 (6.6%)	1138 (22.4%)	382 (7.5%)	112 (2.2%)
40–59	8753 (40.1%)	992 (11.3%)	4105 (46.9%)	824 (9.4%)	354 (4.0%)
60–79	7423 (34.0%)	1670 (22.5%)	5172 (69.7%)	1086 (14.6%)	829 (11.2%)
>80	580 (2.7%)	162 (27.9%)	450 (77.6%)	121 (20.9%)	116 (20.0%)
Cohabitation status
Single	4833 (22.1%)	643 (13.3%)	2098 (43.4%)	592 (12.2%)	316 (6.5%)
Married/living together	17,005 (77.9%)	2516 (14.8%)	8767 (51.6%)	1821 (10.7%)	1095 (6.4%)
Smoking status
Never smoked	9205 (42.2%)	1061 (11.5%)	4155 (45.1%)	901 (9.8%)	452 (4.9%)
Previous smoker	7606 (34.8%)	1415 (18.6%)	4558 (59.9%)	956 (12.6%)	631 (8.3%)
Current smoker	5027 (23.0%)	683 (13.6%)	2152 (42.8%)	556 (11.1%)	328 (6.5%)
Alcohol intake (units/week)
0	3619 (16.6%)	500 (13.8%)	1577 (43.6%)	533 (14.7%)	240 (6.6%)
1–7	10,143 (46.4%)	1391 (13.7%)	4835 (47.7%)	1091 (10.8%)	625 (6.2%)
8–21	6651 (30.5%)	1004 (15.1%)	3609 (54.3%)	651 (9.8%)	418 (6.3%)
22+	1425 (6.5%)	264 (18.5%)	844 (59.2%)	138 (9.7%)	128 (9.0%)
BMI (kg/m^2)
Underweight	107 (0.5%)	16 (15.0%)	33 (30.8%)	13 (12.1%)	9 (8.4%)
Normal	9066 (41.5%)	1179 (13.0%)	4213 (46.5%)	864 (9.5%)	510 (5.6%)
Overweight	9364 (42.9%)	1408 (15.0%)	4813 (51.4%)	1039 (11.1%)	612 (6.5%)
Obese	3301 (15.1%)	556 (16.8%)	1806 (54.7%)	497 (15.1%)	280 (8.5%)
Educational level
<10 years	4054 (18.6%)	618 (15.2%)	2078 (51.3%)	572 (14.1%)	311 (7.7%)
10–12 years	10,748 (49.2%)	1506 (14.0%)	5196 (48.3%)	1241 (11.5%)	657 (6.1%)
>12 years	7036 (32.2%)	1035 (14.7%)	3591 (51.0%)	600 (8.5%)	443 (6.3%)
Household income
Lowest quartile	3119 (14.3%)	418 (13.4%)	1297 (41.6%)	433 (13.9%)	241 (7.7%)
Middle quartile	11,211 (51.3%)	1648 (14.7%)	5488 (49.0%)	1302 (11.6%)	752 (6.7%)
Highest quartile	7508 (34.4%)	1093 (14.6%)	4080 (54.3%)	678 (9.0%)	418 (5.6%)
Labor market affiliation
Working	15,372 (70.4%)	1692 (11.0%)	6562 (42.7%)	1361 (8.9%)	592 (3.9%)
Pension	4986 (22.8%)	1209 (24.2%)	3593 (72.1%)	824 (16.5%)	686 (13.8%)
Out of workforce	1480 (6.8%)	258 (17.4%)	710 (48.0%)	228 (15.4%)	133 (9.0%)

^a The three incontinence symptoms (urge incontinence, stress incontinence and incontinence without stress/urge) were merged into one group termed incontinence.

^b LUTS with any degree of concern or influence on daily activities.

^cBothersome meaning LUTS reported as either of moderate or greater concern or influence.

^dThe three incontinence symptoms (urge incontinence, stress incontinence and incontinence without stress/urge) were merged into one group termed incontinence.

Table 2. Estimated crude and adjusted odds ratios (ORs) with 95% confidence interval (CI) for reporting urological symptoms according to SES and lifestyle, stratified by symptom type, in 23,240 Danish men participating in the Danish Symptom Cohort (2012).

	Incontinence** N = 1411		Nocturia N = 10,865		Frequent urination N = 2413		Difficulty in emptying the bladder N = 3159
	Crude OR (95% CI)	Adj. OR (95% CI)*	Crude OR (95% CI)	Adj. OR (95% CI)*	Crude OR (95% CI)	Adj. OR (95% CI)*	Crude OR (95% CI)	Adj. OR (95% CI)*
Age (years)
< 40	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)
40–59	1.9 (1.5–2.3)	1.9 (1.5–2.3)	3.1 (2.8–3.3)	2.7 (2.5–3.0)	1.3 (1.1–1.5)	1.4 (1.2–1.6)	1.8 (1.6–2.1)	1.7 (1.5–2.0)
60–79	5.6 (4.6–6.8)	3.9 (3.1–5.0)	8.0 (7.3–8.6)	5.8 (5.2–6.5)	2.1 (1.9–2.4)	2.0 (1.7–2.3)	4.1 (3.6–4.7)	3.3 (2.9–3.8)
> 80	11.1 (8.4–14–6)	6.8 (4.9–9.4)	12.0 (9.8–14.7)	8.3 (6.6–10.5)	3.2 (2.6–4.1)	2.7 (2.1–3.6)	5.5 (4.4–6.8)	4.1 (3.2–5.3)
Cohabitation status
Single	1.0 (ref)	.	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)
Married/living together	1.0 (0.9–1.1)	.	1.4 (1.3–1.5)	1.0 (1.0–1.1)	0.9 (0.8–0.9)	0.9 (0.8–1.0)	1.1 (1.0–1.2)	1.0 (0.9–1.1)
Smoking status
Never smoked	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)
Previous smoker	1.8 (1.5–2.0)	1.1 (1.0–1.3)	1.8 (1.7–1.9)	1.1 (1.1–1.2)	1.3 (1.2–1.5)	1.1 (0.9–1.2)	1.8 (1.6–1.9)	1.2 (1.1–1.4)
Current smoker	1.4 (1.2–1.6)	1.2 (1.0–1.4)	0.9 (0.8–1.0)	0.8 (0.8–0.9)	1.1 (1.0–1.3)	1.0 (0.9–1.1)	1.2 (1.1–1.3)	1.1 (1.0–1.2)
Alcohol intake
0	1.1 (0.9–1.3)	1.1 (1.0–1.3)	0.8 (0.9–0.9)	1.0 (0.9–1.1)	1.4 (1.3–1.6)	1.4 (1.2–1.5)	1.0 (0.9–1.1)	1.1 (1.0–1.2)
1–7	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)
8–21	1.0 (0.9–1.2)	0.9 (0.8–1.0)	1.3 (1.2–1.4)	1.2 (1.1–1.2)	0.9 (0.8–1.0)	0.9 (0.8–1.0)	1.1 (1.0–1.2)	1.0 (0.9–1.1)
22+	1.5 (1.2–1.8)	1.2 (1.0–1.5)	1.6 (1.4–1.8)	1.3 (1.2–1.5)	0.9 (0.7–1.1)	0.8 (0.7–1.0)	1.4 (1.2–1.7)	1.2 (1.0–1.4)
BMI (kg/m^2)
Underweight	1.5 (0.8–3.1)	1.4 (0.7–2.9)	0.5 (0.3–0.8)	0.7 (0.4–1.0)	1.3 (0.7–2.4)	1.1 (0.6–2.0)	1.2 (0.7–2.0)	1.3 (0.7–2.2)
Normal	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)
Overweight	1.2 (1.0–1.3)	1.1 (0.9–1.2)	1.2 (1.1–1.3)	1.0 (0.9–1.1)	1.2 (1.1–1.3)	1.1 (1.0–1.2)	1.2 (1.1–1.3)	1.0 (1.0–1.1)
Obese	1.6 (1.3–1.8)	1.4 (1.2–1.6)	1.4 (1.3–1.5)	1.2 (1.1–1.3)	1.7 (1.5–1.9)	1.5 (1.3–1.7)	1.4 (1.2–1.5)	1.2 (1.0–1.3)
Educational level
< 10 years	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	.
10–12 years	0.8 (0.7–0.9)	1.0 (0.9–1.2)	0.9 (0.8–1.0)	1.0 (1.0–1.1)	0.8 (0.7–0.9)	1.0 (0.9–1.1)	0.9 (0.8–1.0)	.
> 12 years	0.8 (0.7–0.9)	1.2 (1.0–1.4)	1.0 (0.9–1.1)	1.1 (1.0–1.2)	0.6 (0.5–0.6)	0.8 (0.7–0.9)	1.0 (0.9–1.1)	.
Household income
Lowest quartile	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	.
Middle quartile	0.9 (0.7–1.0)	0.9 (0.8–1.0)	1.3 (1.2–1.5)	1.1 (1.0–1.2)	0.8 (0.7–0.9)	0.9 (0.8–1.0)	1.1 (1.0–1.2)	.
Highest quartile	0.7 (0.6–0.8)	0.9 (0.7–1.1)	1.7 (1.5–1.8)	1.3 (1.2–1.5)	0.6 (0.5–0.7)	0.8 (0.7–0.9)	1.1 (1.0–1.2)	.
Labor market affiliation
Working	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)	1.0 (ref)
Pension	4.0 (3.6–4.5)	1.8 (1.5–2.1)	3.5 (3.2–3.7)	1.4 (1.2–1.5)	2.0 (1.9–2.2)	1.3 (1.1–1.5)	2.6 (2.4–2.8)	1.3 (1.1–1.4)
Out of workforce	2.5 (2.0–3.0)	2.0 (1.6–2.4)	1.2 (1.1–1.4)	1.2 (1.1–1.4)	1.9 (1.6–2.2)	1.4 (1.2–1.7)	1.7 (1.5–2.0)	1.5 (1.3–1.7)

Bold indicating a p value below 0.05.

^* Adjustments were made for all covariates that had a p value below 0.05 when tested using a Wald test.

^** The three incontinence symptoms (urge incontinence, stress incontinence and incontinence without stress/urge) were merged into one group named incontinence.

Figure 2. Distribution of all reported LUTS by bothersome and not bothersome, with bothersome LUTS further broken out to display: (1) The proportion of bothersome LUTS that are of moderate to extreme influence and no/little concern, (2) The proportion of bothersome LUTS that are of both moderate to extreme influence and moderate to extreme concern, and (3) The proportion of bothersome LUTS that are of moderate to extreme concern and with no/little influence on daily activities.

Table 3. Estimated crude and adjusted odds ratios (ORs) with 95% confidence interval (CI) for GP contact regarding bothersome LUTS by symptom type with SES and lifestyle factors. Only bothersome symptoms were included in this analysis.

	Incontinence** (N = 905)			Nocturia (N = 3716)			Frequent urination (N = 1438)			Difficulty in emptying the bladder (N = 1637)
	n	Crude OR (95% CI)	Adj. OR (95% CI)*	n	Crude OR (95% CI)	Adj. OR (95% CI)*	n	Crude OR (95% CI)	Adj. OR (95% CI)*	n	Crude OR (95% CI)	Adj. OR (95% CI)*
Age (years)
< 40	68	1.0 (ref)	1.0 (ref)	332	1.0 (ref)	1.0 (ref)	188	1.0 (ref)	1.0 (ref)	158	1.0 (ref)	1.0 (ref)
40–59	233	1.3 (0.7–2.4)	1.1 (0.6–2.2)	1287	2.1 (1.4–3.0)	1.9 (1.3–2.9)	449	1.9 (1.3–3.0)	1.9 (1.2–2.9)	483	2.4 (1.5–3.9)	2.2 (1.4–3.6)
60–79	532	2.3 (1.3–4.3)	1.6 (0.8–3.3)	1899	5.2 (3.6–7.5)	3.4 (2.3–5.1)	727	4.1 (2.7–6.1)	3.6 (2.3–5.7)	906	4.8 (3.1–7.6)	3.8 (2.3–6.3)
> 80	72	2.1 (1.0–4.5)	1.3 (0.5–3.0)	198	6.7 (4.3–10.6)	3.4 (2.1–5.7)	74	5.5 (3.1–10.0)	4.7 (2.4–9.2)	30	4.9 (2.7–8.9)	3.5 (1.8–6.8)
Symptom burden
1	65	1.0 (ref)	1.0 (ref)	1640	1.0 (ref)	1.0 (ref)	150	1.0 (ref)	1.0 (ref)	207	1.0 (ref)	1.0 (ref)
2–3	571	1.8 (1.0–3.5)	1.7 (0.9–3.3)	1835	2.5 (2.2–3.0)	2.2 (1.9–2.6)	1043	1.2 (0.8–1.7)	0.8 (0.5–1.2)	1192	1.5 (1.1–2.1)	1.2 (0.8–1.6)
4–6	269	3.3 (1.7–6.4)	2.9 (1.5–5.8)	241	5.1 (3.9–6.8)	4.0 (3.0–5.3)	245	2.7 (1.8–4.1)	1.6 (1.0–2.6)	238	2.6 (1.7–3.8)	1.8 (1.2–2.7)
Cohabitation status
Single	202	1.0 (ref)	.	799	1.0 (ref)	.	378	1.0 (ref)	.	355	1.0 (ref)	.
Married/living together	703	0.9 (0.6–1.2)	.	2917	1.1 (0.9–1.3)	.	1060	1.2 (0.9–1.5)	.	1282	1.1 (0.9–1.4)	.
Smoking status
Never smoked	280	1.0 (ref)	.	1205	1.0 (ref)	1.0 (ref)	496	1.0 (ref)	.	493	1.0 (ref)	.
Previous smoker	404	1.2 (0.9–1.6)	.	1706	1.2 (1.0–1.4)	0.9 (0.8–1.1)	583	1.3 (1.0–1.7)	.	758	1.1 (0.9–1.4)	.
Current smoker	221	0.6–1.3)	.	805	0.8 (0.6–1.0)	0.7 (0.6–0.9)	359	1.1 (0.8–1.5)	.	386	0.9 (0.7–1.2)	.
Alcohol intake
0	160	1.1 (0.8–1.7)	.	690	1.0 (0.8–1.2)	.	333	0.8 (0.6–1.0)	.	287	1.1 (0.9–1.5)	.
1–7	403	1.0 (ref)	.	1600	1.0 (ref)	.	654	1.0 (ref)	.	719	1.0 (ref)	.
8–21	255	0.7 (0.5–1.0)	.	1123	0.9 (0.8–1.1)	.	357	0.9 (0.7–1.2)	.	491	0.9 (0.7–1.1)	.
22+	87	0.7 (0.4–1.1)	.	303	0.7 (0.5–1.0)	.	94	0.7 (0.4–1.1)	.	140	0.7 (0.5–1.0)	.
BMI (kg/m^2)
Underweight	6	1.7 (0.3–8.8)	.	17	1.4 (0.5–3.9)	.	10	1.1 (0.3–4.0)	.	10	1.2 (0.3–4.4)	.
Normal	305	1.0 (ref)	.	1249	1.0 (ref)	.	486	1.0 (ref)	.	566	1.0 (ref)	.
Overweight	404	1.0 (0.7–1.4)	.	1673	1.1 (0.9–1.3)	.	641	1.1 (0.8–1.4)	.	740	1.3 (1.0–1.6)	.
Obese	190	0.7 (0.5–1.0)	.	777	1.1 (0.9–1.4)	.	301	0.9 (0.7–1.2)	.	321	1.2 (0.9–1.5)	.
Educational level
<10 years	204	1.0 (ref)	.	858	1.0 (ref)	.	363	1.0 (ref)	.	357	1.0 (ref)	1.0 (ref)
10–12 years	430	0.9 (0.6–1.2)	.	1884	0.9 (0.7–1.0)	.	753	0.9 (0.7–1.1)	.	811	0.7 (0.5–0.9)	0.8 (0.6–1.0)
>12 years	271	0.9 (0.6–1.4)	.	974	1.0 (0.8–1.2)	.	322	1.1 (0.8–1.5)	.	469	0.8 (0.6–1.0)	0.8 (0.6–1.1)
Household income
Lowest quartile	151	1.0 (ref)	1.0 (ref)	557	1.0 (ref)	.	276	1.0 (ref)	.	243	1.0 (ref)	.
Middle quartile	500	0.7 (0.5–1.1)	0.8 (0.5–1.2)	2040	0.8 (0.7–1.0)	.	765	0.9 (0.7–1.2)	.	872	0.9 (0.7–1.2)	.
Highest quartile	254	0.6 (0.4–0.9)	0.7 (0.4–1.1)	1119	0.8 (0.6–1.0)	.	397	0.8 (0.6–1.2)	.	522	0.9 (0.7–1.3)	.
Labor market affiliation
Working	359	1.0 (ref)	1.0 (ref)	1922	1.0 (ref)	1.0 (ref)	711	1.0 (ref)	1.0 (ref)	782	1.0 (ref)	1.0 (ref)
Pension	450	2.2 (1.6–2.9)	1.5 (1.0–2.4)	1453	2.7 (2.3–3.1)	1.5 (1.2–1.9)	557	2.2 (1.7–2.8)	1.1 (0.8–1.5)	694	2.1 (1.7–2.6)	1.2 (0.9–1.6)
Out of workforce	96	2.1 (1.3–3.3)	1.8 (1.1–3.0)	341	1.5 (1.2–2.0)	1.3 (1.0–1.8)	170	1.2 (0.9–1.8)	1.1 (0.8–1.6)	161	1.3 (0.9–1.9)	1.1 (0.8–1.6)

Bold indicates a p value below 0.05.

*Adjustments were made for all covariates that had a p value below 0.05 when tested using a Wald test.

**The three incontinence symptoms (urge incontinence, stress incontinence and incontinence without stress/urge) were merged into one group named incontinence.