Urinary Incontinence and Risk of All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies.
Yanyan Zhou, Liwei Wang, Weijia Sun et al.
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In 30 seconds
This systematic review and meta-analysis pooled observational cohort studies comparing all-cause mortality in adults with and without urinary incontinence (UI). Across 17 studies involving 82,739 participants, UI was associated with higher mortality (HR = 1.20, 95% CI: 1.07-1.34). Heterogeneity was substantial (I² = 80.4%), and the certainty of evidence was rated very low. Associations appeared stronger with greater UI severity and in studies with shorter follow-up, where reverse causation is possible. The findings indicate an association, not evidence that UI directly causes mortality.
Key findings
- UI was associated with higher all-cause mortality: HR = 1.20, 95% CI: 1.07-1.34.
- Between-study heterogeneity was substantial (I² = 80.4%), and evidence certainty was rated very low.
- Across increasing UI severity categories, reported HRs were 1.20, 1.27, and 1.67.
- For studies with follow-up < 5 years, the association was HR = 1.89, 95% CI: 1.20-2.98.
Why it matters
The pooled association suggests that UI may help identify people with greater overall health vulnerability. However, substantial heterogeneity, very low certainty, and possible residual confounding or reverse causation mean the result should not be interpreted as a direct effect of UI on survival. The review highlights the need to consider UI in the broader context of frailty and multimorbidity.
What to keep in mind
The evidence comes from observational studies, with substantial heterogeneity and very low certainty; residual confounding and reverse causation may explain some of the association.