Sociodemographic factors and uncomplicated cystitis in women aged 15–50 years: a nationwide Swedish cohort registry study (1997–2018)

Abstract

Background Symptoms suggestive of uncomplicated cystitis constitutes one of the most common reasons to seek health care in otherwise healthy women. Previous studies regarding the relationship between sociodemographic factors and uncomplicated cystitis are limited, mainly because of the lack of nationwide population-based data from primary healthcare settings, where most uncomplicated cystitis are diagnosed. Methods A Swedish nation-wide open cohort study consisting of 2 044 065 females who were 15–50 years of age during the study period (1997–2018) was conducted. The outcome was first event uncomplicated cystitis diagnosed in primary health care rather than an assessment of the "true" incidence, which is not feasible in nationwide datasets. Cox regression models were used in the statistical analyses. Findings The study identified 546 076 first events of uncomplicated cystitis (26•7% of the study population), corresponding to an incidence rate per 100 person-years of 2•91 (95% CI 2•90–2•91). In fully adjusted models, rural living was associated with lower risks of uncomplicated cystitis (Hazard ratio, HR, 0•67; 95% CI, 0•66–0•68) compared to urban living, while both Middle Eastern/North African (HR, 1•15; 95% CI, 1•14–1•16) and Latin American/Caribbean (HR, 1•24; 95% CI, 1•22–1•27) women had higher risks compared to Swedish women. Low education and low income were also associated with higher risks compared to high education and high income. Interpretation This study presents novel risk factors associated with uncomplicated cystitis in women. The findings may help health care workers in the treatment of women with symptoms of uncomplicated cystitis. Funding The Primary Healthcare Management and ALF funding (Region Skåne, Sweden) and the Swedish Research Council.

The Effect of Sociodemographic Factors, Parity and Cervical Cancer on Antibiotic Treatment for Uncomplicated Cystitis in Women: A Nationwide Cohort Study

“…Therefore, certain groups of immigrant women might not redeem antibiotics prescribed for their infection (lack of adherence) while risking mistreating their infection with a potentially inadequate antibiotic they have at home. Moreover, we have recently observed that sociodemographic differences in uncomplicated cystitis seem to exist in largely the same population of women in Sweden [ 9 ]. However, the findings of that study [ 9 ], albeit not entirely comparable, were not consistent with the present study, and they indicate that mechanisms involved in uncertainty of diagnosis and variations in patients’ expectation could be at play.…”

“…Moreover, we have recently observed that sociodemographic differences in uncomplicated cystitis seem to exist in largely the same population of women in Sweden [ 9 ]. However, the findings of that study [ 9 ], albeit not entirely comparable, were not consistent with the present study, and they indicate that mechanisms involved in uncertainty of diagnosis and variations in patients’ expectation could be at play. For example, both women from MENA and women with higher parity had lower odds of antibiotic treatment for uncomplicated cystitis in the present study but had higher risks of uncomplicated cystitis in a recent study by our group (compared to Swedish-born women and women with no children, respectively), while the opposite was found in women from Asia (excluding the Middle East) and Oceania, who had an increased risk of uncomplicated cystitis.…”

“…Even though uncomplicated cystitis, in many cases, can be regarded as self-limited without any evident risk of pyelonephritis [ 10 , 11 ], pyelonephritis could be occurring more frequent in patients treated with analgesics [ 12 ]. In addition, some groups seem to be at higher risk of both uncomplicated cystitis [ 9 ] and pyelonephritis [ 32 ], such as MENA or multipara women, who also seem to receive less antibiotic treatment for the former condition. On the other hand, the risks of uncomplicated cystitis [ 9 ] and pyelonephritis [ 32 ] seem to be lower in women living outside large cities, who also receive less antibiotics for the former.…”

“…Urinary tract infection (UTI) is a leading cause of antibiotic use [ 5 ]. Uncomplicated cystitis, also known as uncomplicated lower UTI, is one of the most common infections in otherwise healthy women [ 6 , 7 , 8 , 9 ]. These infections are generally caused by the overgrowth of bacteria in the urinary tract, mainly Escherichia coli followed by Staphylococcus saprophyticus, and are thus often effectively treated with a short duration of antibiotic therapy [ 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…Sweden’s tax-financed healthcare services have the goal to provide healthcare on equal terms for the entire population, irrespective of sociodemographic factors or previous ailments. However, we have recently found that sociodemographic factors are associated with uncomplicated cystitis in primary healthcare settings [ 9 ]. Sociodemographic factors were also associated with redeemed antibiotic prescriptions in a nationwide Swedish sample where specific infectious diagnoses were not considered [ 22 ].…”