Subgroups of lower urinary tract symptoms in men and their association with patient-centered outcomes: a cluster analysis of the 2023 Japan community health survey.

PURPOSE: To apply an unsupervised machine learning approach to identify distinct subgroups of lower urinary tract symptoms (LUTS) in adult men and to evaluate their association with patient-centered outcomes, including quality of life (QoL), willingness to pay (WTP) for treatment, and healthcare-seeking behavior.

METHODS

Data were obtained from 3,112 male participants aged ≥ 20 years in a 2023 nationwide Japanese web-based survey on LUTS. Sixteen LUTS domains, including storage, voiding, and postvoiding symptoms as well as bladder pain and discomfort, were analyzed. Dimensionality reduction was performed using principal component analysis, followed by hierarchical clustering to classify participants based on symptom patterns. Differences in QoL, WTP, and healthcare-seeking behavior were subsequently examined across the identified clusters.

RESULTS

Three symptom-based subgroups were identified: the Mild/Asymptomatic group (n = 1,224, 39.3%), the Moderate Mixed (Storage-Voiding-Postvoiding) group (n = 1,204, 38.7%), and the Severe Complex (Storage-Voiding-Postvoiding-Pain/Discomfort) group (n = 694, 22.3%). The Severe Complex group, characterized by a broad spectrum and high intensity of LUTS, showed the greatest QoL impairment across all domains (daily life, emotions, sleep/energy, personal relationships, and role, physical, and social limitations). Although WTP and physician consultation rates were highest in the Severe Complex group, median monthly WTP was limited to ¥1,000 ($7), and consultation rates remained low (16.1%).

CONCLUSION

An unsupervised machine learning approach identified three clinically relevant subgroups in LUTS among adult men. Even among the most severely affected men, WTP was limited and healthcare-seeking remained low, underscoring the need for greater awareness and targeted intervention. RUNNING HEAD: Clustering of lower urinary tract symptoms in adult men.