How Two or More Trips to the Bathroom at Night Are Costing the U.S. Economy $44.4 Billion a Year

For Release

Tuesday
March 12, 2019

A new study has found that frequent visits to the bathroom at night could cost the U.S. economy $44.4 billion a year. According to researchers at the not-for-profit research organization RAND Europe, waking up more than twice a night due to nocturia, a health condition that affects the lower urinary tract, can have a detrimental effect on a person's wellbeing and productivity at work, which in turn has an impact on a country's GDP.

People who wake up at least twice a night to go to the toilet are more likely to be absent from work due to sickness or be less productive at work, as the disrupted night's sleep affects their ability to function during the day. The study's findings suggest that a person suffering with nocturia loses on average at least seven more working days a year due to absenteeism and presenteeism (being in suboptimal health while at work) than a person who does not have nocturia.

The number of people in the U.S. workforce estimated to suffer with nocturia is 27.5 million, 12.5 percent of the total working population. In the five other countries included in the economic analysis of the report—the UK, Germany, Spain, Japan and Australia—an additional 53.6 million people could have nocturia, ranging from 13 percent to 17 percent of the population of each country (see Table 1 in Notes to Editors).

The economic losses (in GDP terms) associated with nocturia are estimated to be about $13.7 billion in Japan, followed by Germany at $8.4 billion, the UK at $5.9 billion, and Spain and Australia each at about $3 billion (see Table 2, Scenario 1, in Notes to Editors).

Researchers used a unique macroeconomic model to simulate the current economic situation of each of the six countries under consideration and then predicted how economic output would be affected, if the proportion of people suffering with nocturia in the economy were reduced.

People suffering with nocturia also reported lower life satisfaction and work engagement, according to data collected through two large, linked employer-employee surveys (see Notes to Editors below). On average, a person with nocturia has a 2 percent lower life satisfaction compared to a person not suffering with nocturia. This association is similar to if the individual suffered from other serious health conditions such as hypertension, cardiovascular disease or asthma.

Furthermore, people suffering with nocturia have a 1.3 percent lower engagement at work compared to people not suffering from the condition. This is similar to people with chronic conditions like kidney disease or hypertension.

Marco Hafner, lead researcher and senior economist says: “Doctors and health practitioners often overlook nocturia as a potential health problem associated with sleep loss, and patients can delay reporting the condition until it becomes unbearable and substantially affects their wellbeing.

“Given the substantial economic implications of untreated nocturia, this should be a 'wake-up' call to diverse stakeholders, including patients, health-care providers and employers, of the importance of identifying and treating nocturia.”

A variety of demographic, lifestyle and health factors are associated with nocturia and they differ by age and gender. The study found that chronic health conditions such as kidney disease, diabetes, cardiovascular disease, cancer and hypertension could all play a role.

This independent research, prepared for Ferring Pharmaceuticals, was subject to RAND Europe's rigorous evaluation process, including peer review, and does not imply endorsement of any product or service. View the full report, “How frequent night-time bathroom visits can negatively impact sleep, wellbeing and productivity,” or arrange an interview with one of the researchers on the project by contacting Cat McShane via the details above.

- ENDS -

Notes to Editors:

Table 1: Number of Individuals with Nocturia (Two or More Voids Per Night) by Country

 

Total population

Working-age population

Country

Million

Share

Million

Share

Japan

21.8

17.0%

12.5

13.8%

UK

9.1

14.2%

5.7

12.8%

Spain

6.9

14.7%

4.2

12.5%

Germany

12.9

16.0%

7.6

13.1%

USA

40.0

12.9%

27.5

12.5%

Australia

2.9

13.0%

2.0

12.3%

Notes: Calculated using age-gender specific nocturia prevalence population data provided by the UN Population Database for each of the six countries. “Working-age population” covers individuals aged 20 to 69.

Table 2: Estimated Annual Economic Cost Associated with Nocturia in GDP Terms

 

Scenario 1: Real GDP – productivity

Scenario 2: Real GDP – productivity & reduction labor supply

$ billion (2018 Dollars)

Country

Estimate

Low

High

Estimate

Low

High

Australia

3.0

1.6

4.3

3.2

1.6

4.8

Japan

13.7

7.2

19.7

14.6

7.2

22.2

USA

44.4

24.2

63.3

47.9

24.2

73.1

Germany

8.4

4.5

12.1

9.1

4.5

13.8

Spain

3.1

1.7

4.5

3.3

1.7

5.0

United Kingdom

5.9

3.2

8.4

6.3

3.2

9.6

% total GDP

Country

Estimate

Low

High

Estimate

Low

High

Australia

0.21%

0.11%

0.30%

0.22%

0.11%

0.33%

Japan

0.21%

0.11%

0.31%

0.23%

0.11%

0.35%

USA

0.26%

0.14%

0.37%

0.28%

0.14%

0.43%

Germany

0.22%

0.12%

0.32%

0.24%

0.12%

0.37%

Spain

0.20%

0.11%

0.29%

0.22%

0.11%

0.33%

United Kingdom

0.23%

0.12%

0.33%

0.25%

0.12%

0.37%

Notes: All values are reported in 2018 U.S. dollars. “Low” and “High” represent the results from sensitivity analyses using the lower and upper bounds of the 95% confidence intervals for the main input parameters (percent work impairment due to absenteeism and presenteeism and mortality risk). The contribution of the reduction in labor supply can be calculated using the difference in real GDP between Scenario 2 and Scenario 1, however, the estimations including reduced labor supply due to excess mortality associated with nocturia should be used with caution as the evidence on the association between the condition and mortality risk is associated with some robustness issues.

  • Nocturia is a lower urinary tract condition representing the complaint of individuals having to wake up at night one or more times to void, where each void is preceded and followed by sleep. There are multiple types of nocturia, among the most frequent being a large urine volume produced during the night (nocturnal polyuria) or a reduced bladder capacity. Nocturia, defined as at least two night-time voids, is relatively common, affecting on average about 20 percent of the overall population, with prevalence increasing with age.
  • The study is partially based on workplace survey data collected through two large, linked employer-employee datasets by Vitality UK, part of the Discovery Group, and AIA, covering the countries UK, Australia, Malaysia, Hong Kong, Singapore, Thailand, and Sri Lanka.
  • RAND Europe is a not-for-profit research organization whose mission is to help improve policy and decision making through research and analysis www.randeurope.org

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