CARDIA-PLUS: A Life Course Investigation of Biopsychosocial Pathways to Bladder Health and Lower Urinary Tract Symptoms

Project Summary/Abstract This proposal aims to examine four interrelated pathways by which psychosocial and socioeconomic stressors may lead to poorer bladder health (lower urinary tract symptoms [LUTS] and impact of symptoms) among women and men across the life course: affective, cognitive, behavioral, and physiological pathways. The proposed work leverages data and intellectual resources from two NIH initiatives, the 30+ year Coronary Artery Risk Development in Adults (CARDIA) cohort study, initiated in 1985, and the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, initiated in 2015. LUTS, including overactive bladder (OAB) and urinary incontinence (UI), affect the lives of millions of women and men. Prevention of LUTS has been hindered by a lack of epidemiologic research utilizing life course data. In addition, little research has incorporated the concept of well-being and examined factors that promote and maintain bladder health, defined by the PLUS Research Consortium as “a state of complete physical, mental, and social well-being…that permits daily activities, adapts to short-term physical and environmental stressors, and allows optimal well- being (e.g., travel, exercise, social, occupational, or other activities).” The proposed research, which extends beyond PLUS Research Consortium activities, utilizes existing CARDIA data from women and men with bladder health and LUTS and invites a subsample of CARDIA participants recruited from the Year 35 examination (ages 53-65; funded for 2021-22) to complete a new clinical examination. Analyses will strengthen the evidence base for individual pathways that may promote bladder health or LUTS. It is hypothesized that poorer bladder health/LUTS status will be observed as a result of (1) depressive symptoms (affect), (2) impaired cognition, (3) behavioral factors (poor diet, physical inactivity, smoking), and (4) physiological factors (weight gain, central adiposity, hyperglycemia, hypertension, inflammatory biomarkers, and pelvic floor muscle weakness). Analyses will also establish the evidence base for psychosocial and socioeconomic stressors. It is hypothesized that stressors (adverse childhood family environment, stressful life events, job strain, caregiving stress, chronic burden, discrimination, financial hardship, low subjective social standing) will be associated with poorer bladder health/LUTS status. Finally, analyses will examine whether individual pathways mediate proposed associations between stressors and poor bladder health/LUTS status, and whether resources for support weaken hypothesized effects. There is a clear need to develop new approaches to improve both prevention and early treatment of LUTS. Our findings may inform “upstream” approaches (e.g., amelioration of specific stressors shown to serve as risk factors, enhancement of social support and ties shown to serve as a protective factors), as well as “downstream” approaches (e.g., treatment of depressive symptoms; cognitive training exercises; weight loss; behavior modification, including pelvic floor exercises).