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Disparities in the management of multiple sclerosis–related bladder symptoms

From the Department of Neurology (R.A.M.), Cleveland Clinic Foundation, OH, Department of Biostatistics (G.C.), University of Alabama at Birmingham, and Division of Neurology (T.T., T.V., D.C.), Barrow Neurological Institute, Phoenix, AZ.

Address correspondence and reprint requests to Dr Marrie, Mellen Center for MS Treatment and Research, U10, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195 marrier{at}ccf.org

Background: Participants enrolled in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry report disability status using Performance Scales (PS), a self-report measure. The bladder/bowel subscale (PSB) of PS has not been validated. It is also unknown whether ethnic or socioeconomic disparities exist in bladder care.

Objective: We aimed to validate the bladder/bowel subscale used by the NARCOMS registry and to describe urologic symptoms, investigations, and treatments received by registry participants.

Methods: In the Fall 2005 update questionnaire, we collected the Bowel Control Scale (BWCS) and Urogenital Distress Inventory-6 (UDI-6) as criterion measures and urologic investigations and treatments. We measured associations between investigations, treatments, and symptoms with clinical and sociodemographic variables using ² tests for categorical variables and Kruskal–Wallis tests for continuous variables, followed by multivariable logistic regression.

Results: Nine thousand six hundred eighty-eight participants completed the survey. For the UDI-6, the median (interquartile range) score was 33.3 (16.7 to 50.0), for the BWCS 3 (1 to 6), and for the PSB 1 (1 to 3). The correlation between the PSB and the UDI-6 was r = 0.67 and between the PSB and the BWCS r = 0.53 (both p < 0.0001). Participants had increased odds of receiving medication for bladder symptoms if they had health insurance (odds ratio [OR] 1.90; 1.07 to 3.35). Participants who were white (OR 1.5; 1.16 to 1.94) and had health insurance (OR 2.0; 1.3 to 3.07) had increased odds of undergoing urologic investigations.

Conclusion: The Performance Scales bladder question has adequate criterion and construct validity in multiple sclerosis (MS). There are ethnic and socioeconomic disparities in bladder management in MS.

Supplemental data at www.neurology.org

Supported in part by the NIH, National Institute of Child Health and Human Development, and Multidisciplinary Clinical Research Career Development Program grant K12 HD04909. The NARCOMS registry receives support from the Consortium of Multiple Sclerosis Centers.

Disclosure: Although no funding was obtained for this specific study, it addresses issues in multiple sclerosis. Ruth Ann Marrie has received support from NIH, the Consortium of Multiple Sclerosis Centers, and the NMSS. Gary Cutter participated in Data and Safety Monitoring Committees for Sanofi-Aventis, Acorda Pharmaceuticals, Bayhill Pharmaceuticals Inc., BioMS Pharmaceuticals, Centocor, Glaxo Pharmaceuticals, Glycomids Pharmaceuticals, Incyte Pharmaceuticals, Millennium Pharmaceuticals, Neurocrine Pharmaceuticals, Protein Design Labs, NHLBI, NINDS, and the NMSS. He has served as consultant to Millenium Pharmaceuticals, Androclus Pharmaceuticals, Consortium of MS Centers, MS-CORE and NMS-funded research group, Practice Based Research Network NYU, and Klein–Buendel Incorporated. Tuula Tyry has served as consultant to Serono and owns shares in Biogen Idec. Timothy Vollmer has received support from NIH/NINDS U01NS45719-01A1, NIH ITN020AI, Abbott, Acorda, Bayhill Therapeutics Inc., Biogen Idec, Genetech, Protein Design Laboratory, Serono, Pfizer, Teva Neurosciences, Novartis, and Berlex. He has served as a consultant for Acorda Therapeutics, Aventis Pharmaceuticals, Inc., Bayer, Bayhill Therapeutics, Inc., Berlex Laboratories, Bristol–Myers Squibb, Centocor, Eisai Medical Research Inc., Genentech, INC Research, Merck Research Laboratories, Neurocrine Biosciences, PRA International, Protein Design Labs, Inc., Schering, and Scirex Corporation. He has served on the speaker's bureau for Serono and Teva Neurosciences. Denise Campagnolo is a consultant for ALZA and has served on the speaker's bureau for Biogen Idec.

Received October 9, 2006. Accepted in final form February 2, 2007.

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