Comparing SF-36 scores across three groups of women with different health profiles

Background: The widespread use of the Medical Outcomes Study (MOS) 36-item Short-Form Health Survey (SF-36) facilitates the comparison of health-related quality of life (HRQL) across independent studies. Objectives: To compare the scores of eight scales and two summary scales of the SF-36 across participants in the Womens Healthy Eating and Living (WHEL) trial, the Womens Health Initiative-Dietary Modification trial (WHI-DM), and the MOS, and to illustrate the use of effect sizes for interpreting the importance of group differences. Methods: WHEL and WHI-DM are both multi-center dietary interventions; only data from the UC Davis sites were used in our study. WHEL participants had a recent history of breast cancer, WHI-DM participants were healthy, postmenopausal women, and women in the MOS had a history of hypertension, diabetes, heart disease, or depression. General linear models were used to identify statistically significant differences in scale scores. Meaningful differences were determined by effect sizes computed using a common within-group standard deviation (SD) and SDs from normative data. Results: After adjusting for age and marital status, SF-36 scores for the WHI-DM and WHEL samples were similar and both had statistically significantly higher scores than the MOS sample. Relative to the WHEL or WHI-DM studies, MOS scores for scales related to the physical domain were clearly meaningfully lower whereas scale scores related to the mental health domain were potentially meaningfully lower. Conclusions: The HRQL of breast cancer survivors is comparable to that of healthy women and better than that of women with chronic health conditions, particularly with respect to physical health. This study illustrated the use of ranges of effects sizes for aiding the interpretation of SF-36 scores differences across independent studies.     

Psychological distress and quality of life in drug-using and non-drug-using HIV-infected women

BACKGROUND: Quantitative research on women infected with human immunodeficiency virus (HIV) has predominantly involved drug users. The present study assessed the psychosocial burden of HIV infection and identified some possible determinants in both drug-using and non-drug-using women. METHOD: Twenty-three hard-drug-using and 55 non-using HIV-positive women aged 18-64 years participated. Psychological distress (SCL-90, with eight scales and total score) and health-related quality of life (Rand SF-36, with eight scales and physical and psychosocial dimension) were measured. A cross-sectional comparison with reference groups (female general population, female psychiatric patients and HIV-positive homosexual men) was made. For analysis the t-test and multiple regression analysis were used. RESULTS: Compared to the general population, both HIV-positive groups had higher (i.e. unfavourable) SCL total scores (t = 8.33 and p < 0.001 and t = 4.97 and p < 0.001) and lower (i.e. unfavourable) Rand SF-36 scores (p < 0.001 on seven or more scales). Compared to psychiatric patients, drug users had similar (n.s.) and non-drug users had lower (t = -9.09 and p < 0.001) SCL scores. Both groups had lower SF-36 scores (p < 0.001 on seven or more scales). Compared to HIV-positive homosexuals, drug users had higher (t = 2.88 and p < 0.01) and non-drug users had similar SCL scores (n.s.). Psychosocial illness burden (SCL and Rand psychosocial dimension) was associated with low self-esteem, poverty, ethnic minority membership and illness stage (Rand only). Child care, drug use/prostitution and illness stage predicted high physical illness burden. CONCLUSION: Women with HIV/AIDS (acquired immune deficiency syndrome) experience considerable distress and poor quality of life, but drug users do more so than non-users. Drug- and gender-related lifestyles affect illness burden.     

A cross-sectional study of alcohol drinking and health-related quality of life among male workers in Japan

BACKGROUND: Although light and moderate alcohol drinkers are likely to have better subjective health, the sub-scales for subjective health have not been well documented. METHODS: We studied 4,521 male workers aged 25 yr and older with no history of cancer or cardiovascular disease, in 12 occupational groups in Japan. Data were from the High-risk and Population Strategy for Occupational Health Promotion Study (HIPOP-OHP). Drinking status was classified according to daily alcohol intake or frequency of drinking. We assessed the health-related quality of life (HRQOL) based on scores for five scales of the SF-36. RESULTS: Decreased odds ratios of sub-optimal HRQOL conditions, defined as less than the median SF-36 scores, for Role-Physical and General Health were found among persons who consumed 1.0 to 22.9 g/d of alcohol. Odds ratios for sub-optimal Vitality conditions were lowered according to increased levels of alcohol intake. Role-Emotional scores were not associated with alcohol drinking. People who drank 5 to 6 d/wk had higher levels of Role-Physical and Vitality, and those who drank 1 to 2 d/wk had better Vitality and Mental Health scores than non-drinkers. When adjusted for age, marital status, working hours, physical activity at work, self-reported job stress, smoking, regular exercise, hypertension, hyperlipidemia, and diabetes, the associations were almost unchanged except for General Health. CONCLUSIONS: Associations of drinking patterns with subjective health varied in five sub-scales of the SF-36. Overall, alcohol drinkers rated their health as good in comparison with non-drinkers.     

Use of the MQoL-HIV with asymptomatic HIV-positive patients

The purpose of this study was to determine the appropriateness of the recently developed Multidimensional Quality of Life Questionnaire for HIV/AIDS (MQoL-HIV) as a measure of quality of life (QoL) in cases of asymptomatic human immunodeficiency virus (HIV) infection. The MQoL-HIV is a 40-item instrument measuring ten domains (mental health, physical health, physical functioning, social functioning, social support, cognitive functioning, financial status, partner intimacy, sexual functioning and medical care) relevant to HIV infection. An overall QoL score, the MQoL-HIV Index, is a weighted composite of two domain scores. In a sample of 216 HIV-infected men and women, the MQoL-HIV distinguished acquired immune deficiency syndrome (AIDS), symptomatic and asymptomatic cases in overall QoL and in seven individual QoL domains. The index was responsive to perceived QoL changes over 5.5 months (r = 0.52). We also found the MQoL-HIV was less susceptible to ceiling effects in asymptomatic cases than was the Medical Outcomes Study (MOS) SF-20. These results suggest that the MQoL-HIV is a valid and reliable measure of QoL for both asymptomatic and symptomatic HIV infection.     

Comparing the health status of VA and non-VA ambulatory patients: the veterans' health and medical outcomes studies

The purpose of this study was to compare health status and disease profiles of ambulatory patients in specific Veterans Administration (VA) and civilian healthcare settings. A random sample of 2425 male veterans seeking care at 4 Boston-area VA outpatient clinics, who took part in the Veterans Health Study (VHS) in 1993-1995, were compared to 1318 male patients seeking civilian outpatient care in 3 major metropolitan areas covered in the Medical Outcomes Study (MOS) in 1986. The MOS sampled patients who had 1 of 5 conditions--hypertension, noninsulin-dependent diabetes, recent myocardial infarction, congestive heart failure, or depression. These 2 samples were age adjusted and compared in terms of the SF-36 Health Status/Quality of Life measures, and a list of 100 clinical variables (diagnostic, symptom, and medical event reports) collected with comparable instruments by a trained clinical observer. Individual odds ratios (VHS to MOS) were calculated for each measure and clinical variables. SF-36 measures of patient health in the VHS were lower than those in the MOS by more than one half of a standard deviation (SD) on 4 of 8 scales, by more than one quarter of a SD on the other 4, by 58% of a SD on the physical health summary scale, and by 37% of a SD on the mental health summary scale (P < .0001 in all cases). The median odds ratio was 2.2 among the SF-36 scales and 1.9 among clinical variables. Outpatients in the 4 VA clinics had more than twice the illness burden than did patients in the MOS. Current economic condition and service-connected disability explain most, if not all, of the differences. The differences were clinically and socially meaningful and would be consistent with substantially higher expected healthcare use.     

The effect of health-related quality of life (HRQOL) on health service utilisation of a Chinese population

This study was designed to find out whether health-related quality of life (HRQOL) was an independent determinant of health service utilisation of a Chinese population and to determine whether the addition of HRQOL data to sociodemographic and morbidity factors could significantly increase the explanatory power of risk-adjustment models. A cross-sectional random telephone survey of the general adult Chinese population in Hong Kong was conducted among 2410 Chinese aged 18-88yr old, 52% were females and 38% had one or more chronic diseases. Health service utilisation was measured by annual consultation, monthly consultation and hospitalisation rates. HRQOL was measured by the SF-36. Multivariate regressions were used to test the dependence of service utilisation rates on sociodemographic factors, chronic morbidity and the SF-36 scores. Structured multiphase regression analyses were used to determine the magnitude of the effect of the SF-36 scores, in addition to those of sociodemographic and chronic morbidity factors, on service utilisation. Five of eight SF-36 scores were independent determinants of consultation rates. They doubled and tripled the percentages of variance explained for annual and monthly consultation rates, respectively. Role limitation by physical problems and bodily pain scores had a significant effect on hospitalisation rates. This was the first study showing a linear relationship between HRQOL and service utilisation on a Chinese population. It confirmed the clinical relevance of the SF-36 to a culture and health care system that is different from that of the United States where the instrument originated.     

Health-related quality of life among people with HIV disease: Results from the Multicenter AIDS Cohort Study

To examine the effect of HIV status, symptomatology and CD4+ lymphocyte level on health-related quality of life, the Medical Outcomes Study Short-Form Health Survey (SF-36) was administered to 2,295 gay men enrolled in the Multicenter AIDS Cohort Study (MACS) in 1994. Distinct physical and mental health factors of the SF-36 were found. Seropositive asymptomatic individuals and seropositive individuals with CD4+ lymphocytes 500/mm³ scored as well as seronegative participants on all of the mental health domain scales, but lower on the general health perceptions and physical health composite score. Seropositive individuals with at least one symptom or with CD4+ lymphocytes below 200/mm³ scored significantly lower on all of the SF-36 scales and summary scores than seronegative controls. The SF-36 was found to exhibit similar mental and physical health factors for an adult gay male population to that previously seen in general population samples and in patient groups with other diseases. In conclusion, HIV-positive men who are asymptomatic or have CD4+ lymphocytes above 500/mm³ have similar perceived mental health but worse perceived physical health than seronegative men. HIV-positive men who are symptomatic or have CD4+ lymphocytes below 200/mm³ have worse perceived mental and physical health than seronegative men.     

Validation of the Kiswahili version of the SF-36 Health Survey in a representative sample of an urban population in Tanzania

The objective of this study was to assess the validity of a Kiswahili translation of the SF-36 Health Survey (SF-36) among an urban population in Tanzania, using the method of known-groups validation. People were randomly selected from a demographic surveillance system in Dar es Salaam. The representative sample consisted of 3,802 adults (15 years and older). Health status differences were hypothesized among groups, who differed in sex, age, socio-economic status and self-reported morbidity. Mean SF-36 scale scores were calculated and compared using t-test and ANOVA. Women had significantly lower mean SF-36 scale scores (indicating worse health status) than men on all scales and scores were lower for older people than younger on all domains, as hypothesized. On five of the eight SF-36 scales, means were higher for people of higher socio-economic status compared to those of lower socio-economic status. People who reported an illness within the previous 2 weeks scored significantly lower on all scales compared to those who were healthy, as did people who said they had a disability or a chronic condition.     

Health-related Quality of Life and Virologic outcomes in an HIV Clinic

Objective: The purpose of this study was to describe the relationship between viral load and health-related quality of life (HRQOL) in a cohort of persons with human immunodeficiency virus (HIV) infection. Design: We evaluated HRQOL measurements in a clinical cohort of HIV-positive patients recruited from a university-associated HIV primary care clinic. HRQOL instruments included the medical outcomes survey-short form-36(MOS-SF-36) from which mental and physical component summary scores (MCS and PCS) and subscale scores were calculated. Results: Significant negative associations were found between viral load and SF-36 PCS, physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), role-emotional (RE), and vitality (VT). Similar negative associations were found between CD4 cell count and SF-36 summary and subscale scores, with the notable exception of bodily pain. Multivariate analyses controlling for the effects of CD4 cell count and other clinical variables indicated viral load as an independent predictor of SF-36 PCS, RP, BP and VT scores. Conclusions: The relationship between viral load, a measure of HIV disease activity, and several dimensions of the SF-36, a patient-focused measure of HRQOL, appears to be strong and independent of CD4 cell count. These findings suggest that having a lower viral load positively impacts the quality of life of HIV-positive patients. This revised version was published online in July 2006 with corrections to the Cover Date.     

411例肠易激综合征患者生活质量状况调查

目的探讨肠易激综合征（IBS）患者的生活质量状况。方法在西安市2所综合医院选取连续的411例IBS患者，其SF-36量表中8个维度的得分以及生理功能总分和心理功能总分与430名健康对照者的得分相比较。结果IBS患者在SF-36量表所有8项维度的得分比健康对照者显著降低（P〈0．001），得分最低的维度是总体健康和情感职能，分别为33．5±16．9、40．8±25．1。IBS患者生理功能总分和心理功能总分也显著降低（P〈0．001）。结论IBS患者生活质量明显受损。分析结果有助于更好了解IBS对患者功能和健康的影响。     

Disparities in HRQOL of cancer survivors and non-cancer managed care enrollees

Health plan member survey and cancer registry data were analyzed to understand differences in health-related quality of life (HRQOL) among cancer survivors and those without a cancer diagnosis enrolled in Medicare managed care. HRQOL was measured by the physical component summary score (PCS) and mental component summary score (MCS) of the Medical Outcomes Study SF-36, version 1.0. Cancer survivors enrolled in Medicare managed care have lower PCS and MCS scores than those enrollees who have never been diagnosed with cancer. PCS scores are worse than the MCS scores, and lowest for cancer survivors who are Hispanic, Medicaid enrollees, and those who have low income or education. HRQOL disparities are greatest among cancer survivors diagnosed with lung cancer and those with multiple primary cancer diagnoses. The influence of these variables persists when controlling for multiple variables including comorbidity status. Health plans should focus on addressing these disparities.     

Impact of Long-Term Complications on Quality of Life in Patients with Type 2 Diabetes not Using Insulin

Objectives: The complications of diabetes have the potential to greatly impact the health-related quality of life (HRQOL) of patients with type 2 diabetes. The effect of diabetic complications on HRQOL was assessed in 1233 patients with type 2 diabetes who were not using insulin.
Methods and data: Patients were aged 35 and older and had stable fasting serum glucose (FSG) after washout of antidiabetic therapy. Patients who required insulin or suffered from severe cardiovascular or hepatic disease, neuropathy, or retinopathy were excluded. Patients completed the SF-36 generic quality of life questionnaire. Demographic data, including body mass index (BMI), blood glucose hemoglobin A1c (HbA_1c), FSG, and the presence and severity of eight specified diabetic complications were also collected. A linear regression analysis was performed for each of the SF-36 domains and for the physical and mental health summary scales.
Results: The most prevalent diabetic complications were hypertension (46% of patients), peripheral sensory neuropathy (PSN; 12%), coronary artery disease (CAD; 8%), retinopathy (8%), and peripheral vascular disease (PVD; 7%). Most (73%) of the complications were assessed to be mild. PSN was associated with significantly lower scores (i.e., worse quality of life) in the mental health scale; CAD was associated with significant reductions of all but role-emotional and mental health scales of the SF-36; and PVD was associated with significantly lower physical and social functioning scales. Hypertension did not have an independent effect on HRQOL.
Conclusions: The presence of even mild diabetic complications has a significant impact on patients' quality of life. Early diagnosis and treatment is essential to help prevent deterioration of HRQOL in these patients.     

Assessment of quality of life among HIV-infected persons in Pune,India

Objective: To study dimensions of Quality of Life (QOL) amongst HIV infected persons, their relationship with socio-demographic characteristics and disease progression.Design: Cross-sectional study with one time assessment of QOL.Methods: Modified Medical Outcome Study (MOS) core instrument [The Medical Outcome Study 116 core set of Measures of functioning and well being, Appendix A, core survey instrument (internet)] was interview -administered to 100 HIV infected individuals.Results: The instrument showed significant positive inter-domain correlations and desired linear association between QOL scores and the CD4 counts. The scale had a Cronbach α value of 0.75. QOL was markedly affected in the domains of physical health, work and earnings, routine activities and appetite and food intake. Women had significantly lower QOL scores than men despite having less advanced disease. The QOL scores were significantly lower among persons with lower CD4 counts mainly in different domains of physical health.Conclusions: The modified MOS scale had the desired reliability and validity for evaluation of QOL in the HIV-infected persons in India. Low scores in the domains of physical health compared to other domains suggest a strategy to focus on medical intervention. A need for psychosocial intervention for women was perceived. Longitudinal studies must be done to assess the impact of anti-retroviral therapy being rolled out through the national programme on QOL.Source of Funding: National AIDS Research Institute, Intra-mural funds Indian Council Of Medical Research, New Delhi, India.     

299例人类免疫缺陷病毒感染者生命质量的调查

目的用定性访谈和36条目简明量表（short form-36,SF-36）定量调查的方法研究人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者的生命质量,评价HIV感染者的敌意心理趋势。方法在四川、湖北和贵州抽取299例HIV感染者,用SF-36调查其生命质量,并进行信度效度分析。对感染者和防治人员进行访谈,以了解感染者目前最关注的内容。SF-36曾用于与本次调查对象具有相似经济文化背景的四川普通农村居民（1603例）,将两次调查的结果进行比较。通过与相关专家及防治人员进行小组讨论,设计7个条目以评价感染者的敌意心理趋势。结果SF-36共有8个维度,各维度内部一致性信度系数范围0．75～0．90,重测信度系数范围0．54～0．80（40例）。条目与其维度的相关系数范围为0．46～0．97。HIV感染者各个维度平均得分在28．50～77．87之间,四川普通农村居民各个维度平均得分在70．27～91．87之间,各维度得分经Mann-Whitneytest检验,U值在-17．43～-23．87之间,P值均〈0．01。评价敌意心理趋势的7个条目平均得分范围为46．21～82．89。结论HIV感染带来生命质量的严重恶化。SF-36可用于HIV感染者生命质量的研究。     

Impact of hepatitis B and C co-infection on health-related quality of life in HIV positive individuals

Purpose

Concurrent infection with HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) often occurs due to the commonality in risk factors for acquisition. Few studies have examined the effect of co-infection on health-related quality of life (HRQOL) in HIV positive individuals.

Methods

Ontario HIV Treatment Network Cohort Study (OCS) participants who completed an annual interviewer-administered questionnaire on up to three occasions were included. Generalized estimating equations (GEE) were used to assess the impact of HBV and HCV co-infection on physical and mental HRQOL component summary scores (range 0–100) as measured by the Medical Outcomes SF-36 health survey.

Results

As of March 2010, 1,223 participants had completed the questionnaire; 964 were HIV mono-infected, 128 were HIV–HBV co-infected, 112 were HIV–HCV co-infected, and 19 were HIV–HBV–HCV tri-infected. Eighty percent were male, median age 46 (IQR 40–53) years, 61 % Caucasian, median CD4 count 464 (IQR 319–636) cells/mm³, and 74 % had undetectable HIV viremia. Physical HRQOL was lower in HIV–HBV and HIV–HCV co-infected individuals (49.4 (IQR 42.0–53.9) and 48.1 (IQR 36.9–52.8) vs. 51.5 (IQR 45.0–55.4); p = 0.01 and <0.0001) compared to mono-infected individuals. In the multivariable GEE model, the negative impact of HCV remained significant (?2.18; p = 0.01) after adjusting for drug use, smoking, age, and gender. Unadjusted mental HRQOL was lower in HIV–HCV co-infected individuals (44.6 (IQR 34.6–54.0) vs. 48.9 (IQR 36.8–55.9); p = 0.03) compared to mono-infected individuals but no association of mental HRQOL with either co-infection was observed in multivariable GEE models.

Conclusions

HCV appears to negatively impact physical HRQOL suggesting a greater health burden for co-infected individuals. HBV and HCV co-infections were not related to lower mental HRQOL among people living with HIV/AIDS.     

Measuring health related quality of life among women living with HIV

Although women had been under recognized in the literature on HIV/AIDS, increasing numbers of studies have focused on the lives and experiences of women living with HIV/AIDS. Areas of research in which the study of women and HIV continues to be noticeably lacking include health related quality of life (HRQOL). This paper describes HRQOL in an inner city sample of 287 HIV positive non-pregnant women, interviewed as part of a larger multi-site CDC funded study of the reproductive health of women. The average age of the respondents was 33 years and women had known their HIV status an average of 41 months. HRQOL was assessed using a 17-item modified version of the Medical Outcomes Study-HIV Health Survey and demonstrated acceptable internal consistency (0.64-0.89) and variability. Women in our study were similar to other HIV-positive female samples and reported lower levels of well-being and functioning than some HIV-positive male samples. Women's responses to individual items and areas of potential need for health care are discussed. Examination of HRQOL in women with HIV can aid in the comparison of how women and men are affected by HIV and can help health care professionals identify needed services and include possible interventions to promote quality of life. This revised version was published online in June 2006 with corrections to the Cover Date.     

Household income is strongly associated with health-related quality of life among Japanese men but not women

OBJECTIVES: As socio-economic status (SES) strongly reflects individual economic status, evaluating the association between SES and health could provide information that is important for planning integrated economic and public health policies. We examined the association between annual household income as a measure of SES and the eight scale scores of the Medical Outcomes Study Short Form-36 Health Survey (SF-36) as a quantifier of health-related quality of life (HRQOL) in Japan. STUDY DESIGN: Cross-sectional survey. METHODS: Data were from the SF-36 national survey in Japan. A total of 4500 people aged 16 years or older were selected from the entire population of Japan using stratified-random sampling, and 3395 responded to the survey. RESULTS: Men with lower levels of annual household income had lower scores in all SF-36 domains. However, only 'general health perceptions' and 'social functioning' showed statistically significant trends among the women surveyed. In the subgroup of women working full-time, there were no domains that showed significant trends. CONCLUSIONS: A strong association exists between annual household income and SF-36 scores among men, but there is only a limited association among women. The employment and economic policies that affect annual household income potentially influence HRQOL.     

An assessment of factorial structure and health-related quality of life in problem drug users using the Short Form 36 Health Survey

AIMS: To confirm the factorial structure of the Short Form 36 Health Survey (SF-36) in problem drug users and to compare their health-related quality of life (HRQOL) with general Dutch population norms. METHOD: Data of 394 participants from the Amsterdam Cohort Study among drug users, who had completed once the SF-36 standard form (4 weeks recall) between February and August 2005, were analyzed. The factorial structure of the SF-36 was investigated by confirmatory factor analysis. Subsequently, sum scores of the eight SF-36 health dimensions were converted into z-scores by standardizing them with the mean and standard deviation of the corresponding general Dutch population age and gender group. RESULTS: The factor structure was acceptable and also comparable with previous findings. Compared with the general population, participants had significantly lower z-scores on all of the eight SF-36 dimensions, with largest deviations in social functioning (M = -1.13) and mental health (M = -1.01), and smallest deviations in bodily pain (M = -0.32). CONCLUSION: The results corroborate the factorial structure and reliability of the answers of problem drug users to the SF-36. Their HRQOL was low, even though it was assessed irrespective of substance abuse treatment settings.     

Nature and correlates of SF-12 physical and mental quality of life components among low-income HIV adults using an HIV service center

Objectives: This study describes health-related quality of life (HRQOL) among low-income HIV adults using an HIV service center, compares participants scores to US published norms for the general population and persons with chronic conditions, and examines relationships between patient characteristics, nonadherence, and HRQOL. Methods: A cross-sectional survey of individuals on antiretroviral therapy was conducted. The Medical Outcomes Study SF-12 was used to assess HRQOL. Medication nonadherence was assessed using the 9-item Morisky Adherence Scale. Data also were collected on social support, CD4 cell count, and time since diagnosis. Results: Approximately 84% of the 86 participants were male, 50% were white, and 39% were black. The ean ± SD Physical component summary (PCS-12) score of 41.0 ± 12.5 and Mental component summary (MCS-12) score of 41.9 ± 11.0 were lower than US general population norms (p < 0.001). PCS-12 scores were similar to those of patients with other chronic conditions. Respondents reported lower MCS-12 scores than patients with hypertension and diabetes (p < 0.006). Employment and higher social support had positive associations with PCS-12 scores and nonadherence had a negative association with MCS-12 scores (p < 0.05). Conclusions: HRQOL in this sample of low-income HIV adults was comparable to other HIV populations. Identifying strategies for increasing social support and medication adherence for economically disadvantaged persons with HIV/AIDS may improve their HRQOL.Rodney Anderson: At the time of the study Dr. Anderson was Director of Health & Education Services The Damien Center 1350 Pennsylvania Indianapolis, IN 46202, USA