The association between insulin resistance and urge urinary incontinence in non-diabetic women is primarily mediated by obesity: a cross-sectional study based on NHANES from 2005 to 2016.

BACKGROUND: Urinary incontinence is a common urinary tract disorder that has gradually become a significant health issue affecting middle-aged and elderly women worldwide in recent years. This study aimed to investigate the relationship between insulin resistance (IR) and female urge urinary incontinence (UUI). METHOD: This study enrolled individuals aged 20 and older to investigate the relationship between IR and female UUI. The analysis leveraged data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016. We employed multiple logistic regression models to assess the relationship between IR and female UUI. In addition, subgroup analyses, interaction tests, and smooth curve fitting were performed to evaluate the stability of this association. RESULT: This study included a total of 2,961 participants, with a UUI prevalence rate of 28.20%. After adjusting for confounding variables, a positive correlation was found between the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and the prevalence of UUI (Model Ⅲ OR = 1.03,95% CI: 1.00, 1.06, P = 0.0264). Smoothed curve fitting also demonstrated a significant positive linear correlation between HOMA-IR and the risk of UUI in women. Subgroup analysis revealed that the association between HOMA-IR and UUI remained consistent across all subgroups, and no subgroup showed an interaction effect on this association (P for interaction > 0.05). However, when body mass index (BMI) was further added to the fully adjusted model, the association between HOMA-IR and the prevalence of UUI was substantially attenuated. It was no longer statistically significant (Model IV OR = 1.01, 95% CI: 0.98, 1.04, P = 0.4243). In model IV-based smooth curve fitting and subgroup analysis, the association between IR and UUI was weakened and not statistically significant. CONCLUSION: In non-diabetic women, obesity is the primary modifiable risk factor for UUI. It is crucial to prioritize weight management and obesity prevention as core strategies for reducing the risk of UI in this population. Although IR remains an important indicator of metabolic dysfunction, interventions targeting UI should focus on comprehensive weight control rather than directly addressing IR.