Gender Differences in Health Related Quality of Life in Multiple Sclerosis Patients with Increasing Disability
Multiple Sclerosis occurs more frequently in women than men, but men may experience more severe disease progression. Previous research has shown that greater disability is correlated with worse Health-Related Quality of Life (HRQOL) in men, but this association is not observed in women. In fact, women with greater disability may have better HRQOL on some patient reported outcomes (PROs). If this result could be validated, investigations of underlying mechanisms would be important.
To compare PROs in men and women with MS with low, medium, and high levels of disability.
PRO data were collected from the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB) cohort. All CLIMB patients have annual EDSS ratings, and a subgroup of these patients complete PROs biennially including the SF-36, CES-D, MFIS, MSSS, and STAI. The cohort for this analysis consisted of 225 females and 97 males. Patients were categorized as high disability (EDSS ≥6; n=35), mid disability (EDSS ≥3; n=38), and low disability (EDSS <3; n=249). Multiple linear regression was used to compare the genders in terms of mean PRO scores and to assess the interaction between gender and disability level on mean PRO scores. All analyses controlled for age.
Males and females were similar in terms of demographic and baseline clinical characteristics (p>0.1 for each comparison). No significant differences between the genders were observed for any of the summary scores (p>0.05), but females generally had scores indicating better functioning. Mean scores in both groups showed subjects had limited impairment on any of the PROs. In terms of the interaction between gender and disability level, a significant interaction was found only in the analysis of the MFIS. Males and females had similar fatigue at the low EDSS level, but males had greater fatigue at the high EDSS level. For all scales, with the exception of the MSSS, the low EDSS category saw the smallest difference between genders and the high EDSS category saw the largest difference, with females having better HRQOL, although these differences did not reach significance.
Based on our sample, men and women were generally similar in terms of PROs. Future work in larger samples will be required to further investigate the interaction between gender and disability on HRQOL in MS.