Longitudinal changes in health-related quality of life in normal glucose tolerance,prediabetes and type 2 diabetes: results from the KORA S4/F4 cohort study

Purpose

The aim of this study was to examine how transition between normal glucose tolerance, prediabetes and diabetes over a 7 year period is associated with change in health-related quality of life (HRQL) in an elder German population-based cohort.

Methods

We used data from 1,046 participants of the KORA S4/F4 cohort study aged 55–74 years at baseline. Based on an oral glucose tolerance test, prediabetes was defined as impaired fasting glucose and/or impaired glucose tolerance. HRQL was assessed with the SF-12 questionnaire. Using linear regression, we estimated mean change in HRQL over time, depending on glucose status at baseline and follow-up, adjusted by demographic and lifestyle variables.

Results

Individuals progressing to prediabetes or diabetes experienced a greater loss in the physical component score than patients with persistent normal glucose tolerance (?2.31 and ?7.44 vs. ?1.08), but the difference was only significant for subjects converting to diabetes. Subjects with prediabetes at baseline and diabetes at follow-up had a significant loss in mental health compared to subjects with persistent prediabetes.

Conclusions

There is first evidence that worsening of glucose metabolism over time is associated with deteriorating HRQL, however, further and larger longitudinal studies are needed to confirm these findings.     

The relationship between health-related quality of life and weight loss

OBJECTIVE: This is a report of health-related quality of life (HRQOL) changes in obese patients completing at least 1 year of outpatient treatment in a weight reduction program combining phentermine-fenfluramine and dietary counseling. RESEARCH METHODS AND PROCEDURES: Participants were 141 women (87.6%) and 20 men (12.4%) who had an average body mass index at intake of 41.1 kg/m(2) (SD = 7.0, range = 29.5 to 67.0 kg/m(2)) and an average age of 44.9 years (SD = 9.3, range = 23 to 65 years). HRQOL was assessed at intake and at 1-year follow-up using the Impact of Weight on Quality of Life (IWQOL)-Lite questionnaire. The relationship between HRQOL changes and weight loss was examined using Pearson correlations. Clinically meaningful change in HRQOL was defined as a 1.96 SEM reduction in IWQOL-Lite total score. RESULTS: On average, participants lost 20.2 kg or 17.6% of their weight over the 1-year period. Of the participants, 15.5% lost <10% of their weight, 24.2% lost 10% to 14.9%, 23.6% lost 15% to 19.9%, and 36.6% lost 20% or more. All five IWQOL-Lite scales and total score showed statistically significant improvement over the 1-year period. Changes in IWQOL-Lite scores from intake to 1 year showed statistically significant correlations with percentage of weight loss for all subscales and total score. Subscale correlations with weight loss ranged from 0.166 (Public Distress) to 0.396 (Physical Function) and was 0.370 for the total score. Forty-four percent of participants losing <10% met the criterion of clinically meaningful change, compared with 51.3% losing 10% to 14.9%, 55.3% losing 15% to 19.95%, and 76.3% losing >20%. For total score and for three of the five IWQOL-Lite scales (Physical Function, Self-Esteem, and Sexual Life), the relationship between weight loss and clinically meaningful change was linear and was significant at p < 0.05. Physical Function and Self-Esteem were most strongly affected by weight loss. DISCUSSION: HRQOL changes, as measured by an obesity-specific instrument (IWQOL-Lite), are strongly related to weight reduction.     

A bi-directional association between weight change and health-related quality of life: evidence from the 11-year follow-up of 9916 community-dwelling adults

Quality of Life Research - To examine the prospective associations between body mass index (BMI) and health-related quality of life (HRQoL). Data were extracted from a longitudinal, nationally...     

The association between motor vehicle injuries and health-related quality of life: a longitudinal study of a population-based sample in the United States

Purpose

As many as 3 million US residents are injured in traffic-related incidents every year leaving many victims with disabling conditions. To date, limited numbers of studies have examined the effects of traffic-related injuries on self-reported health. This study aims to examine the association between health-related quality of life (HRQOL) and traffic-related injuries longitudinally in a nationally representative sample of US adult population.

Methods/approach

This is a longitudinal study of adult participants (age ≥18) from seven panels (2000–2007) of the Medical Expenditure Panel Survey. The dependent variables included the physical and mental components of the SF-12, a measure of self-reported health. The outcome was assessed twice during the follow-up period: round 2 (~4–5 months into the study) and round 4 (~18 months into the study) for 62,298 individuals. Two methods estimate the association between traffic-related injuries and HRQOL: a within person change using paired tests and a between person change using multivariable regression adjusting for age, sex, income and educational level.

Results

Nine hundred and ninety-three participants reported traffic-related injuries during the follow-up period. Compared to their pre-crash HRQOL, these participants lost 2.7 of the physical component score while their mental component did not change. Adjusted results showed significant deficits in the physical component (?2.84, p value = <.001) but not the mental component (?0.07, p value = .83) of HRQOL after controlling for potential confounders.

Conclusion

Traffic injuries were significantly associated with the physical component of HRQOL. These findings highlight the individual and societal burden associated with motor vehicle crash-related disability in the United States.     

Association of passive and active smoking with incident type 2 diabetes mellitus in the elderly population: the KORA S4/F4 cohort study

Active smoking is a risk factor for type 2 diabetes (T2DM), but it is unclear whether exposure to environmental tobacco smoke (ETS) is also associated with T2DM. The effect of passive and active smoking on the 7-year T2DM incidence was investigated in a population-based cohort in Southern Germany (KORA S4/F4; 1,223 subjects aged 55–74 years at baseline in 1999–2001, 887 subjects at follow-up). Incident diabetes was identified by oral glucose tolerance tests or by validated physician diagnoses. Among never smokers, subjects exposed to ETS had an increased diabetes risk in the total sample (odds ratio (OR) = 2.5; 95% confidence interval (CI): 1.1, 5.6) and in a subgroup of subjects having prediabetes at baseline (OR = 4.4; 95% CI: 1.5, 13.4) after adjusting for age, sex, parental diabetes, socioeconomic status, and lifestyle factors. Active smoking also had a statistically significant effect on diabetes incidence in the total sample (OR = 2.8; 95% CI: 1.3, 6.1) and in prediabetic subjects (OR = 7.8; 95% CI: 2.4, 25.7). Additional adjustment for components of the metabolic syndrome including waist circumference did not attenuate any of these associations. This study provides evidence that both passive and active smoking is associated with T2DM.     

The relation between personality,informal caregiving,life satisfaction and health-related quality of life: evidence of a longitudinal study

Purpose

Personality characteristics of the caregiver might play a role in the relation between informal caregiving and health-related quality of life as well as life satisfaction. However, a limited body of research has examined this relation. This study aimed to examine the role personality characteristics of the caregiver might play in the relation between informal caregiving and well-being outcomes using a longitudinal approach.

Methods

Data were derived from the large Panel ‘Labour Market and Social Security.’ This is an annual household survey, which is conducted by order of the Institute for Employment Research covering persons and households registered as residents of Germany. The SF-12 was used to capture health-related quality of life (covering physical and mental health). A short version of the Big Five Inventory (BFI-K) was used to quantify personality factors. Life satisfaction was measured by a single-item measure. Concentrating on these factors, we used data from the third (2008/2009), sixth (2012), and ninth wave (2015). 34,548 observations were used in fixed effects regressions.

Results

Adjusting for various potential confounders, linear fixed effects regressions showed that the onset of informal caregiving reduced life satisfaction (β?=???.14, p?<?.01), but not physical and mental health. The relation between informal caregiving and life satisfaction was significantly moderated by agreeableness (p?<?.01).

Conclusions

Findings of the present study emphasized that agreeableness moderates the relationship between informal caregiving and life satisfaction. Measuring personality characteristics of the informal caregiver is important for tailoring interventional strategies in order to increase the benefit of these programs.

     

Psychological morbidity and health-related quality of life after injury: multicentre cohort study

Purpose

To demonstrate the impact of psychological morbidity 1 month post-injury on subsequent post-injury quality of life (HRQoL) in a general injury population in the UK to inform development of trauma care and rehabilitation services.

Methods

Multicentre cohort study of 16–70-year-olds admitted to 4 UK hospitals following injury. Psychological morbidity and HRQoL (EQ-5D-3L) were measured at recruitment and 1, 2, 4 and 12 months post-injury. A reduction in EQ-5D compared to retrospectively assessed pre-injury levels of at least 0.074 was taken as the minimal important difference (MID). Multilevel logistic regression explored relationships between psychological morbidity 1 month post-injury and MID in HRQoL over the 12 months after injury.

Results

A total of 668 adults participated. Follow-up rates were 77% (1 month) and 63% (12 months). Substantial reductions in HRQoL were seen; 93% reported a MID at 1 month and 58% at 12 months. Problems with pain, mobility and usual activities were commonly reported at each time point. Depression and anxiety scores 1 month post-injury were independently associated with subsequent MID in HRQoL. The relationship between depression and HRQoL was partly explained by anxiety and to a lesser extent by pain and social functioning. The relationship between anxiety and HRQoL was not explained by factors measured in our study.

Conclusions

Hospitalised injuries result in substantial reductions in HRQoL up to 12 months later. Depression and anxiety early in the recovery period are independently associated with lower HRQoL. Identifying and managing these problems, ensuring adequate pain control and facilitating social functioning are key elements in improving HRQoL post-injury.

     

The impact of menopause on health-related quality of life: results from the STRIDE longitudinal study

Purpose  

We examine the impact of menopausal status, beyond menopausal symptoms, on health-related quality of life (HRQoL).     

The association between post-diagnosis health behaviors and long-term quality of life in survivors of ductal carcinoma in situ: a population-based longitudinal cohort study

Purpose

Women diagnosed with ductal carcinoma in situ (DCIS) often experience adverse changes in health-related behaviors following diagnosis. The impact of health behaviors on long-term quality of life (QoL) in DCIS survivors has not been investigated.

Methods

We examined the association of post-diagnosis body mass index (BMI), physical activity, alcohol, and smoking with QoL among 1448 DCIS survivors aged 20–74 enrolled in the population-based Wisconsin in situ Cohort from 1997 to 2006. Health behaviors and QoL were self-reported during biennial post-diagnosis interviews. Physical and mental QoL were measured using the validated SF-36 questionnaire. Generalized linear regression was used to determine the association between behaviors and QoL with adjustment for confounders. Lagged behavior variables were used to predict QoL during follow-up and avoid reverse causation.

Results

Women reported 3,536 QoL observations over an average 7.9 years of follow-up. Women maintaining a healthy BMI had on average a significantly higher summary measure score of physical QoL than obese women (normal versus obese: β?=?3.02; 2.18, 3.85). Physical QoL scores were also elevated among those who were physically active (5?+?h/week vs. none: β?=?1.96; 0.72, 3.20), those consuming at least seven drinks/week of alcohol (vs. none; β?=?1.40; 0.39, 2.41), and nonsmokers (vs. current smokers: β?=?1.80; 0.89, 2.71). Summary measures of mental QoL were significantly higher among women who were moderately physically active (up to 2 h/week vs. none: β?=?1.11; 0.30, 1.92) and nonsmokers (vs. current smokers: β?=?1.49;0.45, 2.53).

Conclusions

Our results demonstrate that maintaining healthy behaviors following DCIS treatment is associated with modest improvements in long-term QoL. These results inform interventions aimed at promoting healthy behaviors and optimizing QoL in DCIS survivors.

     

Smoking status and health-related quality of life: a longitudinal study in young adults

Purpose

The possibility that tobacco use affects health-related quality of life (HRQoL) has attracted interest. However, a lack of prospective evidence weakens the case for a causal relationship. The aim was to examine the longitudinal relationship between change in smoking status and change in HRQoL in young adults.

Methods

We conducted a population-based cohort study with data collected in 2004–2006 (aged 26–36) and 2009–2011 (aged 31–41). Exposure was change in self-reported smoking status during follow-up. Outcomes were changes in physical and mental HRQoL measured by SF-12.

Results

For physical HRQoL (n = 2080), quitters had a 2.12 (95 % confidence interval (CI) 0.73, 3.51) point improvement than continuing smokers, whereas former smokers who resumed smoking had a 2.08 (95 % CI 0.21, 3.94) point reduction than those who maintained cessation. Resumed smokers were 39 % (95 % CI 10, 75 %) more likely to have a clinically significant (>5 point) reduction of physical HRQoL than former smokers who maintained cessation. In contrast, quitters were 43 % (95 % CI 3, 98 %) more likely to have a clinically significant (>5 point) improvement in physical HRQoL than continuing smokers. Change in smoking status was not significantly associated with change in mental HRQoL (n = 1788).

Conclusions

Smoking by young adults was cross-sectionally associated with lower physical HRQoL and longitudinally associated with reductions in physical HRQoL. The expectation of short- to medium-term gains in physical HRQoL as well as long-term health benefits may help motivate young adult smokers to quit.

     

Predictors of health-related quality of life in people with a complex chronic disease including multimorbidity: a longitudinal cohort study

Purpose

Factors that predict the health-related quality of life (HRQoL) of people with complex chronic diseases have not been investigated to date. Determining the impact of disease on daily activities is a factor that is particularly important with this group of people. This study examined the influence of a range of predictors (including the impact of chronic diseases on daily activities), on HRQoL in patients with complex chronic diseases over a 12-month period.

Method

A longitudinal cohort study was conducted with outcomes measured at baseline, 3, 6 and 12 months post-baseline. Adults attending an Australian community-based rehabilitation service were included. HRQoL was measured using the SF-36 and corresponding preference-based health utility. Predictor variables included sociodemographic factors, disease factors (e.g. impact of diseases on daily activities), intervention factors, psychosocial factors and HRQoL components that were not included as the dependent variable. Linear mixed-effects regression was used to examine the relationship between predictor variables and HRQoL.

Results

Data from 351 participants were included. The impact of chronic disease on daily activities was the most frequent significant predictor of HRQoL outcomes. Other significant predictors included the impact of chronic back pain or sciatica on daily activities, the number of comorbidities, general health functioning and psychological distress.

Conclusion

Models of health care for people with complex chronic disease may be enhanced by greater focus on patients’ daily activities during assessment and intervention delivery. The range of significant predictors highlights the importance of an interdisciplinary team for managing complex chronic disease or targeted intervention strategies.

     

The predictive validity of health-related quality of life measures: mortality in a longitudinal population-based study

Objective This study examined the association between health-related quality of life (HRQL) and mortality risk, and compared the predictive ability of Health Utilities Index Mark 3 (HUI3) with self-rated health (SRH). Methods Data were from the 1994/95 Canadian National Population Health Survey, consisting of 12,375 women and men aged 18 and older. Cox proportional hazards regression models were performed to estimate mortality risk over eight years. Results Mortality risks for people reporting good, fair, and poor health at baseline were, respectively, 1.44 (95% confidence interval [CI] 1.04, 2.00), 1.97 (1.35, 2.88), and 3.21 (2.08, 4.95) times greater than those who reported excellent health. In a model excluding SRH, the effect of HUI3 on mortality was strong and significant (HR = 0.47; 95%, 0.33, 0.67) when adjusted for possible confounders. When HUI3 and SRH were considered simultaneously, the effect of the HUI3 on mortality was somewhat attenuated, but still significant (HR = 0.61, 0.42, 0.89) after adjusting for potential confounders. Conclusions Although SRH is a modestly stronger predictor of mortality than HUI3, HUI3 adds to the mortality prediction ability of SRH.     

The association between sociodemographic factors,frailty, and health-related quality of life in older inpatients: a cross-sectional study

Quality of Life Research - This cross-sectional study aims to explore the association between frailty and domains of quality of life (QOL) among hospitalized patients in older age under...     

Sleep disturbance in relation to health-related quality of life in adults: The fels longitudinal study

Objective  Sleep disturbances are prevalent problems in the general population. Symptoms of insomnia can impact various physical and mental conditions. Furthermore, sleep disturbances may worsen the quality of life independently of co-occurring medical conditions. In this study, we examined the relationships between self-reported sleep disturbance symptoms and health-related quality of life measures in the Fels Longitudinal Study. Design  Cross-sectional study. Participants  A total of 397 adults (175 men and 222 women) aged 40 years and older were included in the present study. Measurements  Three self-reported sleep disturbance measures (difficulty falling asleep, nocturnal awakenings and maintaining sleep, and daytime tiredness) were collected between 2003 and 2006. Health-related quality of life measures were assessed using the Medical Outcomes Survey Short Form (SF)-36. Socio-demographic status (marital status, employment status, and education) and current medical conditions were collected from participants during study visits. Results  Individuals who reported frequent sleep disturbances showed significantly worse quality of life on all SF-36 subscales examined. The odds ratio (OR) ranged from 1.71 to 18.32 based on symptoms of insomnia across seven SF-36 domains in analyses adjusted for significant covariates influencing quality of life. Participants with severe sleep disturbances (both sleep problems and daytime impairment) showed generally higher odds of reporting poor SF-36 scores (adjusted ORs; 5.88–17.09) compared to participants with no problems. Conclusion  Sleep disturbance is comprehensively and independently associated with poor health-related quality of life in middle-aged and older adults.     

Oral health-related quality of life determinants throughout adolescence: a cohort study in Brazil

Quality of Life Research - Oral health-related quality of life (OHRQoL) is a complex construct that reflects the interaction among well-being, socioeconomic, oral health status, and also contextual...     

The longitudinal link between visual acuity and health-related quality of life in patients with diabetic retinopathy

Background  

This study characterized the degree of change in health-related quality of life (HRQL) associated with change in visual acuity among patients with diabetic retinopathy.     

Mental health-related quality of life and the timing of motherhood: a 16-year longitudinal study of a national cohort of young Australian women

Purpose

We examine timing of motherhood in a longitudinal cohort of young Australian women, and its relationship with mental health-related quality of life (SF-36 MHI-5), and with sociodemographic, health behaviour and health-related variables.

Methods

We analysed longitudinal self-report data from a nationally representative cohort of 10,332 Australian women born 1973–1978, surveyed 6 times between 1996 (aged 18–23) and 2012 (aged 34–39).

Results

Group-based trajectory modelling identified four groups. Normative Mothers (46%, mean age at motherhood 30.5 years) made the transition to motherhood close to the Australian median age. Early Mothers (25%, 25.2 years) and Very Early Mothers (7%, 20.0 years) made this transition earlier; Not Mothers (22%) had not given birth. Generalised linear mixed models showed that all groups improved mean MHI-5 scores over time. Patterns of group differences were complex: Normative and Early Mothers scored consistently highest; Very Early Mothers scored lowest at most surveys; Not Mothers’ scores increased relative to others over time. Most effects disappeared after adjustment for confounders. Early and Very Early Mothers showed multiple indicators of social disadvantage, while Not Mothers had very low rates of marriage.

Conclusions

Timing of motherhood is embedded in sociodemographic and personal contexts. Women with socioeconomic advantages were characterised by higher mental health-related quality of life and later transition to motherhood, but adjustment for relative advantage attenuated differences in mental health-related quality of life. The overall findings suggest a pattern of positive adaptation to circumstances, with mental health-related quality of life improving through early adulthood regardless of timing of motherhood.