Rapid communication: CME article| Volume 61, ISSUE 6, P1086-1091, June 2003

Comparison of lower urinary tract symptom severity and associated bother between community-dwelling black and white men: the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men’s Health Study



      To determine the magnitude of racial disparity in lower urinary tract symptom (LUTS) severity and bother by combining two large comparable epidemiologic studies of community-dwelling white and black men, thereby avoiding many of the referral biases present in previous studies. Prior studies evaluating racial differences in benign prostatic hyperplasia have been hampered by selection bias, because nearly all have used surgical treatment as a marker for benign prostatic hyperplasia.


      Data from the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men’s Health Study were combined for a total study sample of 2480 men. We examined LUTS severity and associated bother as measured by the self-administered American Urological Association Symptom Index and Symptom Problem Index.


      Overall 34% of white men reported moderate/severe LUTS compared with 41% of black men (P <0.001). These patterns were consistent across age and persisted after adjustment for age and other sociodemographic factors. The relationship between LUTS severity and bother differed by race in that black men reported less bother for each unit increase in LUTS (P <0.001).


      In contrast to studies based on clinical populations, our community-based study demonstrated greater LUTS severity in black men compared with white men but black men reported less bother for any given level of LUTS severity. Although these findings suggest a racial disparity in benign prostatic hyperplasia, additional studies of anatomic, physiologic, and molecular factors may clarify whether these racial differences are real or due to sociocultural differences in reporting symptom morbidity.
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        • Berry S.J.
        • Coffey D.S.
        • Walsh P.C.
        • et al.
        The development of human benign prostatic hyperplasia with age.
        J Urol. 1984; 132: 474-479
        • Girman C.J.
        • Jacobsen S.J.
        • Tsukamoto T.
        • et al.
        Health-related quality of life associated with lower urinary tract symptoms in four countries.
        Urology. 1998; 51: 428-436
        • Roberts R.O.
        • Rhodes T.
        • Panser L.A.
        • et al.
        Natural history of prostatism.
        Urology. 1994; 43: 621-628
        • Sidney S.
        • Quesenberry Jr, C.P.
        • Sadler M.C.
        • et al.
        Incidence of surgically treated benign prostatic hypertrophy and of prostate cancer among blacks and whites in a prepaid health care plan.
        Am J Epidemiol. 1991; 134: 825-829
        • Xia Z.
        • Roberts R.O.
        • Schottenfeld D.
        • et al.
        Trends in prostatectomy for benign prostatic hyperplasia among black and white men in the United States.
        Urology. 1999; 53: 1154-1159
        • Jacobsen S.J.
        • Guess H.A.
        • Panser L.A.
        • et al.
        A population-based study of health care-seeking behavior for treatment of urinary symptoms. The Olmsted County Study of Urinary Symptoms and Health Status Among Men.
        Arch Fam Med. 1993; 2: 729-735
        • Oesterling J.E.
        • Jacobsen S.J.
        • Chute C.G.
        • et al.
        Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges.
        JAMA. 1993; 270: 860-864
        • Wei J.T.
        • Schottenfeld D.
        • Cooper K.
        • et al.
        The natural history of lower urinary tract symptoms in black American men.
        J Urol. 2001; 165: 1521-1525
      1. Girman CJ: Natural history and epidemiology of benign prostatic hyperplasia: relationship among urologic measures. Urology 51 (4A suppl): 8–12, 1998

        • Cooney K.A.
        • Strawderman M.S.
        • Wojno K.J.
        • et al.
        Age-specific distribution of serum prostate-specific antigen in a community-based study of African-American men.
        Urology. 2001; 57: 91-96
        • Barry M.J.
        • Fowler Jr, F.J.
        • O’Leary M.P.
        • et al.
        • Measurement Committee of the American Urological Association
        The American Urological Association Symptom Index for benign prostatic hyperplasia.
        J Urol. 1992; 148: 1549-1564
      2. Moon TD, Brannan W, Stone NN, et al:Effect of age, educational status, ethnicity and geographic location on prostate symptom scores. J Urol 152 (5 Pt 1): 1498–1500, 1994

        • Platz E.A.
        • Kawachi I.
        • Rimm E.B.
        • et al.
        Race, ethnicity and benign prostatic hyperplasia in the Health Professionals Follow-Up Study.
        J Urol. 2000; 163: 490-495