Contemporary Time Trend Analysis of Caffeine and Alcohol Intake Among Patients with Urge Incontinence
Zhiyu (Jason) Qian, MD, Jane Kielhofner, BS, Dejan Filipas, MD, Alexander P. Cole, MD, Quoc-Dien Trinh, MD, MBA, Elodi Dielubanza, MD.
Brigham and Women's Hospital, Boston, MA, USA.
Background: Urge urinary incontinence (UUI) affects a substantial number of individuals in the United States. Behavioral therapies, including dietary modifications, have been recommended as first-line treatment since the 2012 guidelines from the American Urological Association/Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (AUA/SUFU). We aimed to investigate the national trend of caffeine and alcohol adherence in the past decade, around the time of the 2012 recommendations.
Methods: We utilized data from the National Health and Nutrition Examination Survey 2009-2018 and included all adult individuals who reported UUI. The primary outcomes of interest were caffeine and alcohol consumption, represented in binary as moderate consumption vs. above moderate consumption, while the primary independent variable of interest was the years of the survey, stratified into before and after 2012. Univariable and multivariable logistic regression were conducted to analyze patient-level factors associated with the level of alcohol and caffeine consumption. Adjusted difference-in-difference analyses were conducted to understand the time trend.
Results: A total of 7,043 individuals were included in the study. Among them, 71% and 83% had moderate caffeine and alcohol intake, respectively, while 29% and 17% had above moderate intake. In multivariable analysis, the year of the survey was not significantly associated with above moderate caffeine or alcohol consumption. Adjusted difference-in-differences analyses did not show a statistically different change in trend after the 2012 recommendations (p=0.79 and 0.80, respectively).
Conclusions: A sizable proportion of individuals with UUI are consuming more than moderate alcohol and caffeine. We did not observe a significant change in trend since the recommendations from the 2012 AUA/SUFU guidelines. Our study highlights the need for healthcare providers to identify effective strategies to improve UUI patient adherence to dietary modifications, which could reduce the potential adverse effects from over-medication. 
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