Epidemiological Investigation Of Pelvic Organ Prolapse In Chinese Adult Women

BackgroundPelvic organ prolapse(POP)is defined as the herniation of the pelvic organs to or beyond the vaginal walls,including anterior compartment prolapse,posterior compartment prolapse,and enterocele.POP is strongly associated with advanced age;therefore,with the aging of the population,the number of women with POP is expected to increase by 46%by 2050 in the U.S.POP is a common condition with the prevalence is increasing in the past decades.The prevalence of POP reported in the literature varies greatly.And the prevalence of POP varies among different studies depending on the definition of POP and research methodology.However,epidemiological studies of POP are few in China,especially diagnosed in a physical examination.And no prospective cohort study has been conducted nationwide.To address the gap in knowledge regarding POP among Chinese women,we investigated the prevalence of symptomatic POP using validated questionnaires combined with physical examinations of women recruited throughout China.We also explored factors that are associated with symptomatic POP.Objective1.To estimate the prevalence and incidence of symptomatic POP of adult women in different areas with different ages in China.2.To investigate the potential risk factors of symptomatic POP in China.3.To evaluate the bother sylptomatic POP impose on adult women in China.MethodsThis is the analysis of a population-based cross-sectional survey on symptomatic POP conducted in nationwide of China.The baseline survey was conducted in from September 2014 to December 2015.Participants were 20 years or older at the time of recruitment.We recruited at least 54,000 adult women,aged 20yr and older,who have lived in the current residence more than 5 years from seven administrative regions of the mainland of China(Northeast,North China,East,South-central,Northwest and Southwest),using a multi-center,stratified random sampling method,which was stratified according to the urbanization and age distribution.And the follow-up was conducted 4 years later from September 2018 to December 2018 The questionnaire included three parts.The first part is the demographic data.The second part consisted of 8 symptoms.If a subject had a positive response for any of the 8 symptoms,she underwent a physical examination in the dorsal lithotomy position.The third part is the PFIQ-7(Pelvic Floor Impact Questionnaire)questionnaire.If a women was diagnosed stage ? or higher prolapse,she has to completed the PFIQ-7 questionnaire.Descriptive statistics,x2 tests,and multivariate logistic regressions were used for data analysis.ResultsA total of 29,767 respondents were included.The prevalence of symptomatic pelvic organ prolapse in China is 8.94%.And the prevalence of stage ? prolapse,stage ? prolapse,and stage ? prolapse is 6.98%,1.66%,0.3%,respectively.The prevalence of stage ? prolapse in 20-29 years is 1.29%and gradually increased to 12.77%over 70 years.The prevalence of stage ? and stage IV gradually increased from 0.06%,0%to 4.99%,1.84%,respectively.Urban area in China had a higher prevalence than rural area(7.09%vs6.88%))in stage ? prolapse.But the prevalence of stage ? prolapse,stage ? prolapse is urban area than in rural area(2.04%vsl.05%;0.47%vs0.12%).In the 4 years follow-up study,the prevalence of symptomatic POP is lower than in the base study.The incidence of symptomatic pelvic organ prolapse in China is 4.51%.The incidence of stage ? and IV prolapse is is 0.95%.The incidence of symptomatic pelvic organ prolapse increased with age in adult women in China.The incidence of symptomatic POP in 50-59 years(6.32%)is significantly higher than in 40-49 years(3.68%).The incidence of symptomatic pelvic organ prolapse in rural China(4.97%)is higher than in urban China(3.99%).Multiple factors increased the odds of symptomatic pelvic organ prolapse.Older age,multiparity,obese and assisted vaginal deliveiy were strong predictors.Women aged over 70 years(AOR(adjusted odds ration)3.03,95%Cl 2.07-4.53)were more likely to have symptomatic POP than women aged 20-29 years.Compared with women of normal weight,overweight and obese women were more likely to have symptomatic POP(AOR=1.41,95%Cl 1.23-1.61;AOR=1.67,95%Cl 1.34-2.07).Symptomatic POP was positively associated with assisted vaginal delivery(AOR 3.42,95%Cl 2.08-5.42).The bothersome of symptomatic pelvic organ prolapse increased with the stage prolapse.And there is a difference in the bothersome in different age with the same degree prolapse.Conclusion1.The prevalence of symptomatic pelvic organ prolapse in China is 8.94%.The prevalence of stage ? prolapse is 6.98%,stage ? prolapse is 1.66%,stage ?prolapse is 0.3%.The prevalence of symptomatic pelvic organ prolapse increased with age in adult women in China.2.The incidence of symptomatic pelvic organ prolapse in China is 4.51%.The incidence of stage ? and stage ? prolapse is 0.95%.The incidence of symptomatic organ prolapse increased with age in adult women in China.3.The prevalence of symptomatic pelvic organ prolapse in rural China is lower than in urban China.But the incidence of symptomatic pelvic organ prolapse in rural China is higher than in urban China.3.Multiple factors influenced symptomatic pelvic organ prolapse.Older age,multiparity obese and assisted vaginal delivery were strong predictors.4.The bothersome of symptomatic pelvic organ prolapse increased with the stage prolapse.