Urinary incontinence (UI) is common in older adults, but its prognostic meaning is uncertain. We hypothesised that higher UI frequency would be associated with worse cardiovascular health and greater 10-year loss of event-free life in adults aged ≥65 years, and that this burden would be driven in part by competing mortality rather than incident cardiovascular disease (CVD) alone.

We performed a triangulated analysis using two nationally representative US datasets. In the Health and Retirement Study (HRS), we included adults aged ≥65 years without baseline CVD and classified UI frequency as no UI, monthly, weekly, or daily. We modelled incident CVD using Fine–Gray subdistribution hazards with death as a competing event, and all-cause mortality and the composite endpoint (incident CVD or death) using Cox models. We quantified 10-year absolute burden using restricted mean time lost (RMTL), decomposed into loss attributable to incident CVD versus death before CVD. In the National Health and Nutrition Examination Survey (NHANES), we profiled Life’s Essential 8 (LE8) component scores and prevalent CVD according to UI frequency in adults aged ≥65 years. A supplementary continuous dose–response analysis modelled UI frequency as days/month using restricted cubic splines to address the broad weekly category.

In HRS, daily UI was associated with higher all-cause mortality (hazard ratio [HR] 1.49) and higher incident CVD in the older-adult restricted analysis (subdistribution HR 1.29). By 10 years, the composite risk increased from 0.42 in participants without UI to 0.58 in those with daily UI. Daily UI was associated with an additional 0.98 years of event-free time lost by 10 years versus no UI, and most of this excess was attributable to death before CVD (0.76 years) rather than incident CVD (0.22 years). In income-stratified analyses, low-income participants had greater absolute healthspan loss, although multiplicative interaction was not statistically significant. In NHANES, daily UI was associated with lower LE8 component scores, especially for body mass index, blood pressure, glucose, physical activity, and sleep, and with higher prevalent CVD (odds ratio 1.57). The continuous spline analysis showed that risk gradients intensified toward higher frequencies of leakage, supporting clinically relevant heterogeneity within the broad weekly category.

Among adults aged ≥65 years, frequent UI appears to function less as an isolated lower urinary tract symptom and more as a marker of systemic vulnerability. The decomposition of time lost suggests that the clinical burden of daily UI is dominated by competing mortality, while NHANES profiles indicate coexisting deficits in modifiable cardiometabolic health domains. Taken together, these findings support interpreting daily UI as a pragmatic clinical trigger for broader cardiovascular and geriatric assessment rather than as a stand-alone CVD surrogate.

Daily UI in older adults is associated with substantial 10-year healthspan loss, driven predominantly by death before CVD, and accompanied by poorer LE8 profiles and higher prevalent CVD. These findings support routine recognition of frequent UI as a clinically meaningful signal of vulnerability in geriatric continence care and justify prospective evaluation of UI-triggered cardiometabolic assessment pathways.