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ORIGINAL ARTICLE
Year : 2006  |  Volume : 22  |  Issue : 1  |  Page : 27-31
 

Prevalence and determinants of lower urinary tract symptoms among expatriate male workers in Qatar


1 Division of Urology, Hamad Medical Corporation, Doha, Qatar
2 Department of Urology, Tampere University Hospitall, Tampere, Finland
3 Tampere School of Public Health, University of Tampere, Tampere, Finland

Correspondence Address:
V Krishna Prasad
Division of Urology, Hamad Medical Corporation, P.O. Box 3050, Doha
Qatar
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.24649

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   Abstract 

Objectives:0 To estimate the prevalence and determinants of lower urinary tract symptoms (LUTS), in male expatriate workers in Qatar and to assess the impact of LUTS on the quality of life (QoL). MATERIALS AND Methods:0 A number of 570 male expatriate workers aged 20 to 63 years, mostly of Indian origin (87%), were interviewed orally by trained interviewers. The International Prostate Symptoms Score (IPSS) questionnaire was used for the assessment of LUTS and QoL. Results:0 The mean age of the study population was 40 years (SD 9.2). Overall, 52% of the study population reported at least one urinary symptom. The most frequent symptom was nocturia (31%,) and the most infrequent straining (11%). Twenty-one percent of the men had moderate or severe LUTS (IPSS score > 7). The prevalence of storage symptoms was significantly higher than that of voiding symptoms in all age groups. LUTS was not associated with nationality, smoking, or body mass index. Men with diabetes (OR= 1.4, 95% CI 0.8-2.3) or hypertension (OR= 1.4, 95% CI 0.8-2.3) were slightly at higher risk of LUTS, than those without diabetes or hypertension. Men with moderate (OR = 4.1, 95% CI 2.3-7.4) or severe LUTS (OR = 12.8, 95% CI 4.6-36.0), had poorer quality of life, compared to those with no or mild symptoms. Conclusions:0 Lower urinary tract symptoms, especially storage symptoms, are common in young male expatriates in Qatar. LUTS has a strong negative impact on the quality of life.


Keywords: LUTS; Prevalence; expatriate male workers


How to cite this article:
Prasad V K, Hakkinen J T, Shiri R A, Al Ansari A. Prevalence and determinants of lower urinary tract symptoms among expatriate male workers in Qatar. Indian J Urol 2006;22:27-31

How to cite this URL:
Prasad V K, Hakkinen J T, Shiri R A, Al Ansari A. Prevalence and determinants of lower urinary tract symptoms among expatriate male workers in Qatar. Indian J Urol [serial online] 2006 [cited 2019 Jun 24];22:27-31. Available from: http://www.indianjurol.com/text.asp?2006/22/1/27/24649


Lower urinary tract symptoms (LUTS) are common among men worldwide.[1],[2],[3] They are associated with age, comorbidities and lifestyle factors and have a profound impact on quality of life (QoL).[4],[5] Mild symptoms are most usual and marked fluctuation in occurrence of symptoms, as well as great variation in the prevalence of different types of LUTS has been reported.[6],[7] Although prevalence studies of LUTS have been performed in numerous European, American and Asian countries, they are still few within Indian Subcontinent population. No reports are published mostly on the expatriate population of Indian origin in Gulf countries.

Qatar is a small Middle Eastern country with a rapidly developing economy, causing an influx of expatriate labour force. The native population constitute only one-third of the total population of 863,051 (2005 July). Because of a huge number of expatriate workers in the country, 73% of the population falls within the 15 to 64 age group, with the number of males being almost double to that of the females.

Expatriate workers form a special group of people in many countries. Especially in Middle Eastern fast-growing countries, workers from the countries of the Indian Subcontinent are numerous and an important group in society. Expatriate workers tend to be young males in the lower socio-economic strata, performing manual labour jobs on contract. In Qatar, the Indian expatriate society is more versatile. Indians are working on different levels of Qatari society and in many families, already the second or third generation is living in the country.

To our knowledge, there is no information on the prevalence and determinants of LUTS among expatriate workers in Gulf countries. The aims of this study were to determine the prevalence and determinants of LUTS among male expatriates in Qatar and to investigate the impact of LUTS on the quality of life.


   Materials and methods Top


Annual open health screenings for South Asian expatriate workers has been organised in Qatar for the last four years by voluntary organisations. People of low income group (salary less than US $ 300 per month) were recruited with mail and public announcements regarding the survey. The group of 570 consecutive men participating in this free-of-charge health screening were interviewed for this study.

During the health examination, history of diabetes, hypertension and smoking was taken. Physical examination with assessment of weight, height and blood pressure was performed and a laboratory test for blood sugar level measurement was taken. Patients who were already known with diabetes mellitus and hypertension and those who had persistent blood pressure values above normal (Systolic 140 and or diastolic 90 mm of Hg) and fasting blood sugar values (more than 110 mg%), were categorised as having the appropriate co-morbidity. Patients were also categorised as either presently smokers or non-smokers. The men were interviewed by specially trained interviewers using IPSS as a tool to assess urological symptoms. In this study LUTS was assessed by IPSS questionnaire,[8] because it is a reliable and widely used instrument since 1991,[9] and it offers best comparability of the findings. The QoL question of IPSS was used to assess the bothersomeness of the symptoms for all participants. Oral interview was chosen, because many of the study population were illiterate. A validated native language version of IPSS was also not available at the time of the study. Interviewers were trained by an urologist (K.P.V.), to understand and express the IPSS questions correctly. According to patients, choice English or his native language was used for the interview.

Symptomatic men were classified into three categories of symptom severity: mild, moderate and severe, as proposed by Homma et al ,[10] with the exception that asymptomatic men (score 0) formed a fourth individual group. For the statistical analysis of the LUTS determinants, IPSS was dichotomised into no or mild, versus moderate or severe symptoms. However, for the assessment of the impact of LUTS on QoL, IPSS was categorized into three groups: no or mild (score 0-7), moderate (score 8-19), or severe (score 20-35). The QoL question was dichotomised into two groups: delighted, pleased, mostly satisfied, or mixed versus mostly dissatisfied, unhappy or terrible. For further characterization of the symptoms, the International Continence Society (ICS) standardised terminology was used and intermittency, weak stream and straining were considered as voiding symptoms and frequency, urgency and nocturia as storing symptoms.[11]

The statistical significance (two-tailed P value 0.05) was assessed by a chi-square test. Association between background characteristics and LUTS and between LUTS and QoL was assessed by multivariate logistic regression model, using prevalence odds ratio (OR) with 95 percent confidence intervals (CI). Age, nationality, diabetes, hypertension, smoking and obesity (BMI 30) were included in the multivariate models as covariates. The final models were limited to age and the variables associated with LUTS or QoL at a P value less than 0.1 in the age-adjusted analyses.


   Results Top


Information on urinary symptoms sufficient for completion of IPPS score, was achieved from 545 (96%) men. Those with incomplete IPSS data were excluded from the analysis. The mean age of the men in the final study population was 40.2 years (SD 9.2, range 20-63). Prevalence of other sociodemographic and medical factors of the group are seen in [Table - 1].

Prevalence

Overall, 52% of the study population reported at least one urinary symptom and 9% only one symptom with lowest score. Half of the men were free of symptoms, 29% had mild symptoms and 21% had moderate or severe LUTS. Mean age of the symptomatic men was 41.2 years (SD 9.4) and that of the non-symptomatic 39.1 years (SD 8.9). Nocturia was the most frequent symptom with the overall prevalence of 31% and straining (11%) the least. Other symptoms occurred as follows: frequency 27%, incomplete emptying 23%, urgency 20%, intermittency 17% and weak stream 16% [Table - 2].

The prevalence of moderate or severe storage symptoms was significantly higher than voiding symptoms (22% vs. 14% respectively, P <0.001). The mean IPSS score increased slightly by age, while QoL score remained the same in all age groups [Figure - 1].

Moderate or severe symptoms were reported by 16% of the men aged 20 to 29 years and 23%, 20% and 24% of the men aged 30-39, 40-49 and 50-63 years old, respectively. The proportion of the men with severe symptoms varied from 2.5% to 5.6% and that of the moderately symptomatic group from 13.6% to 20.0% [Figure - 2].

Determinants

Age was associated with LUTS in the univariate analysis. The association however, was not statistically significant after adjustment for the effects of other covariates [Table - 3]. LUTS was not associated with nationality, smoking and body mass index. Men with diabetes or hypertension were slightly at higher risk of LUTS, compared with those free from diabetes or hypertension, but the associations were not statistically significant.

A clear association was found between LUTS and QoL. Men with moderate or severe urinary symptoms had poorer QoL, than men with no or mild LUTS [Table - 4].

Comments

Our findings suggest that lower urinary tract symptoms, especially storage symptoms are common among expatriate men in Qatar and that LUTS has strong negative impact on the quality of life.

We studied an expatriate worker population of 570 men in Qatar with IPSS questionnaire in an open health survey. Face-to-face interview was chosen, because no validated translation of IPSS questionnaire was available in the native languages of the study population mostly from Kerala, India and the literacy rate among low-schooling workers was also low. Oral interview probably led to minor bias that can be seen in [Table - 2], where in all symptoms except nocturia, the highest symptom level (score 5) was more prevalent than lower levels of symptoms (scores 1 to 4). This was probably due to the person's implicit need to present their symptoms severe enough to convince the interviewer. However, moderate and severe symptoms were combined into a single group for the analyses, which may have reduced misclassification.

Another limitation of the study is the fact, that the study population comprised of the men who attended the voluntary screening program and were probably not representative of the expatriate population. Men seeking medical attention in a free screening program may be more concerned about their health, than the general population. On the other hand, men with co-morbidity or low QoL may have no interest in participating in a screening program because of other substantial health and social problems.

The overall prevalence of LUTS in the current study was 52%, which is low compared to previous studies.[7],[12],[13] Variation in LUTS prevalence may be related to younger age of our study population. Male expatriate workers are more likely to be healthier than their native general population. Compared to results in mother country India, men in their fifth or sixth decade in Qatar seemed to be a little less symptomatic, but reported slightly greater impact on their QoL. Homma and colleagues presented an epidemiological survey of LUTS in Indian (Nadiad) and Pakistani (Karachi) male population. The percentage of men who had moderate or severe symptoms (IPSS 8) varied from 16 to 51% in different age groups. Prevalence of moderate or severe LUTS was 25% among men aged 40-49, 37% among those aged 50-59 in India and 15% and 34 % respectively in Pakistan, which are higher than the prevalence in the present study. These figures are also slightly higher than those reported in Europe and America, suggesting that LUTS are common in Indian subcontinent populations. A recent findings of a population-based study by Ganpule and associates from Gujarat revealed even higher prevalence especially severe LUTS.[14]

Prevalence of LUTS is seldom reported in men younger than 40 years. Prevalence of moderate or severe LUTS in men at their third and fourth decade in our population was more than twice as high, as in an Austrian study by Haidinger et al .[15] The same difference was also seen in men aged 40 to 49 years, while in men over 50 years, the prevalence of moderate to severe LUTS in the Austrian population exceeded our prevalence. Face-to-face interview was used in the both studies. However, the population of the Austrian study was random.

A clear age increase in the prevalence of LUTS is seen in most previous studies in middle aged to elderly men.[3],[12],[15],[16],[17],[18] Homma et al . found a clear association between age and LUTS both in Indian and Pakistani men, but not in the Gujarat study. In our study, mean IPSS, as well as the prevalence of moderate to severe LUTS increased by age, but after controlling the effects of other confounder's, age was not significantly associated with LUTS. Although LUTS increases with age, it is not an inevitable consequence of aging. Some age-related diseases are also common in men with LUTS, leading to increase in the prevalence of urinary symptoms with age. The increment is seen especially in older cohorts, which were not represented in the present study.

Other risk factors commonly associated with an increased risk of LUTS are obesity, smoking, alcohol consumption and elevated blood pressure.[4],[19],[20] In our study, a 40% increase in the risk of moderate to severe LUTS was found in men with history of diabetes or hypertension.

LUTS has strong negative impact on the quality of life. In the present study, only one QoL question of IPSS was used, which is not a very thorough measure. An association between increasing symptom severity and impairment in QoL was found in this study, though we require generic QoL questionnaire to be used in future studies.

Our high prevalence of LUTS in younger men may indicate that risk factors other than benign prostatic enlargement are involved in the etiology of LUTS. One possible explanation is prostatitis, that typically causes irritation of bladder neck and leads to storing symptoms. In our population, nocturia and frequency were the most usual symptoms and storing symptoms were more prevalent than voiding symptoms. This is indirectly supported by the findings of small prostates, but high symptoms score in the Gujarat study.


   Conclusion Top


Our findings suggest that one out of five middle-aged expatriate men in Qatar suffers from moderate to severe LUTS. Storage symptoms are more common than voiding symptoms. Moderate or severe lower urinary tract symptoms have profound negative impact on quality of life.

 
   References Top

1.Homma Y, Kawabe K, Tsukamoto T, Yamanaka H, Okada K, Okajima E, et al . Epidemiologic survey of lower urinary tract symptoms in Asia and Australia using the international prostate symptom score. Int J Urol 1997;4:40.  Back to cited text no. 1    
2.Platz EA, Smit E, Curhan GC, Nyberg LM, Giovannucci E. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and non cancer prostate surgery in U.S. men. Urology 2002;59:877-83.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, et al . Lower urinary tract symptoms and male sexual dysfunction: The multinational survey of the aging male (MSAM-7). Eur Urol 2003;44:637-49.  Back to cited text no. 3    
4.Haidinger G, Temml C, Schatzl G, Brossner C, Roehlich M, Schmidbauer CP, et al . Risk factors for lower urinary tract symptoms in elderly men. For the Prostate Study Group of the Austrian Society of Urology. Eur Urol 2000;37:413-20.  Back to cited text no. 4    
5.Koskimδki J, Hakama M, Huhtala H, Tammela TL, et al . Is reduced quality of life in men with lower urinary tract symptoms due to concomitant diseases? Eur Urol 2001;40:661-5.  Back to cited text no. 5    
6.Masumori N, Tsukamoto T, Rhodes T, Girman CJ. Natural history of lower urinary tract symptoms in men-result of a longitudinal community-based study in Japan. Urology 2003;61:956-60.  Back to cited text no. 6    
7.Hδkkinen J, Koskimδki J, Huhtala H, Tammela TL, Hakama M, Auvinen A. Changes in prevalence of urinary symptoms in Finnish men - a population-based 5-year follow-up study. Scand J Urol Nephrol 2004;38:378-84.  Back to cited text no. 7    
8.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;148:1549-57.  Back to cited text no. 8    
9.Mebust W, Roizo R, Schr φder FH, et al . Correlation between pathology, clinical symptoms and the course of the disease. In : The International Consultation on Benign Prostatic Hyperplasia (BPH). Edited by ATK Cockett, Y Aso, C Chatelain et al . SCI: 1991. p. 53-62.  Back to cited text no. 9    
10.Homma Y, Kawabe K, Tsukamoto T, et al . Estimate criteria for diagnosis and severity in benign prostatic hyperplasia. Int J Urol 1996;3:261.  Back to cited text no. 10    
11.Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al . The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology 2003;61:37-49.  Back to cited text no. 11    
12.Andersson SO, Rashidkhani B, Karlberg L, Wolk A, Johansson JE. Prevalence of lower urinary tract symptoms in men aged 45-79 years: A population-based study of 40 000 Swedish men. BJU Int 2004;94:327-31.   Back to cited text no. 12    
13.Chicharro-Molero JA, Burgos-Rodriguez R, Sanchez-Cruz JJ, del Rosal-Samaniego JM, Rodero-Carcia P, Rodriguez-Vallejo JM.Prevalence of benign prostatic hyperplasia in Spanish men 40 years old or older. J Urol 1998;159:878-82.  Back to cited text no. 13    
14.Ganpule AP, Desai MR, Desai MM, Wani KD, Bapat SD. Natural history of lower urinary tract symptoms: Preliminary report from a community-based Indian study. BJU Int 2004;94:332-4.  Back to cited text no. 14    
15.Haidinger G, Madersbacher S, Waldhoer T, Lunglmayr G, Vutuc C. The prevalence of lower urinary tract symptoms in Austrian males and associations with sociodemographic variables. Eur J Epidemiol 1999;15:717-22.  Back to cited text no. 15    
16.Sagnier PP, Girman CJ, Garraway M, Kumamoto Y, Lieber MM, Richard F, et al . International comparison of the community prevalence of symptoms of prostatism in four countries. Eur Urol 1996;29:15-20.  Back to cited text no. 16    
17.Logie J, Clifford GM, Farmer RD. Incidence, prevalence and management of lower urinary tract symptoms in men in the UK. BJU Int 2005;95:557.  Back to cited text no. 17    
18.Verhamme KM, Dieleman JP, Bleumink GS, van der Lei J, Sturkenboom MC, Artibani W, et al . Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care-the Triumph project. Eur Urol 2002;42:323-8.  Back to cited text no. 18    
19.Temml C, Brossner C, Schatzl G, Ponholzer A, Knoepp L, Madersbacher S, et al . The natural history of lower urinary tract symptoms over five years. Eur Urol 2003;43:374-80.  Back to cited text no. 19    
20.Rohrmann S, Smit E, Giovannucci E, Platz EA. Associations of obesity with lower urinary tract symptoms and noncancer prostate surgery in the Third National Health and Nutrition Examination Survey. Am J Epidemiol 2004;159:390-7.  Back to cited text no. 20    


    Figures

  [Figure - 1], [Figure - 2]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]

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