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Volume 23, Issue 6 (November 2021) 23, 633–639; 10.4103/aja.aja_12_21

Depressive males have higher odds of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a retrospective cohort study based on propensity score matching

Yang Xiong1,2, Yang-Chang Zhang3, Tao Jin4, Feng Qin1, Jiu-Hong Yuan1,2

1 Andrology Laboratory, West China Hospital, Sichuan University, Chengdu 610041, China
2 Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
3 Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
4 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China

Correspondence: Dr. JH Yuan (jiuhongyuan2107@163.com)

Date of Submission 17-Oct-2020 Date of Acceptance 11-Jan-2021 Date of Web Publication 02-Apr-2021


Lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH) and depression are both increasing in Chinese aging males. However, the relationship still remains unknown. To explore their relationship, a retrospective cohort study based on propensity score matching (PSM) was conducted by analyzing the China Health and Retirement Longitudinal Study dataset. After data cleaning, a total of 5125 participants were enrolled and subjected to PSM; 1351 pairs were matched and followed for 2 years. Further logistic regression and restricted cubic spline (RCS) were performed to evaluate, model and visualize the relationship between depression and LUTS/BPH. Moreover, subgroup analyses and sensitivity analyses were adopted to verify the robustness of the conclusions. Before PSM, depressive patients showed higher odds of LUTS/BPH in all three models adjusting for different covariates (P < 0.001). After PSM, univariate logistic regression revealed that depressive patients had higher risks for LUTS/BPH than participants in the control group (odds ratio [OR] = 2.10, P < 0.001). The RCS results indicated a nonlinear (P < 0.05) and inverted U-shaped relationship between depression and LUTS/BPH. In the subgroup analyses, no increased risks were found among participants who were not married or cohabitating, received an education, had an abnormal body mass index (<18.5 kg m−2 and ≥28 kg m−2), slept more than 6 h, did not smoke, and drank less than once a month (all P > 0.05). The results of sensitivity analyses indicated identical increased risks of LUTS/BPH in all four models (all P < 0.001). In conclusion, depression enhances the risks of LUTS/BPH in aging males.

Keywords: aging males; benign prostatic hyperplasia; depression; lower urinary tract symptoms; propensity score matching

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