Biological Aging Exhibits an Inverted J-Shaped Relationship with Stress Urinary Incontinence in Women

Dec 30, 2025International journal of women's health

Biological Aging and Stress Urinary Leakage in Women Show an Inverted J-Shaped Link

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Abstract

The third quartile of biological age metrics PhenoAge and Klemera-Doubal Method is associated with a 58% increased risk of .

Higher biological age as measured by PhenoAge and Klemera-Doubal Method is linked to increased risk of urinary incontinence.
The highest risk for stress urinary incontinence occurs at the third quartile of both biological age metrics.
Greater severity of urinary incontinence is associated with higher quartiles of biological age.
Inverted J-shaped relationships are found for stress urinary incontinence with respect to PhenoAge and Klemera-Doubal Method.
Inverted U-shaped relationships are observed for urgency and mixed urinary incontinence with Klemera-Doubal Method.

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BACKGROUND: Biological aging is a systemic driver of chronic disease, yet its relationship with female urinary incontinence (UI) remains unexamined. We leveraged three conceptually distinct metrics-PhenoAge (PA), Klemera-Doubal Method (KDM), and Homeostatic Dysregulation (HD)-to quantify biological age and assessed their associations with stress UI (), urgency UI (UUI), and mixed UI (MUI) in a nationally representative cohort.

METHODS: This cross-sectional study included 8,561 women ≥20 years from NHANES 2005-2010 and 2015-2018. After outlier exclusion and covariate selection via LASSO regression, multivariable logistic regression and restricted cubic splines (RCS) were used to estimate ORs and dose-response shapes. Subgroup analyses, mediation analyses, and sensitivity analyses were performed.

RESULTS: PA and KDM were positively associated with UI. The third quartile of PA and KDM conferred the highest risk for SUI (PA: Q3 OR = 1.58, 95% CI 1.33-1.88; KDM: Q3 OR = 1.39, 95% CI 1.20-1.62). Higher quartiles were also linked to greater UI severity. Fully adjusted RCS models revealed inverted J-shaped relationships for SUI (PA inflection: 43.6; KDM: 34.7) and inverted U-shaped relationships for UUI and MUI with KDM (UUI inflections: 40.7 and MUI inflections: 40.5). Associations were robust across most subgroups but attenuated with increasing reproductive risk factors. No significant mediation by sex steroids or α-Klotho was observed.

CONCLUSION: Biological aging is significantly positively associated with UI, and its relationship with SUI follows an inverted J-shaped curve. Interventions that slow biological aging may offer a novel strategy for UI prevention; however, longitudinal studies are required to establish causality.

Key numbers

1.58

Higher Risk for ()

for third quartile of

1.39

Higher Risk for ()

for third quartile of

43.6

Inflection Point for ()

Inflection point for the relationship between and

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Biological Aging Exhibits an Inverted J-Shaped Relationship with Stress Urinary Incontinence in Women

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