Neurourology and Urodynamics · Apr 8, 2026

Urinary Incontinence and Risk of All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies

By Zhou Y, Wang L, Sun W et al.

AIMS: Urinary incontinence (UI) is a prevalent condition among adults and imposes a substantial societal burden, yet its association with all-cause mortality remains uncertain. This study systematically reviewed and quantified the association between UI and mortality risk. METHODS: A systematic literature search was conducted in PubMed, EMBASE, and the Cochrane Library from inception to January 10, 2026, following PRISMA guidelines. Observational cohort studies comparing all-cause mortality between individuals with and without UI were included. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using random-effects models. Prespecified subgroup analyses and random-effects meta-regression were performed to explore heterogeneity, and the certainty of evidence was assessed using the GRADE approach. RESULTS: Seventeen studies involving 82,739 participants were included. UI was associated with a higher risk of all-cause mortality (HR = 1.20, 95% CI: 1.07-1.34), although heterogeneity was substantial (I² = 80.4%). Sensitivity analyses supported the robustness of the observed association. Subgroup analyses suggested stronger associations with increasing UI severity (HR = 1.20, 1.27, and 1.67 across severity categories) and in studies with shorter follow-up ( < 5 years, HR = 1.89, 95% CI: 1.20-2.98), raising the possibility of reverse causation. Meta-regression identified diagnostic modality (p = 0.026) as a potential contributor to heterogeneity. The certainty of evidence was rated as very low. CONCLUSIONS: UI was associated with increased all-cause mortality; however, this finding should be interpreted cautiously due to substantial heterogeneity, potential residual confounding, and potential reverse causation. Rather than indicating a direct causal effect, UI may function primarily as a clinical marker of frailty, multimorbidity, and overall health decline. Further well-designed prospective studies with repeated exposure assessment and more comprehensive adjustment for frailty and comorbidity are needed. TRIAL REGISTRATION: This systematic review and meta-analysis was registered with PROSPERO (International Prospective Register of Systematic Reviews) under the registration number CRD42024618197.

doi.org/10.1002/nau.70283Open accessPubMed 41947693Populations