Morbidity and quality of life and the moderating effects of level of education in the elderly.

The moderating effect of level of education (as an indicator of socioeconomic status) on the associations between chronic medical morbidity and six domains of health-related quality of life (physical function, role function, social function, health perceptions, bodily pain and mental health) is studied in a large community-dwelling elderly sample (N = 5279). The results showed that health-related quality of life is substantially affected by chronic medical morbidity, and that level of education has weak, but significant unique contributions to physical function, social function, health perceptions, and mental health. We did not find substantial evidence for the differential vulnerability hypothesis. At best, low education might amplify the negative effects of the number of chronic medical conditions on mental health only, but this result was not confirmed in four specific disease groups.     

Comparing patients with depressive complaints and patients with chronic medical conditions on their functioning and medical consumption

BACKGROUND: Several studies have found that depressive complaints are associated with limitations in functioning that are at least comparable with those of chronic medical conditions, such as diabetes or lung diseases. However, the consequences of these associations for the utilization of general health care services are not known, certainly not for health care settings outside the United States. AIMS OF THE STUDY: To investigate the association of depressive complaints with functioning and health care utilization, comparing this with the association of chronic medical conditions with functioning and health care utilization. METHODS: In a community-based sample of Dutch adults (N=9428), chronic conditions (21 types) and depressive complaints were assessed by self-report. Only active conditions and depressive complaints, for which treatment was taking place, were selected for the analyses. Health status and disabilities were also assessed by self-report. Information on the utilization of health care services was based on self-report as well as on data extracted from a claims database. This database also provided information on the use of psychoactive medications. The associations between chronic conditions, depressive complaints and dependent variables were determined by analysis of variance or regression analysis, adjusting for possibly confounding factors (gender, age, living conditions). RESULTS: Depressive complaints, more than any chronic condition (except back problems), were associated with fatigue, poor subjective health and days spent in bed. Those having depressive complaints visited their general practitioner (GP) more often than the others. They also contacted a medical specialist more often than other patient categories, apart from patients with heart diseases. The combination of depressive complaints and chronic medical conditions was not associated with increased utilization or lower functioning. CONCLUSION: Depressive complaints are not only connected to functioning, but also to the utilization of general health care services. The strength of these associations is comparable with that of chronic medical conditions. This study stresses the pertinence of (research on) the management and treatment of patients with depressive complaints in general health care settings.     

Health-related and overall quality of life of patients with chronic hip and knee complaints in general practice

Background: Information about quality of life of patients with chronic hip or knee complaints in general practice is scarce. This study describes the health-related and overall quality of life (HRQL) of these complaints. Methods: Data were obtained from a cohort study in general practice. HRQL at three months follow-up was analysed. HRQL was measured as: symptoms, physical, psychological and social functioning, and general health perceptions, using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the MOS 36-item short-form-health survey (SF-36). Overall quality of life was measured using a 5-point rating scale. Results: The results show that patients with chronic hip or knee complaints have a substantial lower HRQL compared to patients who had recovered from baseline hip or knee complaints. The largest effect was found on symptoms and physical functioning: up to 2.9 standard deviations below patients who had recovered from baseline hip or knee complaints. Scores of patients with both chronic hip and knee complaints were significantly worse than scores of patients with only knee complaints on most subscales. Conclusion: In patients with chronic hip or knee complaints the worst scores were seen on scales that measure symptoms and physical functioning, but still a substantially lower score was obtained for overall quality of life. Quality of life was poorer for patients with both chronic hip and knee complaints compared to those with chronic hip or knee complaints only.     

Suburban sprawl and physical and mental health

OBJECTIVE: To study the association between objective measures of suburban sprawl and chronic medical conditions and mental health disorders in the USA. METHODS: Cross-sectional analysis of survey data merged with objective measures of suburban sprawl. Outcomes are self-reported medical conditions, mental health disorders and health-related quality of life. RESULTS: Sprawl significantly predicts chronic medical conditions and health-related quality of life, but not mental health disorders. An increase in sprawl from one standard deviation less to one standard deviation more than average implies 96 more chronic medical problems per 1000 residents, which is approximately similar to an aging of the population of 4 years. CONCLUSIONS: A robust association between sprawl and physical (but not mental) health suggests that suburban design may be an important new avenue for health promotion and disease prevention.     

Health-related quality of life (HRQoL) in patients with cancer and other concurrent illnesses

This study analyzed the impact of eight common chronic medical conditions on cancer patients' health-related quality of life (HRQoL) as measured by the functional living index-cancer (FLIC). The FLIC was administered to a population of 405 people in 14 communities in the North Central US within 4-8 weeks of diagnosis with breast or colorectal cancer. At that time, patients also self-reported any other health conditions for which they had been receiving medical treatment. The impact of the selected chronic conditions on the FLIC scores was analyzed using Student's t-tests and linear multiple regression. In the bivariate analysis, patients with heart/circulation problems had lower FLIC total scores (p < 0.05), physical well-being subscale scores (p < 0.05), and nausea subscale scores (p < 0.01). Patients with diabetes had lower nausea subscale scores (p < 0.05). The social well-being subscale score was higher with the report of arthritis/joint problems (p = 0.001). In multivariate analysis adjusted for age, arthritis/joint problems were predictive of the social well-being (p < 0.01) and hardship due to cancer (p < 0.05) subscale scores; heart/circulation problems (p < 0.001) and diabetes were predictive of the nausea subscale scores. ECOG performance status was significant predictor for the FLIC total and all of the subscale scores. HRQoL as measured with the FLIC scores in patients with cancer is impacted by the presence of other concurrent health conditions; this finding has implications for HRQoL theory and application.     

The health-related quality of life of patients with epilepsy compared with angina pectoris, rheumatoid arthritis, asthma and chronic obstructive pulmonary disease

The objective of this study was to compare the health-related quality of life (HRQL) of patients with epilepsy with populations suffering from different chronic diseases, using the short form 36 (SF-36) health profile measure. The populations to be compared were adult patients drawn from hospital based registers, with confirmed epilepsy (n = 397), angina pectoris (n = 785), rheumatoid arthritis (n = 1030), asthma (n = 117) and chronic obstructive pulmonary disease (COPD) (n = 221). Health-related quality of life scores were compared using analysis of covariance (ANCOVA) for predicting mean scores adjusted for age, gender, education and comorbidity. Patients with epilepsy on average scored highest on all scales, reflecting that in our sample the majority had well-controlled epilepsy. Our results indicate that the HRQL of a representative sample of patients with epilepsy is good, when compared with other chronic disorders, although reduced in several dimensions compared with a general reference population. Patients with rheumatoid arthritis (RA) and COPD scored lowest on the physical function scales, while rheumatoid arthritis patients reported most pain. This revised version was published online in June 2006 with corrections to the Cover Date.     

Leisure time physical activity and health-related quality of life: Cross-sectional and longitudinal associations

Studies that relate change in physical activity to change in health-related quality of life in the general population are needed to confirm associations suggested by cross-sectional studies. In the present study, cross-sectional as well as longitudinal associations between leisure time physical activity and health-related quality of life were studied in an apparently healthy population. The present study showed cross-sectional associations between at least moderately intense leisure time physical activity and general health perceptions, vitality, physical functioning and role limitations due to physical health problems. No associations were present for total leisure time physical activity. Change in leisure time physical activity was associated with change in social functioning in men as well as in women, irrespective of the intensity of physical activity. Only in men, change in total leisure time physical activity was associated with change in vitality and general mental health. In our study, cross-sectional associations were not confirmed by longitudinal analyses. Cross-sectional associations were mainly found for physical components of health-related quality of life, whereas longitudinal associations were predominantly observed for mental components of health-related quality of life. Confirmation of our results by those of other studies is needed in order to quantify health promotion messages.     

Does obesity contribute as much to morbidity as poverty or smoking?

The prevalence of obesity is increasing in America, but its impact on morbidity relative to other health risks is unclear. This paper compares the effects of overweight, poverty, smoking and problem drinking on occurrence of chronic conditions and health-related quality of life. The data were collected from a nationally representative household telephone survey of 9585 adults fielded in 1998, using self-reported measures of height and weight, poverty, smoking status, problem drinking, chronic conditions and SF-12 global scales. Regression analyses were used to estimate effects of health risk factors on morbidity. Thirty-six percent of adults are overweight but not obese (25< or =BMI<30) and another 23% are obese (BMI> or =30). Controlling for demographics, obesity is associated with more chronic conditions and worse physical health-related quality of life (P<0.01). Smoking history and poverty predict having chronic conditions, but their effect sizes are significantly smaller. Even after controlling for chronic conditions, obesity predicts physical health-related quality of life, in that case with an effect size similar to poverty. The effect of problem drinking is always smaller. Obesity is highly prevalent and associated with at least as much morbidity as are poverty, smoking and problem drinking. Nevertheless, the latter have achieved more consistent attention in recent decades in clinical practice and public health policy.     

Adalimumab for Rheumatoid Arthritis

Third-party payors and national health systems require evidence that new medications for rheumatoid arthritis are cost effective. To determine cost effectiveness, one must consider the cost of a given therapy versus the long-term cost of the disease, with and without therapy. The direct and indirect costs of rheumatoid arthritis over the course of the disease, including the considerable costs related to hospitalization and disability, have been quantified. Resource utilization and treatment costs are high for patients with rheumatoid arthritis, and there is a strong link between functional disability and direct cost of care.Traditional disease-modifying antirheumatic drugs (DMARDs) [such as methotrexate and gold] have limited long-term effects in improving lives and avoiding costs for patients with rheumatoid arthritis. Tumor necrosis factor (TNF) antagonists, the newest class of rheumatoid arthritis drug therapies, significantly improve patient outcomes, including reducing the signs and symptoms of rheumatoid arthritis, improving physical function and health-related quality of life, and inhibiting radiographie damage. Failing to treat rheumatoid arthritis effectively is very costly; effective treatment includes early, aggressive therapy. As a result, the National Health Service in the UK, other societal decision-makers, and third-party payors have recommended the use of TNF antagonists, in many instances, for the treatment of rheumatoid arthritis.The TNF antagonists — infliximab, etanercept, and the most recently approved, adalimumab — address the limitations of traditional DMARDs, thus setting a new therapeutic standard for rheumatoid arthritis. Data from three key studies (Anti-TNF Research Program of the Monoclonal Antibody Adalimumab in Rheumatoid Arthritis, DE019 and DE011) indicate that adalimumab provides a rapid, sustainable, predictable, and significantly greater reduction in the signs and symptoms of rheumatoid arthritis than traditional DMARDs. Adalimumab yields significantly less structural joint damage as measured by the total Sharp scores and scores on its two major components: joint erosions and joint space narrowing. It also improves physical function (as measured by the Health Assessment Questionnaire Disability Index) and health utility (as measured by the Health Utilities Index Mark 3).In conclusion, rheumatoid arthritis and other musculoskeletal diseases are costly, but an upfront investment in highly effective therapies may provide long-term cost savings compared with traditional therapies. The immediate, out-of-pocket costs of TNF antagonists are greater than traditional DMARDs, but with the potential to significantly improve response rates, inhibit structural joint damage, and improve disability and health utility, TNF antagonists have the potential to be more cost effective over the long run. TNF antagonists can be valuable for patients in need and therefore appropriate for reimbursement by national health systems and third-party payors.     

Messung der gesundheitsbezogenen Lebensqualität mit dem SF-8

The SF-8, a relatively new instrument for measuring health-related quality of life, was used in the German National Telephone Health Survey 2003. The SF-8 provides results which are comparable to those of the SF-36, the instrument most commonly used internationally. The German National Telephone Health Survey provides nationally representative data for the residential population in Germany aged 18 and older. In addition to the measurement of health-related quality of life, comprehensive information on chronic illnesses and complaints, health care needs, utilisation of health care, risk factors, risk behaviour and social status is also collected, making differentiated analyses possible. According to the data collected, men rate their quality of life in all dimensions higher than women. With increasing age, quality of life for both men and women decreases in the physical dimensions, while increasing in the mental health dimensions. Apart from chronic disease and pain having a negative impact on health-related quality of life, social differences are also observable, in that worse health-related quality of life is reported by respondents with lower socioeconomic status.     

类风湿关节炎患者生命质量/患者报告结局影响因素分析:QLICD-RA的应用

目的 探究影响类风湿关节炎患者生命质量/患者报告结局的因素,为提高患者生命质量提供科学依据。方法 应用类风湿关节炎生命质量测定量表（quality of life instruments for chronic diseases in rheumatoid arthritis （version 2.0）,QLICD-RA（V 2.0））调查100例住院患者的生命质量,并记录临床相关客观指标。应用t检验、方差分析、多元逐步回归等统计学方法分析影响类风湿关节炎患者生命质量/患者报告结局的因素。结果 单因素分析中,不同文化程度和家庭经济状况的患者生命质量总分及各领域得分差异均有统计学意义（均有P<0.05）。多元逐步回归分析中,筛选出28关节中的关节肿胀得分（disease activity score-28,DAS28）、家庭经济状况（economy conditions, EC）和天门冬氨酸氨基转移酶（aspartate aminotransferase,AST）与丙氨酸氨基转移酶（alanine aminotransferase,ALT）比值（AST/ALT）这3个变量进入回归方程,其回归方程为:Y=55.239-1.390DAS28+12.729EC-4.491AST/ALT,调整决定系数R_a2=0.558。结论 类风湿关节炎患者生命质量/患者报告结局受多种因素影响,缓解患者症状、提高经济水平对提高类风湿关节炎患者的生命质量/患者报告结局有重要意义。     

Activities of daily living, chronic medical conditions, and health-related quality of life in older adults

This study investigated associations between chronic medical conditions, activities of daily living (ADL), and health-related quality of life (HRQOL). Our findings suggest that the number of ADL limitations reported by older adults is associated with their HRQOL. Findings from our analyses also suggest that the association between having multiple comorbid conditions and HRQOL is stronger for those with no ADL limitations than those with at least some limitations. These data will aid practitioners in determining the relative importance of chronic medical conditions and ADL limitations on HRQOL and demonstrate how ADL limitations and comorbid conditions may differentially impact HRQOL.     

Valued life activity disability played a significant role in self-rated health among adults with chronic health conditions

ObjectiveBecause self-rated health (SRH) is strongly associated with health outcomes, it is important to identify factors that individuals take into account when they assess their health. We examined the role of valued life activities (VLAs), the wide range of activities deemed to be important to individuals, in SRH assessments.Study Design and SettingData were from three cohort studies of individuals with different chronic conditions—rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and chronic obstructive pulmonary disease (COPD). Each cohort's data were collected through structured telephone interviews. Logistic regression analyses identified factors associated with ratings of fair/poor SRH. All analyses included sociodemographic characteristics, general and disease-specific health-related factors, and general measures of physical functioning.ResultsSubstantial portions of each group rated their health as fair/poor (RA 37%, SLE 47%, COPD 40%). In each group, VLA disability was strongly associated with fair/poor health (RA: OR = 4.44 [1.86,10.62]; SLE: OR = 3.60 [2.10,6.16]; COPD: OR = 2.76 [1.30,5.85]), even after accounting for covariates.ConclusionVLA disability appears to play a substantial role in individual perceptions of health, over and above other measures of health status, disease symptoms, and general physical functioning.     

锦州市空巢老人慢性病患病现状及其影响因素分析

摘要:目的 了解辽宁省锦州市空巢老人慢性疾病患病现状及其影响因素,为提高空巢老人生活质量及合理有效分配医疗卫生资源提供理论指导。方法 于2014年1-12月,应用整群随机抽样方法,抽取辽宁省锦州市超过60岁的空巢老人2058例为研究对象,对其实施问卷调查。结果 锦州市空巢老人慢性病的患病率是76.4%,其中患1、2、3、4和≥5种慢病者分别占患慢性病者总数的36.5%、27.1%、15.9%、9.1%和11.4%。总患病率居于前5位的慢性病分别为高血压、心脏病、脑血管疾病、糖尿病、风湿性关节炎;城市户口空巢老年人慢性病患病率前5位分别是高血压、心脏病、糖尿病、风湿性关节炎、骨质疏松;农村户口的空巢老人慢性病患病率前5位分别是高血压、骨质疏松、脑血管疾病、心脏病、风湿性关节炎。多重logistic回归分析结果显示,年龄超过70岁、有其他医疗保险和农村合作医疗保险是锦州市空巢老人慢性病患病的危险因素;而收入足够满足需要、在职工作、睡眠正常、生活质量良好、日常生活能力正常、心理症状指数正常是锦州市空巢慢性病患病的保护因素。结论 锦州市空巢老人慢性病患病率较高;收入是否满足需要、医保类型、年龄、工作现状、日常生活能力、睡眠质量、生活质量、心理症状指数是空巢老人慢性病患病的主要影响因素。     

Depression and anxiety symptoms in bronchiectasis: associations with health-related quality of life

Background and purpose

Bronchiectasis causes pulmonary infections and loss of lung function, resulting in chronic respiratory symptoms and worsening health-related quality of life. The aims of this study were to measure symptoms of depression and anxiety in a sample of patients with bronchiectasis and evaluate their relationship to health outcomes and health-related quality of life.

Methods

This cross-sectional study included adolescents and adults with bronchiectasis. Patients completed the hospital anxiety and depression scale and the St. George respiratory questionnaire. Health outcome data, including clinical, radiological and spirometric values, were recorded from medical charts.

Results

Ninety-three participants with bronchiectasis of any aetiology were recruited: 20 % had elevated depression-related scores and 38 % had elevated anxiety-related scores. Increased symptoms of depression and anxiety were significantly associated with age; anxiety was associated with more frequent exacerbations. Regression analyses indicated that after controlling for demographic (gender and age) and clinical variables (exacerbations frequency, daily sputum, aetiology and spirometry), both depression and anxiety symptoms predicted significantly worse health-related quality of life. In comparison with other predictors, psychological symptoms explained the largest amount of variance in health-related quality of life.

Conclusions

Symptoms of depression and anxiety were significant predictors of health-related quality of life in patients with bronchiectasis, independently of respiratory involvement, gender, age or other variables.     

Patients undergoing subacute rehabilitation have accurate expectations of their health-related quality of life at discharge

ABSTRACT: BACKGROUND: Expectations held by patients and health professionals may affect treatment choices and participation (by both patients and health professionals) in therapeutic interventions in contemporary patient-centered healthcare environments. If patients in rehabilitation settings overestimate their discharge health-related quality of life, they may become despondent as their progress falls short of their expectations. On the other hand, underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit. There is a scarcity of empirical evidence evaluating whether patients' expectations of future health states are accurate. The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life. METHODS: A prospective longitudinal cohort investigation of agreement between patients' anticipated discharge health-related quality of life (as reported on the EQ-5D instrument at admission to a rehabilitation unit) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken. The mini-mental state examination was used as an indicator of patients' cognitive ability. RESULTS: Overall, 232(85%) patients had all assessment data completed and were included in analysis. Kappa scores ranged from 0.42-0.68 across the five EQ-5D domains and two patient cognition groups. The percentage of exact correct matches within each domain ranged from 69% to 85% across domains and cognition groups. Overall 40% of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses. CONCLUSIONS: Patients admitted for subacute in-hospital rehabilitation were able to anticipate the discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy. This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury. Accurate patient expectations of the impact of treatment (or disease progression) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved.     

Depression and comorbid illness in elderly primary care patients: impact on multiple domains of health status and well-being

PURPOSE: Our objective was to examine the relative association of depression severity and chronicity, other comorbid psychiatric conditions, and coexisting medical illnesses with multiple domains of health status among primary care patients with clinical depression. METHODS: We collected cross-sectional data as part of a treatment effectiveness trial that was conducted in 8 diverse health care organizations. Patients aged 60 years and older (N = 1,801) who met diagnostic criteria for major depression or dysthymia participated in a baseline survey. A survey instrument included questions on sociodemographic characteristics, depression severity and chronicity, neuroticism, and the presence of 11 common chronic medical illnesses, as well as questions screening for panic disorder and posttraumatic stress disorder. Measures of 4 general health indicators (physical and mental component scales of the SF-12, Sheehan Disability Index, and global quality of life) were included. We conducted separate mixed-effect regression linear models predicting each of the 4 general health indicators. RESULTS: Depression severity was significantly associated with all 4 indicators of general health after controlling for sociodemographic differences, other psychological dysfunction, and the presence of 11 chronic medical conditions. Although study participants had an average of 3.8 chronic medical illnesses, depression severity made larger independent contributions to 3 of the 4 general health indicators (mental functional status, disability, and quality of life) than the medical comorbidities. CONCLUSIONS: Recognition and treatment of depression has the potential to improve functioning and quality of life in spite of the presence of other medical comorbidities.     

The Relative Contribution of Domains of Quality of Life to Overall Quality of Life for Different Chronic Diseases

This study examined the contribution of the quality of life (QoL) domains physical, social and psychological functioning to the explanation of overall QoL. Various disorders may differentially affect QoL domains due to disease-specific factors and, consequently, the relationship between QoL domains and overall QoL may vary between diseases. We therefore studied this relationship for several diseases as well as the differential impact of these diseases on QoL. The present study had a cross-sectional design. We selected patients (aged 57 years and older) with one of the following eight chronic medical conditions: lung disorder, heart condition, hypertension, diabetes mellitus, back problems, rheumatoid arthritis, migraine, or dermatological disorders. The total group of respondents included 1457 patients and 1851 healthy subjects. Regression analyses showed that the domain of psychological functioning contributed to overall QoL for all disorders, whereas physical and social functioning contributed to overall QoL for some disorders. Differences were found between most patient groups and healthy subjects with respect to physical functioning; with respect to social and psychological functioning some groups differed from the healthy group. Explanations for the findings and implications for clinical practice are discussed.     

Associations of cancer and other chronic medical conditions with SF-6D preference-based scores in Medicare beneficiaries

Purpose

Documenting the impact of different types of cancer on daily functioning and well-being is important for understanding burden relative to other chronic medical conditions. This study examined the impact of 10 different cancers and 13 other chronic medical conditions on health-related quality of life.

Methods

Health-related quality of life data were gathered on the Medicare Health Outcomes Survey (MHOS) between 1998 and 2002. Cancer information was ascertained using the National Cancer Institute’s surveillance, epidemiology, and end results program and linked to MHOS data.

Results

The average SF-6D score was 0.73 (SD = 0.14). Depressive symptoms had the largest unique association with the SF-6D, followed by arthritis of the hip, chronic obstructive pulmonary disease/asthma, stroke, and sciatica. In addition, the majority of cancer types were significantly associated with the SF-6D score, with significant negative weights ranging from ?0.01 to ?0.02 on the 0–1 health utility scale. Distant stage of cancer was associated with large decrements in the SF-6D ranging from ?0.04 (prostate) to ?0.08 (female breast).

Conclusion

A large number of chronic conditions, including cancer, are associated uniquely with decrements in health utility. The cumulative effects of comorbid conditions have substantial impact on daily functioning and well-being of Medicare beneficiaries.     

Health-related quality of life among adults with arthritis--behavioral risk factor surveillance system, 11 states, 1996-1998

Arthritis and other rheumatic conditions are the leading cause of disability in the United States, affecting 43 million persons in 1998 and-with the aging of the "baby boom" generation-are projected to affect an estimated 60 million by 2020. In 1992, these conditions cost $65 billion in medical care and lost productivity and were associated with 744,000 hospitalizations and 44 million ambulatory-care visits in 1997. Because arthritis and other rheumatic conditions seldom cause death but have a substantial impact on health, health-related quality of life (HRQOL) measures are better indicators of their impact than related mortality rates. This report examines data from 11 states that included an arthritis module in the 1996-1998 Behavioral Risk Factor Surveillance System (BRFSS); findings indicate that persons with arthritis have worse HRQOL than persons without arthritis, regardless of sex, age, or education level.