The impact of overactive bladder on health-related quality of life, sexual life and psychological health in Korea.

Abstract

We aimed to estimate the prevalence of overactive bladder (OAB) in Korea, to assess the variation in prevalence by sex and age, and to measure the impact of OAB on quality of life.
A population-based, cross-sectional telephone survey was conducted between April and June 2010 with a questionnaire regarding the prevalence of OAB, demographics, and the impact of OAB on quality of life. A geographically stratified random sample of men and women aged ≥30 years was selected.
The overall prevalence of OAB was 22.9% (male, 19%; female, 26.8%). Of a total of 458 participants with OAB, 37.6% and 19.9% reported moderate or severe impact on their daily life and sexual life (5.6% and 3.5%, respectively, in participants without OAB). Anxiety and depression were reported by 22.7% and 39.3% of participants with OAB, respectively (9.7% and 22.8%, respectively, in participants without OAB). Only 19.7% of participants with OAB had consulted a doctor for their voiding symptoms, but 50.7% of respondents with OAB were willing to visit a hospital for the management of their OAB symptoms.
This study confirmed that OAB symptoms are highly prevalent in Korea, and many sufferers appear to have actively sought medical help. OAB has severe effects on daily and sexual life as well as psychological health.

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Copyright © 2011 Korean Continence Society www.einj.or.kr
Int Neurourol J 2011;15:143-151
http://dx.doi.org/10.5213/inj.2011.15.3.143
pISSN 2093-4777 · eISSN 2093-6931
International Neurourology Journal
The Impact of Overactive Bladder on Health-Related Quality of
Life, Sexual Life and Psychological Health in Korea
Eun Sang Yoo, Bum Soo Kim, Duk Yoon Kim1, Seung-June Oh2, Joon Chul Kim3
Department of Urology, Kyungpook National University School of Medicine, Daegu;
1Department of Urology, Catholic University of Daegu School of Medicine, Daegu;
2Department of Urology, Seoul National University College of Medicine, Seoul;
3Department of Urology, The Catholic University of Korea School of Medicine, Seoul, Korea
Purpose: We aimed to estimate the prevalence of overactive bladder (OAB) in Korea, to assess the variation in prevalence by sex
and age, and to measure the impact of OAB on quality of life.
Methods: A population-based, cross-sectional telephone survey was conducted between April and June 2010 with a question-
naire regarding the prevalence of OAB, demographics, and the impact of OAB on quality of life. A geographically stratified ran-
dom sample of men and women aged ≥30 years was selected.
Results: The overall prevalence of OAB was 22.9% (male, 19%; female, 26.8%). Of a total of 458 participants with OAB, 37.6%
and 19.9% reported moderate or severe impact on their daily life and sexual life (5.6% and 3.5%, respectively, in participants with-
out OAB). Anxiety and depression were reported by 22.7% and 39.3% of participants with OAB, respectively (9.7% and 22.8%,
respectively, in participants without OAB). Only 19.7% of participants with OAB had consulted a doctor for their voiding symp-
toms, but 50.7% of respondents with OAB were willing to visit a hospital for the management of their OAB symptoms.
Conclusions: This study confirmed that OAB symptoms are highly prevalent in Korea, and many sufferers appear to have active-
ly sought medical help. OAB has severe effects on daily and sexual life as well as psychological health.
Keywords: Overactive urinary bladder; Prevalence; Demography
Corresponding author: Joon Chul Kim
Department of Urology, Bucheon St. Mary’s Hospital, The Catholic University of
Korea School of Medicine, 2 Sosa-dong, Wonmi-gu, Bucheon 420-717, Korea
Tel: +82-32-340-7071 / Fax: +82-32-340-2124 / E-mail: kjc@catholic.ac.kr
Submitted: June 28, 2011 / Accepted after revision: August 19, 2011
INTRODUCTION
Overactive bladder (OAB) is a common disabling condition that
affects health-related quality of life [1]. Estimates of the preva-
lence and impact of OAB on quality of life vary widely, in part
due to variation in the assessment of symptoms, the popula-
tions surveyed, the methods used to collect data, and the crite-
ria used to define OAB. OAB is a subset of storage lower uri-
nary tract symptoms (LUTS) defined as ‘urgency, with or with-
out urge incontinence, usually with frequency and nocturia’.
Previous reports from the European Prospective Investiga-
tion into Cancer and Nutrition (EPIC) study estimated the over-
all prevalence of OAB in Europe and Canada to be 12.8% among
women and 10.8% among men, whereas the overall prevalence
of any LUTS was estimated to be 62.5% in men and 66.6% in
women [2]. In the US-based study, Stewart et al. [3] estimated
the prevalence of OAB to be 16.0% among men and 16.9%
among women. The Korean EPIC study, which was conducted
in 2006, showed the overall prevalence of OAB to be 12.2% (10.0
% of men, 14.3% of women) [4].
The impact of OAB on quality of life has been reported in
foreign countries, but no population-based prevalence surveys
have been published reporting the impact of OAB symptoms
on aspects of psychological and sexual life in Korea.
The objective of this study was to evaluate the nationwide
prevalence of OAB and the impact of OAB on quality of life re-
garding role limitation, sexual life, and psychological aspects
(anxiety and depression). We also to aimed to investigate the
Original Article

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difference in quality of life between patients with and those
without OAB, and to study whether OAB symptoms were prop-
erly treated.
MATERIALS AND METHODS
Between April 2010 and June 2010, a geographically stratified
random sample of men and women aged ≥30 years and repre-
sentative of the general population of Korea was selected for a
telephone interview. A random sample of phone numbers was
acquired through the Post and Address Registry of Korea. A
two-step sampling method was adopted, in which step 1 en-
tailed sampling of households with a residence telephone num-
ber, and step 2 entailed sampling of a single person within the
household. Those who reported currently being pregnant or
having a urinary tract infection were excluded. The interview
was conducted after obtaining verbal informed consent.
A questionnaire about OAB symptoms (overactive bladder
symptom score, OABSS) was administered among subjects
contacted by phone in whom a survey was feasible [5]. A total
of 3 points with at least 2 points on question 3 was required for
a diagnosis of OAB. Total scores of <5, 6-11, and >11 were
considered mild, moderate, and severe, respectively. The basic
demographic data collected consisted of gender, age, job, and
education level (Table 1). Questions were asked to identify dis-
eases that cause symptoms similar to OAB. Once OAB was de-
termined on the basis of the OABSS questionnaire, whether a
doctor had been consulted for OAB symptoms or treatment had
been provided was evaluated. Also, the reason for no treatment
and willingness to receive treatment were evaluated.
Two items modified from The Korean version of the King’s
Health Questionnaire (KHQ) were used to survey the impact
of OAB on work, daily life, and sexual life, and the Korean ver-
sion of the Hospital Anxiety and Depression Scale (K-HADS)
was used to evaluate the impact of OAB on psychological as-
pects such as anxiety and depression. The KHQ was developed
to evaluate the severity of OAB, bother, and quality of life, and
it was used for OAB or urinary incontinence. The score of each
item has 4 scales (Table 2). In this investigation, we evaluated
the impact of OAB on quality of life by choosing 2 validated and
modified items related to role limitations and personal relation-
ships. Because the KHQ comprises only two simple questions
to assess psychological effects such as anxiety and depression,
the K-HADS was used for more in-depth analysis [6]. The
HADS consists of a total of 14 questions designed to respond
on a scale of 4 scores, and the K-HADS translated from the
HADS has been standardized nationwide (Table 2). When the
lower cut-off for depression was 8, the sensitivity and specificity
of the HADS were shown to be 89.2% and 82.5%, respectively.
When the lower cut-off for anxiety was 8, the sensitivity and
specificity of the HADS were shown to be 78.8% and 82.5%, re-
spectively. The construct validation was high in differentiating
between abnormality and normality given the significant differ-
ence between the group with anxiety and depression and the
normal group. The control group with no OAB symptoms was
compared with subjects complaining of OAB symptoms.
To analyze differences in prevalence by gender and age, sub-
jects were stratified into age categories (30 to 39, 40 to 49, 50 to
59, and ≥60), and a total of 2,000 subjects with 250 men and
250 women in each age category were targeted for the survey.
Table 1. Demographic data of the participants (n=2,000)
Positive OAB
symptoms
(n=458)
Negative OAB
symptoms
(n=1,542)
Total
Sex
Male
Female
Age (yr)
30-39
40-49
50-59
≥60
Job
Agriculture
Business
Marketing
Labor
Office work
Management
Housekeeping
Student
None
Education level
Below Junior high school
Junior high school graduate
High school graduate
College or graduate
190
268
810
732
1,000
1,000
94
111
130
123
406
389
370
377
500
500
500
500
5
47
26
28
104
42
126
1
79
10
135
120
90
448
187
317
9
226
15
182
146
118
552
229
443
10
305
34
44
132
248
82
104
464
892
116
148
596
1,140
OAB, overactive bladder.

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Table 2. Questions for the assessment of overactive bladder and the impact of overactive bladder on health-related quality of life
Question
Overactive bladder symptom score
How many times do you typically urinate from waking in the morning until sleeping at night?
AnswersScore
≤7
8-14
≥15
0
1
2
How many times do you typically wake up to urinate from sleeping at night until waking in the
morning?
0
1
2
≥3
0
1
2
3
How often do you have a sudden desire to urinate, which is difficult to defer?
Not at all
Less than once a week
Once a week or more
About once a day
2-4 times a day
5 times a day or more
0
1
2
3
4
5
How often do you leak urine because you cannot defer the sudden desire to urinate?
Not at all
Less than once a week
Once a week or more
About once a day
2-4 times a day
5 times a day or more
0
1
2
3
4
5
Two questions modified from King’s Health Questionnaire
Does your bladder problem affect your job household tasks? (cleaning, shopping, etc.)
Not at all
Slightly
Moderately
A lot
1
2
3
4
Does your bladder problem affect your sexual life?
Not at all
Slightly
Moderately
A lot
1
2
3
4
Hospital Anxiety and Depression Scalea)
1. I feel tense or ‘wound up’
Most of the time
A lot of the time
From time to time, occasionally
Not at all
3
2
1
0
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Table 2. (Continued from the previous page) Questions for the assessment of overactive bladder and the impact of overactive bladder on
health-related quality of life
Question
2. I still enjoy the things I used to enjoy
Answers Score
Definitely as much
Not quite so much
Only a little
Hardly at all
0
1
2
3
3. I get a sort of frightened feeling as if something awful is about to happen
Very definitely and quite badly
Yes, but not too badly
A little, but it doesn’t worry me
Not at all
3
2
1
0
4. I can laugh and see the funny side of things
As much as I always could
Not quite so much now
Definitely not so much now
Not at all
0
1
2
3
5. Worrying thoughts go through my mind
A great deal of the time
A lot of the time
From time to time, but not too often
Only occasionally
3
2
1
0
6. I feel cheerful
Not at all
Not often
Sometimes
Most of the time
3
2
1
0
7. I can sit at ease and feel relaxed
Definitely
Usually
Not often
Not at all
0
1
2
3
8. I feel as if I am slowed down
Nearly all the time
Very often
Sometimes
Not at all
3
2
1
0
9. I get a sort of frightened feeling like ‘butterflies’ in the stomach
Not al all
Occasionally
Quite often
Very often
0
1
2
3
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After a sample was drawn by simple random sampling, post-
stratification was used. The percentages listed in the results are
weighted. The crude prevalence of OAB was determined, and
the data were analyzed by using stratification and a regression
model to elucidate differences in symptom severity according
to demographic data and a medical history. Differences in qual-
ity of life according to the presence or absence of OAB were
compared by analyzing the above-mentioned questionnaires.
Chi-square analyses were performed to test for significant dif-
ferences between the proportions from categorical variables.
RESULTS
The overall prevalence of OAB was 22.9% (458/2,000), with
prevalences of 19% among male and 26.8% among female Ko-
rean individuals aged ≥30 years. The prevalence of OAB was
higher in women than in men at all ages, and the prevalence in-
creased with age in men. In women, however, the prevalence
was higher in the age group of 50 to 59 years than in the age
group of ≥60 years (Fig. 1). More than 37% of participants with
OAB reported moderate (31.4%) or severe (6.2%) bother of
their daily life (housework, shopping, etc.) owing to OAB symp-
toms. By contrast, about 5% of participants without OAB re-
ported moderate (5.0%) or severe (0.6%) bother (P<0.001; Fig.
2). Of 458 participants with OAB, 19.9% reported that OAB
symptoms affected their sexual life. However, only 3.5% of par-
ticipants without OAB reported that their sexual life was affect-
ed by OAB symptoms (P<0.001; Fig. 2).
The K-HADS was used to analyze the effects of OAB on anx-
iety and depression. Of 458 participants with OAB, 22.7% and
Table 2. (Continued from the previous page) Questions for the assessment of overactive bladder and the impact of overactive bladder on
health-related quality of life
Question
10. I have lost interest in my appearance
AnswersScore
Definitely
I don’t take as much care as I should
I may not take quite as much care
I take just as much care as ever
3
2
1
0
11. I feel restless as I have to be on the move
Very much indeed
Quite a lot
Not very much
Not at all
3
2
1
0
12. I look forward with enjoyment to things
As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all
0
1
2
3
13. I get sudden feelings of panic
Very often indeed
Quite often
Not very often
Not at all
3
2
1
0
14. I can enjoy a good book or radio or TV program
Often
Sometimes
Not often
Very seldom
0
1
2
3
a)The questions with odd numbers are related to anxiety, and the questions with even numbers are related to depression. Scoring: 0-7, normal; 8-10,
borderline abnormal; 11-21, abnormal.