SOCIOECONOMIC INFERIORITY INTERFERES WITH QUALITY OF LIFE IN PELVIC FLOOR DYSFUNCTION
B. ROCHA 1, I. FROTA 2, C. VASCONCELOS 3, J. VASCONCELOS NETO 4, S. A. KARBAGE 5, K. L. AUGUSTO 6, A. P. BILHAR 7, T. F. MAGALHAES 8, J. M. HADDAD 9, L. S. BEZERRA10;
1Univ.e de São Paulo, Fortaleza, Brazil, 2Hosp. geral de fortaleza, Fortaleza, 3Univ.e Federal do Ceará, Fortaleza, Brazil, 4Hosp. Geral de Fortaleza, Fortaleza, Brazil, 5Univ.e Federal do Cearÿ, Fortaleza - Ceara, Brazil, 6Laparoscopy and Minimally invasive surgery, Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil, 7UNIFESP, Fortaleza, Brazil, 8Univ.e Federal do Ceara, Fortaleza, Brazil, 9Univ.e de Sao Paulo, Sao Paulo, Brazil, 10Saúde Materno Infantil, Federal Univ. of Ceara, Fortaleza, Brazil.
Introduction: Pelvic floor dysfunctions (PFD), including urinary incontinence (UI) and pelvic organ prolapse (POP) are common gynecologic conditions that affect patients’ confidence and self-esteem. Such disturbances are frequently encountered around the menopause and have a negative influence on quality of life (QoL) and are responsible for a great morbidity within the affected population. Variables such as personal income, education, and occupation may interfere with the individual perception of wellbeing and perhaps, its measurement are related to of QoL. Additionally, the level of impact caused by these conditions may vary largely according to personal and cultural differences among subjects. Nowadays, it was not found in the researched literature studies that evaluate the relationship among socioeconomic status and its impact in general QoL of women with PFD
Objective: We aim to analyze the association between different socioeconomic classes and its impact on general QoL in postmenopausal Brazilian women with PFD
Methods: Cross sectional, case-control, descriptive study All women with complaints of PFD evaluated in period of study were invited to participate in the research. Initially a total of 361 patients were found to be eligible for the study. Subjects were required to have sufficient cognitive, physical and emotional health to answer the required questionnaires. On account of this, women were not included because they did had cognitive disorders and/or neurological diseases, uninhibited detrusor contractions on urodynamic testing, undergone hormone replacement therapy or had a history of previous gynecological surgery in the past six months. Finally our sample consisted of 230 multiparous women in post-menopause. They were divided into two groups: Case (136 women with PFD) and Control (94 women without PFD, confirmed by clinical interview and gynecologic examination). Case and control groups were tested for homogeneity regarding age, BMI, number of pregnancies, parity, number of Cesarean sections and of vaginal deliveries. The initial selection for PFD was based on the presence of clinical complaints: a “dragging or heavy sensation”, the “feeling of a lump in the vagina”; symptoms indicating stress-related involuntary loss of urine. Medical Outcomes Study 36-item short-form (SF-36), was applied. The Criterion of Brazilian Economic Classification (CCEB) was used for the economic stratification, according to schooling and possession of items. Non-parametric Mann-Whitney U, Kruskal-Wallis H test and Spearman correlation coefficient were used to evaluate, the statistical significance considering p <0.05.
Results: Women from belonged to classes B, C or D comparing between groups we found that most epidemiological variables were similar. Scores of almost all SF-36 domains were statically different between groups with and without PFD (p< 0.000), except to social aspects (p< 0.06). Comparing women in each socioeconomic class, we found women from class B with PFD had worse SF-36 scores in five domains. They did not have differences in class B for vitality (p=0.08), social aspects (p=0.28) and mental health (p=0.5). Women from class C with PFD had worse SF-36 scores in all eight domains (p< 0.000). Women from class D with PFD had worse SF-36 scores in only one domain: functional capacity (p< 0.000).
Conclusions: Women with PFD showed worse QOL compared to women without PFD. Women with PFD and D class had less interference in QOL compared with women of the classes of groups B and C. Socioeconomic status should be considered relevant in future studies about PFD and QoL.
References: Farage M, Miller K, Berardesca E, Howard M. Psychosocial and societal burden of incontinence in the aged population: a review. Arch Gynecol Obstet 2008;277:285-90. Jelovsck JE, Barber MD. Women seeking treatment for advanced pelvic organ prolapsed have decrease body image and quality of life. Am J Obstet Gynecol 2006; 194:1455-1461.