Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a common disease in men representing a substantial disease burden. BPH is characterised by a proliferation of both the stromal and epithelial cells of the prostate in the transitional zone surrounding the urethra.Approximately 50% of men >50 years of age have pathological evidence of BPH, increasing to >80% as men reach their eighth decade of life and older. When men reached 80 years, this number increases to 83%. As the world population aged, the incidence and prevalence of BPH have rapidly increased.

Lower urinary tract symptoms (LUTS) have been specified by the standardisation subcommittee; of the International Continence Society in February 2002: ‘LUTS are the subjective indicators of a disease or change in conditions as perceived by the patients; carer or partners and may lead him/her to seek help from health care professionals. China has a population of 1.3 billion, 25.3% aged 50 years or older and 13.26% aged more than 60 years. The ageing of the general population means that elderly people now account for a much greater proportion of patients with BPH.

Pathogenesis of Benign prostatic hyperplasia

Many modifiable risk factors play roles in the pathogenesis of BPH, including sex steroid hormones; the metabolic syndrome cardiovascular disease, obesity, diabetes, diet, physical activity and inflammation. But these risk factors cause a large variation in the prevalence of LUTS/BPH in various regions of China. Epidemiological studies comparing the prevalence of LUTS/BPH according to age; socioeconomic status and geographical region by the same research method will provide reliable estimates on the understanding of potential risk factors of LUTS/BPH and help design healthcare plans.

CHARLS is a survey of the elderly in China base on a sample of households with members who are middle-age and elderly and their spouses. Individuals aged 50 years and above were include in this study. However, data on socioeconomic and health status were collect using standardize questionnaire. The baseline survey was conduct in 2011–2012; covering 450 villages/urban communities in 28 provinces. Eligible individuals were select through four-stage, stratify cluster sampling. Probabilities proportional to size sampling was use to determine sample size. Detailed descriptions are provided in a previous publication.

A total of 5888 participants were involve in our study and the characteristics; of the baseline population give in Five hundred and ninety-nine respond positively. The mean age was 62.78 (SD: 8.56). Most of the participants were married. About a quarter of the participants did not receive formal education and half of the rest received elementary or middle school education. But the majority of the respondent participants lived in rural areas. About one-third of the respondents were classified in three levels of GDP per capita.

Increasing the prevalence of LUTS/BPH

Rapid population ageing in China is increasing the prevalence of LUTS/BPH among older people and so does the economic burden associated with it. In our study, the adjusted prevalence of LUTS/BPH among men aged beyond 50 years reached 10.66% (95% CI 9.36 to 12.12), which could influence the quality of their life and impose economic burden on both individuals and society.Therefore, a prevalence study on LUTS/BPH can help guide public health policy.

When responding positively to a question on the diagnosis of a benign prostate illness; an individual means that some symptoms of LUTS occur in him, and that he sought for medical care and was diagnose with a benign prostate illness. Benign prostate illness primarily refers to prostatitis and BPH, which shared many overlapping symptoms. Prostatitis without BPH is a diagnosis in young men; however, inflammation in the prostate is also observe in elderly men presenting with BPH.

However, in several studies, socioeconomic status play an important role in the progression of LUTS/BPH and might vary the results, particularly the prevalence and effects of LUTS/BPH. For example, some researchers found higher rates of BPH in upper income groups; but this may be due to selection bias, because of higher utilisation of medical care.

There are some limitations as well. First, CHARLS did not collect weight and height; so we could not analyse the relationship of body mass index or obesity and the prevalence of LUTS/BPH. Second, testicular androgens are require in the prostate for the development of BPH. Third, as China is a large country, and we all adhere to the principles of diagnosis from the China Urology Association, the diagnosis of LUTS/BPH may be slightly different among regions. We cannot detect these differences, since the data from CHARLS provide an established diagnosis.