Health-related quality of life in patients with chronic rheumatic disease after a multidisciplinary rehabilitation regimen

Introduction

Multidisciplinary rehabilitation has beneficial effects on health-related quality of life (HRQoL) in patients with chronic rheumatic diseases. However, whether this intervention benefits different age groups in women or men is largely unknown.

Purpose

To investigate HRQoL in patients with chronic rheumatic disease after completion of a 3-week multidisciplinary treatment, with special focus on differences in effect between age and gender groups.

Method

HRQoL was measured with SF-36. Mean scores for all SF-36 domains were compared before and after the 3-week regimen and again at 3-, 6-, and 12-month follow-ups. Multivariable linear regression models using generalized estimating equations to account for repeated measurement were employed. A weighting procedure to account for differential dropouts was applied.

Results

Three hundred fifty-six women and 74 men with chronic rheumatic disease were included. There were short-term improvements in all SF-36 domains irrespective of age or gender. These effects persisted for up to 1 year in the psychological, social, and energy domains for women under 50. We found no lasting effects for men; however, young men showed similar trends.

Conclusion

Inpatient multidisciplinary rehabilitation improves short-term HRQoL in all patients. Younger women maintain these beneficial effects for up to 1 year. Additional intervention should be considered for elderly women and for men in order to sustain rehabilitation effects.

     

Eating disorder features and quality of life: Does gender matter?

Purpose

This study examined whether gender moderates the associations between eating disorder features and quality-of-life impairment and whether eating disorder features can explain gender differences in quality of life in a sample of undergraduate students.

Methods

The SF-12 Physical and Mental Component Summary Scales were used to measure health-related quality of life (HRQoL), and the Eating Disorders Examination Questionnaire (EDE-Q) was used to quantify eating disorder behaviors and cognitions. These self-report forms were completed by undergraduate men and women (n = 709).

Results

Gender was a significant predictor of mental HRQoL, such that women in this sample reported poorer mental HRQoL than men. Eating disorder cognitions were the strongest predictor of undergraduate students’ mental and physical HRQoL, while binge eating negatively predicted their physical HRQoL only. Gender was not found to moderate the associations between eating disorder features and HRQoL, and eating disorder cognitions were found to mediate the association between gender and mental HRQoL such that a proportion of the difference between undergraduate men and women’s mental HRQoL was attributable to eating disorder cognitions.

Conclusion

This study provided further evidence of the significant impact of eating disorder features, particularly eating disorder cognitions, on HRQoL. The finding that gender did not moderate the relationships between eating disorder features and HRQoL indicates the importance of investigating these features in both men and women in future research.

     

Obesity,metabolic abnormality,and health-related quality of life by gender: a cross-sectional study in Korean adults

Purpose

This study sought to compare the association between health-related quality of life (HRQoL) and four body health types by gender.

Methods

The study included 6217 men and 8243 women over 30 years of age chosen from a population-based survey. Participants were grouped by body mass index and metabolic abnormality into four types: metabolically healthy normal weight, metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO). HRQoL was measured using the EQ-5D health questionnaire. The outcomes encompassed five dimensions (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression), and the impaired HRQoL dichotomized by the EQ-5D preference score. Complex sample multivariate binary logistic regression analyses were conducted to adjust for sociodemographic variables, lifestyle factors, and disease comorbidity.

Results

Among men, those in the MANW group presented worse conditions on all dimensions and the impaired HRQoL compared to other men. However, no significant effect remained after adjusting for relevant covariates. For women, those in the MAO group had the most adversely affected HRQoL followed by those females in the MHO group. The domain of mobility and impaired HRQoL variable of the MAO and MHO groups remained significant when controlling for all covariates in the model.

Conclusions

The MANW is the least favorable condition of HRQoL for men, suggesting that metabolic health may associate with HRQoL more than obesity for males. In women, the MAO and MHO groups had the most adversely affected HRQoL, implying that MHO is not a favorable health condition and that obesity, in general, may be strongly associated with HRQoL in women.

     

The relationship between SF-6D utility scores and lifestyle factors across three life stages: evidence from the Australian Longitudinal Study on Women’s Health

Purpose

To investigate how SF-6D utility scores change with age between generations of women and to quantify the relationship of SF-6D with lifestyle factors across life stages.

Methods

Up to seven waves of self-reported, longitudinal data were drawn for the 1973–1978 (young, N?=?13772), 1946–1951 (mid-age, N?=?12792), 1921–1926 (older, N?=?9972) cohorts from the Australian Longitudinal Study on Women’s Health. Mixed effects models were employed for analysis.

Results

Young and mid-age women had similar average SF-6D scores at baseline (0.63–0.64), which remained consistent over the 16-year period. However, older women had lower scores at baseline at 0.57 which steadily declined over 15 years. Across cohorts, low education attainment, greater difficulty in managing income, obesity, physical inactivity, heavy smoking, no alcohol consumption, and increasing stress levels were associated with lower SF-6D scores. The magnitude of effect varied between cohorts. SF-6D scores were lower amongst young women with high-risk drinking behaviours than low-risk drinkers. Mid-age women, who were underweight, never married, or underwent surgical menopause also reported lower SF-6D scores. Older women who lived in remote areas, who were ex-smokers, or were underweight, reported lower SF-6D scores.

Conclusion

The SF-6D utility score is sensitive to differences in lifestyle factors across adult life stages. Gradual loss of physical functioning may explain the steady decline in health for older women. Key factors associated with SF-6D include physical activity, body mass index, menopause status, smoking, alcohol use, and stress. Factors associated with poorer SF-6D scores vary in type and magnitude at different life stages.

     

The impact of depression on health-related quality of life and wellbeing: identifying important dimensions and assessing their inclusion in multi-attribute utility instruments

Purpose

Wellbeing measures have been proposed for inclusion in economic evaluation to measure the effect of depression and compensate for shortcomings of existing multi-attribute utility instruments (MAUIs). The aims of this study were to identify dimensions of health-related quality of life (HRQoL) and wellbeing that are most affected by depression and to examine the extent to which these are captured by MAUIs.

Methods

Data were used from the Multi-Instrument Comparison study. Dimensions of HRQoL (SF-36v2 and AQoL-8D dimensions), capability wellbeing (ICECAP-A), and subjective wellbeing (including PWI, SWLS, and IHS) were identified that distinguished most individuals with depression from a healthy public. The extent to which these dimensions explain the content of five existing MAUIs (15D, AQoL-8D, EQ-5D-5L, HUI-3, and SF-6D) was examined using regression analyses. Additionally, the sensitivity of all MAUIs was also assessed towards depression-specific symptoms measured by DASS-21 and K-10.

Results

The sample consisted of 917 individuals with self-reported depression and 1760 healthy subjects. Dimensions that distinguished most individuals with depression from the healthy group (effect size?>?2) included AQoL-8D coping, AQoL-8D happiness, AQoL-8D self-worth, ICECAP-A, SF-36 mental health, and SF-36 social functioning. The AQoL-8D was most sensitive to the dimensions above as well as towards the depression-specific measures, the K10, DASS-S, and DASS-D.

Conclusions

This study has shown that psychosocial dimensions of HRQoL have the greatest ability to capture the impact of depression when compared with dimensions of capability wellbeing and SWB. Some MAUIs, such as the AQoL-8D, are sensitive to most distinguishing dimensions of HRQoL and wellbeing, which may obviate the need for supplementary wellbeing instruments.

     

Preference-based health-related quality of life among victims of bullying

Purpose

No previous study has estimated the association between bullying and preference-based health-related quality of life (HRQoL) (“utility”), knowledge of which may be used for cost-effectiveness studies of interventions designed to prevent bullying. Therefore, the aim of the study was to estimate preference-based HRQoL among victims of bullying compared to non-victims.

Methods

A cross-sectional survey data collection among Swedish adolescents aged 15–17 years in the first year of upper secondary school was conducted in the city of Gothenburg in Sweden (N = 758). Preference-based HRQoL was estimated with the SF-6D. Regression analyses were conducted to adjust for some individual-level background variable.

Results

Mean preference-based health-related quality of life scores were 0.77 and 0.71 for non-victims and victims of bullying, respectively. The difference of 0.06 points was statistically significant (p < 0.05) and robust to inclusion of gender, age, and parental immigrant status.

Conclusions

The preference-based HRQoL estimates in this study may be used as an upper bound in economic evaluations of bullying prevention interventions, facilitating a comparison between costs and quality-adjusted life-years.

     

The relationship between body mass index and 10-year trajectories of physical functioning in middle-aged and older Russians: Prospective results of the Russian HAPIEE study

Objective

To investigate the associations of overweight and obesity with longitudinal decline in physical functioning (PF) among middle-aged and older Russians.

Design

Prospective cohort study.

Setting

Four rounds of data collection in the Russian Health, Alcohol and Psychosocial factors In Eastern Europe study with up to 10 years of follow-up.

Participants

9,222 men and women aged 45-69 years randomly selected from the population of two districts of Novosibirsk, Russia.

Measurements

PF score (range 0-100) was measured by the Physical Functioning Subscale (PF-10) of the 36-item Short Form Health Survey (SF-36) at baseline and three subsequent occasions. Body mass index (BMI), derived from objectively measured body height and weight at baseline, was classified into normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obesity class I (BMI 30.0-34.9), and obesity class II+ (BMI≥35.0).

Results

The mean annual decline in the PF score during the follow-up was -1.92 (95% confidence interval -2.17; -1.68) in men and -1.91 (-2.13; -1.68) in women. At baseline, compared with normal weight, obesity classes I and II+ (but not overweight) were associated with significantly lower PF in both sexes. In prospective analyses, the decline in PF was faster in overweight men (difference from normal weight subjects -0.38 [-0.63; -0.14]), class I obese men and women (-0.49 [-0.82; -0.17] and -0.44 [-0.73; -0.15] respectively) and class II+ obese men and women (-1.13 [-1.73; -0.53] and -0.43 [-0.77; -0.09] respectively). Adjustment for physical activity and other covariates did not materially change the results.

Conclusions

PF decreased more rapidly in obese men and women than among those with normal weight. The adverse effect of high BMI on PF trajectories appeared to be more pronounced in men than in women, making more extremely obese Russian men an important target population to prevent/slow down the process of decline in PF.

     

Gender differences in the impact of mental disorders and chronic physical conditions on health-related quality of life among non-demented primary care elderly patients

Purpose

This paper aims to estimate the comorbidity of mental disorders and chronic physical conditions and to describe the impact of these conditions on health-related quality of life (HRQoL) in a sample of older primary care (PC) attendees by gender.

Methods

Cross-sectional survey, conducted in 77 PC centres in Catalonia (Spain) on 1192 patients over 65 years old. Using face-to-face interviews, we assessed HRQoL (SF–12), mental disorders (SCID and MINI structured clinical interviews), chronic physical conditions (checklist), and disability (Sheehan disability scale). We used multivariate quantile regressions to model which factors were associated with the physical component summary—short form 12 and mental component summary—short form 12.

Result

The most frequent comorbidity in both men and women was mood disorder with chronic pain and arthrosis. Mental disorders mainly affected ‘mental’ QoL, while physical disorders affected ‘physical’ QoL. Mental disorders had a greater impact on HRQoL than chronic physical conditions, with mood and adjustment disorders being the most disabling conditions. There were some gender differences in the impact of mental and chronic physical conditions on HRQoL. Anxiety disorders and pain had an impact on HRQoL but only in women. Respiratory diseases had an effect on the MCS in women, but only affected the PCS in men.

Conclusions

Mood and adjustment disorders had the greatest impact on HRQoL. The impact profile of mental and chronic physical conditions differs between genders. Our results reinforce the need for screening for mental disorders (mainly depression) in older patients in PC.

     

Unchained melody: revisiting the estimation of SF-6D values

Purpose

In the original SF-6D valuation study, the analytical design inherited conventions that detrimentally affected its ability to predict values on a quality-adjusted life year (QALY) scale. Our objective is to estimate UK values for SF-6D states using the original data and multi-attribute utility (MAU) regression after addressing its limitations and to compare the revised SF-6D and EQ-5D value predictions.

Methods

Using the unaltered data (611 respondents, 3503 SG responses), the parameters of the original MAU model were re-estimated under three alternative error specifications, known as the instant, episodic, and angular random utility models. Value predictions on a QALY scale were compared to EQ-5D3L predictions using the 1996 Health Survey for England.

Results

Contrary to the original results, the revised SF-6D value predictions range below 0 QALYs (i.e., worse than death) and agree largely with EQ-5D predictions after adjusting for scale. Although a QALY is defined as a year in optimal health, the SF-6D sets a higher standard for optimal health than the EQ-5D-3L; therefore, it has larger units on a QALY scale by construction (20.9 % more).

Conclusions

Much of the debate in health valuation has focused on differences between preference elicitation tasks, sampling, and instruments. After correcting errant econometric practices and adjusting for differences in QALY scale between the EQ-5D and SF-6D values, the revised predictions demonstrate convergent validity, making them more suitable for UK economic evaluations compared to original estimates.

     

A preference-based measure of health: the VR-6D derived from the veterans RAND 12-Item Health Survey

Purpose

The Veterans RAND 12-Item Health Survey (VR-12) is currently the major endpoint used in the Medicare managed care outcomes measure in the Healthcare Effectiveness Data and Information Set (HEDIS^®), referred to as the Health Outcomes Survey (HOS). The purpose of this study is to adapt the Brazier SF-6D utility measure to the VR-12 to generate a single utility index.

Methods

We used the HOS cohorts 2 and 3 for SF-36 data and 9 for VR-12 data. We calculated SF-6D scores from the SF-36 using the algorithms developed by Brazier and colleagues. The values of the Brazier SF-6D were used to estimate utility scores from the VR-12 using a mapping approach based on a 2-stage mapping procedure, named as VR-6D.

Results

The VR-6D derived from the VR-12 has similar distributional properties as the SF-6D. The change in VR-6D showed significant variations across disease groups with different levels of morbidity and mortality.

Conclusions

This study produced a utility measure for the VR-12 that is comparable to the SF-6D and responsive to change. The VR-6D can be used in evaluations of health care plans and cost-effectiveness analysis to compare the health gains that health care interventions can achieve.

     

Quality of Life and Mental Health in Older Adults with Obesity and Frailty: Associations with a Weight Loss Intervention

Objective

To examine the bi-directional associations of a weight loss intervention with quality of life and mental health in obese older adults with functional limitations.

Design

Combined-group analyses of secondary variables from the MEASUR-UP randomized controlled trial.

Setting

Academic medical center.

Participants

Obese community-dwelling men and women (N = 67; age ≥60; BMI ≥30) with functional limitations (Short Physical Performance Battery [SPPB] score of 4–10 out of 12).

Intervention

Six-month reduced calorie diet at two protein levels.

Measurements

Weight, height, body composition, physical function, medical history, and mental health and quality of life assessments (Center for Epidemiologic Studies Depression Scale [CES-D]; Profile of Mood States [POMS], Pittsburgh Sleep Quality Index [PSQI]; Perceived Stress Scale [PSS]; Satisfaction with Life Scale [SWLS]; and Short Form Health Survey [SF-36]) were acquired at 0, 3 and 6 months.

Results

Physical composite quality of life (SF-36) improved significantly at 3 months (β = 6.29, t2,48 = 2.60, p = 0.012) and 6 months (β = 10.03, t2,48 = 4.83, p < 0.001), as did several domains of physical quality of life. Baseline depression symptoms (CES-D and POMS) were found to predict lower amounts of weight loss; higher baseline sleep latency (PSQI) and anger (POMS) predicted less improvement in physical function (SPPB).

Conclusion

The significant bi-directional associations found between a weight loss intervention and mental health/quality of life, including substantial improvements in physical quality of life with obesity treatment, indicate the importance of considering mental health and quality of life as part of any weight loss intervention for older adults.

     

Health-related quality of life among pulmonary tuberculosis patients in Pakistan

Purpose

Health-related quality of life (HRQoL) of pulmonary TB patients has not been assessed in Pakistan. We assessed self-reported HRQoL of pulmonary TB patients in Karachi, Pakistan utilizing the EQ-5D and EQ-VAS prior to, during, and after completion of TB treatment.

Methods

We enrolled 226 pulmonary TB patients in a longitudinal cohort study. Health-utility scores were estimated by the EQ-5D five dimensions and the EQ-Visual Analogue Scale (VAS) at baseline (month 0) and each monthly follow-up visit until treatment completion at month 6. Repeated-measures ANOVA was used to investigate effect of time into treatment on EQ-5D and EQ-VAS scores.

Results

EQ-5D health utility and EQ-VAS scores increase with treatment progression. For the enrolled TB patients, the mean EQ-5D utility scores more than doubled from 0.43 to 0.88, p?<?.001, effect size η²?=?0.40 from treatment initiation to treatment completion.

Conclusion

Perceived HRQoL of TB patients improves with treatment progression. This can inform targeted treatment plans as well as TB policy and funding for high-burden countries.

     

Measuring health-related quality of life in patients with conservatively managed stage 5 chronic kidney disease: limitations of the Medical Outcomes Study Short Form 36: SF-36

Purpose

Chronic kidney disease (CKD) negatively affects health-related quality of life (HRQoL), which is often measured using the Medical Outcomes Study Short Form 36 (SF-36) questionnaire. However, the adequacy of SF-36 in this population has not been reported. We aimed to determine floor and ceiling effects and responsiveness to change of SF-36 in patients with conservatively managed stage 5 CKD.

Methods

SF-36 data were collected prospectively. Floor and ceiling effects were estimated for each SF-36 scale and summary measure based on raw scores. The minimal clinically important difference (MCID) was estimated using a combination of anchor-based and distribution-based methods. Responsiveness to change was assessed by comparing MCID for each scale and summary measure to its smallest detectable change.

Results

SF-36 data were available for 73 of the 74 study participants. Using baseline data, floor and/or ceiling effects were detected for 3 of the 8 SF-36 scales. The anchor-based estimation of MCID based on differences in baseline functional status yielded the most reliable results. For the physical component summary, MCID was estimated at 5.7 points. Whilst the two SF-36 summary measures were responsive to change and free of floor and/or ceiling effects, six of the eight scales were not.

Conclusions

This small study of patients with conservatively managed stage 5 CKD found that only the summary measures of SF-36 and 2 of its 8 scales can be used to assess changes in HRQoL over time. These findings suggest that in this population, alternative HRQoL assessment tools should be considered for future studies.

     

Socio-demographic,clinical characteristics and utilization of mental health care services associated with SF-6D utility scores in patients with mental disorders: <Emphasis Type="Italic">contributions of the quantile regression</Emphasis>

Purpose

Health-related quality of life (HRQoL) is a widely used concept in the assessment of health care. Some generic HRQoL instruments, based on specific algorithms, can generate utility scores which reflect the preferences of the general population for the different health states described by the instrument. This study aimed to investigate the relationships between utility scores and potentially associated factors in patients with mental disorders followed in inpatient and/or outpatient care settings using two statistical methods.

Methods

Patients were recruited in four psychiatric sectors in France. Patient responses to the SF-36 generic HRQoL instrument were used to calculate SF-6D utility scores. The relationships between utility scores and patient socio-demographic, clinical characteristics, and mental health care utilization, considered as potentially associated factors, were studied using OLS and quantile regressions.

Results

One hundred and seventy six patients were included. Women, severely ill patients and those hospitalized full-time tended to report lower utility scores, whereas psychotic disorders (as opposed to mood disorders) and part-time care were associated with higher scores. The quantile regression highlighted that the size of the associations between the utility scores and some patient characteristics varied along with the utility score distribution, and provided more accurate estimated values than OLS regression.

Conclusions

The quantile regression may constitute a relevant complement for the analysis of factors associated with utility scores. For policy decision-making, the association of full-time hospitalization with lower utility scores while part-time care was associated with higher scores supports the further development of alternatives to full-time hospitalizations.

     

Long-term health-related quality of life in eating disorders

Objective

There is limited evidence on the long-term development of health-related quality of life (HRQoL) in eating disorders and its relation to eating disorder symptoms. Our objective was to measure long-term change in the HRQoL of eating disorder patients and compare it to normal population.

Methods

Fifty-four bulimia nervosa (BN) and forty-seven anorexia nervosa (AN) patients (ICD-10 diagnosis) entering treatment completed the 15D HRQoL questionnaire and the Eating Disorder Inventory (EDI) before and approximately 8 years after the start of treatment.

Results

Baseline HRQoL was severely impaired in the patients. During follow-up, mean HRQoL, body mass index (BMI) and EDI improved statistically significantly in both groups. BMI of AN patients reached normal values, but HRQoL was still severely impaired in both AN and BN compared to general population.

Conclusions

The long-term HRQoL after treatment continues to improve, but is still after 8 years poor. Eating disorders are very serious conditions with long-lasting impact on quality of life even after symptom remission.

     

Physical training following gastric bypass: effects on physical activity and quality of life—a randomized controlled trial

Background

Obesity is associated with physical inactivity and impaired health-related quality of life (HRQoL). We aim to test the hypothesis that Roux-en-Y gastric bypass (RYGB) followed by supervised physical training improves physical activity (PA) levels and HRQoL.

Methods

Sixty patients, qualified for RYGB, were at 6 months post-surgery randomized to 26 weeks of a supervised physical training intervention (INT) or to a control (CON) group. PA was assessed by accelerometry and using the questionnaire RPAQ. HRQoL was measured by the SF-36 questionnaire. All assessments were performed pre-surgery and 6, 12, and 24 months post-surgery.

Results

RYGB did not improve objectively or self-reported PA, but improved all domains of SF-36 (all p?<?0.01). Objectively measured light PA, moderate to vigorous PA, and step counts tended to increase in INT compared to CON 12 months after RYGB (0.05?<?p?<?0.09), but the effects failed to persist. The SF-36 domain “general health” increased in INT compared to CON 24 months after RYGB (p?=?0.041).

Conclusion

RYGB improves HRQoL, but does not increase PA. Supervised physical training intervention improves general health 24 months after RYGB and tends to improve certain domains of PA right after the intervention period, but fails to increase the patients’ overall PA level over time. Clinical Trial Registration Registered at ClinicalTrials.gov—no. NCT01690728.

     

Frailty index and its relation to falls and overnight hospitalizations in elderly Chinese people: A population-based study

Objectives

To investigate current status of frailty index (FI) defined as deficit accumulation and its relations to falls and overnight hospitalizations in an elderly Chinese population.

Design

A cross-sectional cohort study.

Setting

All of the 31 valiages in Jiang’an township, a typical medium-sized township in Rugao city, China.

Participants

Overall 1773 participants aged 70-84 years were randomly recruited.

Measurements

A FI including symptoms, activities of daily living, co-morbidities, cognitive and psychological function was constructed using 45 health deficits.

Results

The mean of FI was 0.14 in men and 0.19 in women. According to a usual FI cut-point of 0.25, 8.2% of men and 23.2% of women were classified as frail. Literate participants had lower levels of FI than their illiterate counterpart. In men, the FI was positively related to age (r = 0.186, p<.001), with a mean rate of deficit accumulation of 0.032 (on a log scale) per year. Each increment of 0.01 on the FI was associated with significantly increased risks of falls and overnight hospitalizations, with odds ratios of 1.05 (95% CI: 1.03, 1.07) and 1.05 (95% CI: 1.03, 1.08). Similarly, the aforementioned associations were observed in women. Education level moderated the associations of FI with falls in men and women.

Conclusion

Elderly Chinese women were more frail than men. The FI significantly increased with chronological age and was significantly associated with falls and overnight hospitalizations, and education level may play an important role. This study provides preliminary but crucial evidences for future researches on frailty in China.

     

Relationship between diet-related indicators and overweight and obesity in older adults in rural Japan

Objectives

To identify the relationship between diet-related indicators and overweight and obesity in older adults in rural Japan.

Design

Cross-sectional survey.

Setting

Obira, Hokkaido, Japan.

Participants

Local residents aged between 65 and 74 years, except for those with poor health, were included.

Intervention

A health- and diet-related questionnaire was applied to participants house-to-house by trained health professionals.

Measurements

The following indicators were examined: number of meals, number of balanced meals, food diversity, food group diversity, chewing ability, alcohol intake habit, smoking habit, instrumental activities of daily living scores, age, and residing alone or with family.

Results

Of 550 residents, 317 residents completely responded to the questionnaire. Of these, 41 were had low body mass index (BMI≤20) and were excluded. This resulted in a sample of 307 subjects comprising 117 men and 190 women; 37.6% and 46.8% of men and women were classified as obese (BMI≥25), respectively. Women with a normal BMI (20<BMI<25) had significantly higher food diversity in diet-related indicators compared with women with high BMI. The mean number of meals per day of normal men was significantly higher than of obese men. Using logistic regression analysis (stepwise), it was found that the number of meals per day was associated with obesity in men (OR=3.02; 95% CI 0.91–9.98; P=0.071), and food diversity was significantly associated with obesity in women (OR=1.95; 95% CI 1.12–3.38; P=0.018).

Conclusions

The associations between dietary indicators and obesity differed by sex. Food diversity may be a potential indicator to measure nutritional status in women.

     

“Eating together” is associated with food behaviors and demographic factors of older Japanese people who live alone

Objective

This study aimed to examine the relationships between eating together and subjective health, frailty, food behaviors, food accessibility, food production, meal preparation, alcohol intake, socioeconomic factors and geography among older Japanese people who live alone.

Design

A cross-sectional, multilevel survey was designed. The questionnaire was distributed by post and self-completed by participants.

Setting

The sample was drawn from seven towns and cities across Japan.

Participants

A geographic information system was used to select a representative sample of older people who lived alone based on their proximity to a supermarket. Recruitment for the study was conducted with municipal assistance.

Measurements

A logistic regression analysis was performed that adjusted for the respondent’s age, socioeconomic status and proximity to a supermarket using stepwise variable analyses. The dependent variable was whether the respondent ate together more or less than once a month.

Results

In total, 2,196 older people (752 men and 1,444 women) completed the questionnaire (63.5% response rate). It was found that 47.1% of men and 23.9% of women ate together less than once a month. Those who ate together less than once a month had a significantly lower rate of subjective health, food diversity and food intake frequency than those who ate together more often. A stepwise logistic analysis showed that the factors most strongly related to eating together less than once a month were not having any food shopping assistance (men: OR = 3.06, women: OR = 2.71), not receiving any food from neighbors or relatives (men: OR = 1.74, women: OR = 1.82), daily alcohol intake (women: OR = 1.83), frailty (men: OR = 0.48) and income (men: OR = 2.16, women: OR = 1.32).

Conclusion

Eating together is associated with subjective health and food intake. Factors that affect how often older Japanese people who live alone eat together include food accessibility, daily alcohol intake, frailty and a low income.

     

Refined comorbidity index based on dimensionality of comorbidity for use in studies of health-related quality of life

Purpose

To refine two subscales of the health-related quality of life comorbidity index (HRQoL-CI) into a single index measure.

Methods

The 2010 and 2012 Medical Expenditure Panel Surveys were utilized as development and validation datasets, respectively. The least absolute shrinkage and selection operator was applied to select important comorbidity candidates associated with HRQoL. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to assess dimensionality in comorbidity. Statistical weights were derived based on standardized factor loadings from CFA and regression coefficients from the model predicting HRQoL. Prediction errors and model R² values were compared between HRQoL-CI and Charlson CI (CCI).

Results

Eighteen comorbid conditions were identified. CFA models indicated that the second-order multidimensional comorbidity structure had a better fit to the data than did the first-order unidimensional structure. The predictive performance of the refined scale under a multidimensional structure utilizing statistical weights outperformed the original scale and CCI in terms of average prediction error and R² in the prediction models (R² values from refined scale model are 0.25, 0.30, and 0.28 versus those from CCI of 0.10, 0.09, and 0.06 for general health, SF-6D, and EQ-5D, respectively).

Conclusion

The dimensionality of comorbidity and the weight scheme significantly improved the performance of the refined HRQoL-CI. The refined single HRQoL-CI measure appears to be an appropriate and valid instrument specific for risk adjustment in studies of HRQoL. Future research that validates the refined scales for different cultures, age groups, and healthcare settings is warranted.