Jimenez-Cidre Miguel, Costa Pierre, Ng-Mak Daisy, Sahai Arun, Degboe Arnold, Smith Christopher Patrick, Tsai Kathleen, Herschorn Sender
Hospital Universitario Ramon y Cajal , Madrid, Spain.
Curr Med Res Opin. 2014 Aug;30(8):1557-64. doi: 10.1185/03007995.2014.918028. Epub 2014 May 12.
Abstract Objective: To assess the association between incontinence severity, treatment-seeking behavior, and healthcare resource utilization (HRU) among participants with overactive bladder (OAB) in eight countries.
A cross-sectional online survey of subjects ≥18 years old in Australia, Europe, and North America, who had a past OAB diagnosis and/or experienced ≥1 urinary incontinence (UI) episode in the preceding 12 months, were eligible to participate. Subjects contacted for the survey were primarily from a voluntary medication monitoring registry, MediGuard. Predominantly stress incontinence subjects were excluded. Incontinence severity was assessed by the number of UI episodes over 3 days and grouped as 0 ('dry'), 1-2, 3-4, and ≥5 UI episodes/day. Subject demographics, employment status, comorbidities, treatment-seeking behavior (past OAB diagnosis; spoken to healthcare provider [HCP]), and HRU (diagnostic tests; HCP visits in 6 months before screening) were analyzed by incontinence severity.
Overall, 1341 subjects with OAB (mean age 54.5 years; 70.7% female) were surveyed; 20.2%, 47.7%, 18.8%, and 13.3% of subjects reported 0, 1-2, 3-4, and ≥5 UI episodes/day, respectively. Employment status and comorbidities were significantly (p < 0.05) associated with incontinence severity. The two measures of treatment-seeking behavior were significantly (p < 0.05) associated with incontinence severity groups; the proportion of subjects with a past diagnosis of OAB were 35.8%, 44.8%, 52.4%, and 64.0% in the 0, 1-2, 3-4, and ≥5 UI episodes/day groups, respectively; and 59.0%, 63.6%, 65.9%, and 78.1% of subjects in the respective UI severity groups talked to a HCP about their OAB symptoms. Multivariate linear regression analyses showed a positive and consistent association between incontinence severity and HRU; subjects reported a mean of 2.7, 4.1, 4.4, and 7.7 diagnostic tests overall (p < 0.001), and a mean of 1.4, 2.2, 2.7, and 4.0 HCP visits in the 0, 1-2, 3-4, and ≥5 UI episodes/day groups, respectively (p < 0.001). A potential limitation of the study is the cross-sectional survey methodology which limits the ability to draw causal inferences from the results. Additionally, since this is a web-based survey it is possible respondents who have access to/are familiar with technology were more likely to be enrolled.
Incontinence severity was positively associated with both treatment-seeking behavior and HRU among subjects with OAB.
摘要 目的：评估八个国家中膀胱过度活动症（OAB）患者的尿失禁严重程度、就医行为和医疗资源利用（HRU）之间的关联。
对澳大利亚、欧洲和北美的18岁及以上受试者进行横断面在线调查，这些受试者过去曾被诊断为OAB且/或在过去12个月内经历过≥1次尿失禁（UI）发作，符合参与条件。被联系进行调查的受试者主要来自一个自愿性药物监测登记处MediGuard。主要为压力性尿失禁的受试者被排除。尿失禁严重程度通过3天内UI发作次数评估，并分为0次（“无尿失禁”）、1 - 2次、3 - 4次和≥5次/天。按尿失禁严重程度分析受试者的人口统计学特征、就业状况、合并症、就医行为（过去的OAB诊断；与医疗保健提供者[HCP]交谈过）和HRU（诊断测试；筛查前6个月内的HCP就诊次数）。
总体而言，对1341名OAB患者（平均年龄54.5岁；70.7%为女性）进行了调查；分别有20.2%、47.7%、18.8%和13.3%的受试者报告每天有0次、1 - 2次、3 - 4次和≥5次UI发作。就业状况和合并症与尿失禁严重程度显著相关（p < 0.05）。两种就医行为指标与尿失禁严重程度组显著相关（p < 0.05）；在每天0次、1 - 2次、3 - 4次和≥5次UI发作组中，过去被诊断为OAB的受试者比例分别为35.8%、44.8%、52.4%和64.0%；在相应尿失禁严重程度组中，分别有59.0%、63.6%、65.9%和78.1%的受试者与HCP谈论过他们的OAB症状。多变量线性回归分析显示尿失禁严重程度与HRU之间存在正向且一致的关联；受试者总体报告的诊断测试平均次数分别为2.7次、4.1次、4.4次和7.7次（p < 0.001），在每天0次、1 - 2次、3 - 4次和≥5次UI发作组中，HCP就诊的平均次数分别为1.4次、2.2次、2.7次和4.0次（p < 0.001）。该研究的一个潜在局限性是横断面调查方法限制了从结果中得出因果推断能力。此外，由于这是一项基于网络的调查，有可能能够访问/熟悉技术的受访者更有可能被纳入。
在OAB患者中，尿失禁严重程度与就医行为和HRU均呈正相关。
