Population-based survey for benign prostatic hyperplasia focusing on self-perception period and air pollution

다국어 초록 (Multilingual Abstract)

Objectives: This study aimed to investigate the association between the self-perception period (S-PP) of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and the International Prostate Symptom Score (IPSS).
Methods: This study used data from two large-population surveys: a community-based survey and a university hospital outpatient-based interview survey. Both surveys were conducted in male subjects aged 40 years and older who gave consent to the questionnaire survey and voluntarily expressed their intention to participate. Propensity score matching (PSM) was used to reduce selection bias from the sampled population and to organize the population in both surveys into randomized groups. Excluding those with missing values, 483 subjects were assigned to each group by PSM.
Results: The S-PP of LUTS became significantly longer as the severity of BPH increased. The S-PP was shown to be 4.15 years in the mild group, 4.36 years in the moderate group, and 6.23 years in the severe group, and this was a statistically significant difference. The correlation between S-PP of LUTS and IPSS was measured by partial correlation while controlling for age (correlation coefficient = 0.20, P <0.001). A multiple regression analysis performed while controlling for age found that a one-year increase in the S-PP of LUTS increased the IPSS by 0.322 points (P <0.001), which was statistically significant.
Discussion: This study clarifies the association between the S-PP of LUTS and IPSS in a large-scale population. These findings suggest that from the perspective of public health, S-PP is an important risk factor for BPH progression, along with age.

다국어 초록 (Multilingual Abstract)

Objectives: Potential explanations for large geographic differences in benign prostatic hyperplasia (BPH) prevalence may be due to genetic, lifestyle, or environmental factors. However, little is known about the role of environmental factors in benign tumors associated with BPH. Therefore, we focused on air pollution as an environmental factor affecting BPH and attempted to explain the regional differences in BPH prevalence in relation to air pollution.
Methods: The present study used data from two large population surveys––communityand university hospital outpatients-based surveys––that covered 9 major areas of South Korea, with a total of 56 institutions and 1,734 participants in those areas. This study attempted to determine the mean emissions of air pollutants using the National Air Pollutants Emission (NAPE) 2010 report and the telemetering system established by the National Institute of Environmental Research within the Korean Ministry of Environment.
Results: The mean International Prostate Symptom Score was 16.16 ± 7.98, 17.58 ± 7.28, and 18.58 ± 8.50 in the low-, medium- and high-level area groups, respectively, according to the emission of air pollutants per capita on the basis of the NAPE report, and the differences between the groups were statistically significant (P <0.01). In order to examine the risk for BPH due to air pollution substances, we analyzed logistic regression models for each substance. The NAPE data showed that the risk of BPH increased as the overall concentration of air pollutants increased, and in particular, nitrogen oxides (NOx) and sulfur oxides (SOx) were significantly associated with a dose-dependent increased risk of BPH (NOx: odds ratio [OR], 1.729; 95% confidence interval [CI], 1.252–2.388 for the high-level areas; SOx: OR, 1.356; 95% CI, 1.071–1.716 and 2.022, 1.421-2.877 for the medium-level and high-level area groups, respectively).
Discussion: Air pollutants (i.e., NOx, SOx, carbon monoxide, total suspended particles, particle matter less than 10 μm in diameter, volatile organic compounds, and ammonia) as environmental factors increase estrogen levels that can affect prostate development and lead to permanent developmental effects such as malignant neoplasm of the urinary tract, which in turn will affect the development of benign tumors such as BPH. Accordingly, the differences in such associations with air pollutants emission could explain variations in BPH prevalence among geographic areas.
Conclusion: This study is the first in the world to demonstrate the association between air pollution and BPH. These findings demonstrate increased risks of BPH among men exposed to higher concentrations of air pollution.

목차 (Table of Contents)

• Abstract ······························································································ i
• List of tables ·················· ································································· v
• List of figures ·················· ······························································· vi
• Chapter 1. Introduction ································································· 1
• Chapter 2. Association between the Self-Perception Period of Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia and the International Prostate Symptom Score ··············································································· 6
• Chapter 3. Association between Air Pollution and Benign Prostatic Hyperplasia···································································· 29
• Chapter 4. Conclusions ······························································· 52
• Introduction in Korean ·································································· 54