Rural vs. urban disparities in association with lower urinary tract symptoms and benign prostatic hyperplasia in ageing men, NHANES 2001–2008

Summary Objective The objective of this study was to investigate rural/urban and socio‐demographic disparities in lower urinary tract symptoms and benign prostatic hyperplasia ( LUTS / BPH ) in a nationally representative population of men. Methods Data on men age ≥40 years (N = 4,492) in the 2001‐2008 National Health and Nutrition Examination Surveys were analysed. Self‐report of physician‐diagnosed enlarged prostate and/or BPH medication use defined recognised LUTS / BPH . Urinary symptoms without BPH diagnosis/medications defined unrecognised LUTS / BPH . Rural–Urban Commuting Area Codes assessed urbanisation. Unadjusted and multivariable associations (odds ratios ( OR )) between LUTS / BPH and covariates were calculated using logistic regression. Results Recognised and unrecognised LUTS / BPH weighted‐prevalence estimates were 16.5% and 9.6%. There were no significant associations between LUTS / BPH and rural/urban status. Significant predisposing factors for increased adjusted odds of recognised and unrecognised LUTS / BPH included age, hypertension ( OR =1.4;1.4), analgesic use ( OR =1.4;1.4) and PSA level >4 ng/ mL ( OR =2.3;1.9) when adjusted for rural/urban status, race, education, income, alcohol, health insurance, health care and proton pump inhibitor ( PPI ) use (all p ≤ 0.1). Restricting to urban men only (N = 3,371), healthcare use (≥4visits/year) and PPI 's increased adjusted odds of recognised LUTS / BPH ( OR =2.0;1.6); no health insurance and <high school education decreased odds ( OR =0.5;0.6) after adjusting for variables listed above, antidepressant and calcium channel blocker use (p ≤ 0.1). Also among urban men, adjusted odds of unrecognised LUTS / BPH increased for blacks ( OR =1.9), Hispanic/Other ( OR =1.9) and income<$34,999 ( OR =1.6). Among rural men only (N = 1,121), adjusted odds of recognised and unrecognised LUTS / BPH increased for age, hypertension ( OR =1.9;1.7) and analgesic use ( OR =2.0;1.5) when adjusting for race, CRP , antidepressant and dyslipidaemic use (p ≤ 0.1). Conclusion Rural/urban status was not associated with significantly increased adjusted odds of either recognised or unrecognised LUTS / BPH .