Health-Related Quality of Life and Associated Factors Among Oldest-Old in China

The oldest old population has become the fastest growing segment with excess need of care and social support, it is crucial to improve the health-related quality of life (HRQoL) of these populations. This study seeks to evaluate the health status and to investigate modifiable factors associated with health-related quality of life for oldest old adults in China. A cross-sectional population-based study. Hainan Province in the south of China. 1,278 adults aged 80 years or older. HRQoL was assessed by three-level EuroQol-5D scale (EQ-5D-3L) and a visual analogue scale (VAS). Demographic and health-related variables were analysed by estimating mean values and standard deviations for continuous variables, percentages and standard deviations for categorical variables. Tobit regressions, ordinary least Squared (OLS) regressions and ordered probit regressions were adopted to determine the associated factors for overall HRQoL and for each health dimension. Anxiety/depression was the least reported problem while mobility was the most frequently reported with problem. Female respondents had lower EQ-5D score (0.76 vs. 0.86) and VAS score (66.55 vs. 69.84) than male respondents. Better health-related quality of life was significantly associated with higher BMI, no drinking habit, more leisure activities, living with family members, good sleeping quality, closer social and family connections, fewer numbers of drugs consumed per day, without having hearing or visual impairment, and fewer chronic conditions, after controlling for potential confounders. Findings from this study suggested that quality of life was not only associated with age-related diseases, but also correlated with a range of health-related lifestyles, and factors indicating social and family support.     

Health-Related Quality of Life Among Older Adults With and Without Functional Limitations

Objectives. We examined factors that influence health-related quality of life (HRQOL) among individuals aged 50 years and older with and without functional limitations.Methods. We analyzed data from the 2009 Behavioral Risk Factor Surveillance System to assess associations among demographic characteristics, health care access and utilization indicators, modifiable health behaviors, and HRQOL characterized by recent physically and mentally unhealthy days in those with and those without functional limitations. We defined functional limitations as activity limitations owing to physical, mental, or emotional health or as the need for special equipment because of health.Results. Age, medical care costs, leisure-time physical activity, and smoking were strongly associated with both physically and mentally unhealthy days among those with functional limitations. Among those without functional limitations, the direction of the effects was similar, but the size of the effects was substantially smaller.Conclusions. The availability of lower cost medical care, increasing leisure-time physical activity, and reducing rates of cigarette smoking will improve population HRQOL among older adults with and without functional limitations. These factors provide valuable information for determining future public health priorities.Disability affects a substantial portion of the population, and the prevalence of disabilities increases with age. Adults with disabilities represent 31% of those aged 55–64 years and 52% of those aged 65 years and older.1 Annual disability-associated health care expenditures have been estimated at almost $400 billion, or 27% of all US adult health care expenditures in 2006,2 making this an important economic issue for public health.Disability definitions have evolved over the past 2 centuries because of the medical profession’s changing attitudes regarding health care treatment of individuals with disabilities and changing societal perspectives, including the destigmatization of attitudes and beliefs regarding disability and increased support for designing environments that encourage independent living.3,4 Recently, advocates for a social model of disability5,6 have argued that disability results from functional impairment and limitations that are the result of social, cultural, and environmental factors. Expanding this more integrated conceptualization of disability, the World Health Organization published the International Classification of Functioning Disability and Health (ICF) in 2001.7 The ICF depicts disability as resulting from the interaction of a person’s functional impairment with environmental factors to create limitations. The ICF provides a framework for considering health and disability at the individual and population level across the entire lifespan and provides an important step forward for assessing the relationships among disability, environment, and health outcomes.The shift in focus in public health to health promotion and quality of life is advancing quickly because of increases in life expectancy and the increasing number of individuals living with chronic diseases. Furthermore, as the population of the United States continues to age, the public health community has become more focused on understanding how to improve health-related quality of life (HRQOL) among individuals with multiple chronic conditions and disabilities.8 HRQOL is a multidimensional population health outcome that supplements more traditional measures of mortality and morbidity and is useful because it provides broad summary measures of perceived health.9,10 HRQOL constructs include measures of physical health, mental health, and social functioning.11,12 These measures have the potential to bridge boundaries between disciplines and among social, mental, and medical services. For example, Health and Human Services’ Healthy People 2020 initiative has provided overarching goals that emphasize the desire to create high quality lives for individuals with disabilities, including the creation of social and physical environments that promote optimal health, and has recommended the use of HRQOL measures to assess progress in this area.13When depicting the nature of the relationships among disability, functional limitations, and HRQOL, it is important to consider the perspective of the individual evaluating the health outcome. Previous studies have shown significant differences between self-report and proxy reports for individuals with disabilities.14,15 For example, 1 study found that more than 50% of adults with serious and persistent disabilities reported good or excellent HRQOL despite living a daily life that other individuals might regard as less than optimal.15 This apparent contradiction between self-reported health and assessment of health by others was named “the disability paradox.” This paradox emphasizes the importance of self-report for determining HRQOL. The disability paradox can be explained, in part, by the fact that quality of life and well-being do not involve merely the absence of illness and disability. Indeed, many people with disabilities or illness experience a fine quality of life, and, conversely, many who are not ill or infirm still do not flourish. Furthermore, although self-report is generally the preferred method for measuring HRQOL,10,16 another concern in measuring HRQOL among people with longstanding functional limitations is that some popular measures of HRQOL include function domains in their summary measures of HRQOL. Consequently, these measures will reduce scores of HRQOL related to functional limitations among those who may otherwise perceive their HRQOL to be very good, resulting in an HRQOL score that is artificially low.17,18 This concern has been documented for the Rand Medical Outcomes Study Short Form–36 health survey as a measure of HRQOL19 derived from differential item analyses. These differential item analysis estimates appear to be smaller for the Centers for Disease Control and Prevention (CDC) Healthy Days measures of HRQOL.20In a seminal article on understanding the structure of perceived health (more recently referred to as HRQOL) among older Americans, Johnson and Wolinsky21 developed a conceptual and statistical model to understand the relationships among 4 primary components of health: disease, disabilities, functional limitations, and perceived health. As part of their causal model, functional limitations are considered, in part, to result from disabilities and are a useful way for classifying how a particular disability has affected an individual.22Measuring HRQOL can assist in determining the burden of disabilities and chronic diseases and can provide valuable new insights into the relationships between HRQOL and risk factors. We investigated which risk factors and public health policies should be considered for improving HRQOL among those with and those without functional limitations. On the basis of the conceptual definitions the ICF presented, the theoretical model presented by Johnson and Wolinsky,21 and the health services model of Andersen,23,24 we assessed the associations between HRQOL and predisposing factors (age, race/ethnicity, and marital status), enabling factors (health care coverage, medical care cost issues, and health care utilization), and modifiable health behaviors (smoking, nutrition, and leisure-time physical activity) among individuals aged 50 years and older with and without functional limitations. We derive our definition for functional limitations from Healthy People 2010 surveillance objectives. The definition represents the standard questions and classifications used for the CDC Behavioral Risk Factor Surveillance System (BRFSS). This definition combines general limitations in function owing to disability or health conditions and adds the use of assistive technology to capture those who may not report limitations because these aids obviate the body limitation. Asking respondents about attribution to disability and health conditions especially helps include older adults with disability, who might otherwise ascribe their limitations to aging. We hypothesized that poor HRQOL would be associated with lower rates of health care coverage, difficulties with cost for medical care, higher smoking rates, poor nutrition, and less leisure-time physical activity. We also hypothesized that the factors that influence HRQOL would differ for those with functional limitations from those without. On the basis of the results of these analyses, we have identified promising future directions for public health prevention and research.     

Body Mass Index,Poor Diet Quality,and Health-Related Quality of Life Are Associated With Mortality in Rural Older Adults

In an aging population, potentially modifiable factors impacting mortality such as diet quality, body mass index (BMI), and health-related quality of life (HRQOL) are of interest. Surviving members of the Geisinger Rural Aging Study (GRAS) (n = 5,993; aged ≥74 years) were contacted in the fall of 2009. Participants in the present study were the 2,995 (1,267 male, 1,728 female; mean age 81.4 ± 4.4 years) who completed dietary and demographic questionnaires and were enrolled in the Geisinger Health Plan over follow-up (mean = 3.1 years). Cox proportional hazards multivariate regression models were used to examine the associations between all-cause mortality and BMI, diet quality, and HRQOL. Compared to GRAS participants with BMIs in the normal range, a BMI < 18.5 was associated with increased mortality (HR 1.85 95% CI 1.09, 3.14, P = 0.02), while a BMI of 25–29.9 was associated with decreased risk of mortality (HR 0.71 95% CI 0.55, 0.91, P = 0.007). Poor diet quality increased risk for mortality (HR 1.53 95% CI 1.06, 2.22, P = 0.02). Finally, favorable health-related quality of life was inversely associated with mortality (HR 0.09 95% CI 0.06, 0.13, P < 0.0001). Higher diet quality and HALex scores, and overweight status, were associated with reduced all-cause mortality in a cohort of advanced age. While underweight (BMI < 18.5) increased risk of all-cause mortality, no association was found between obesity and all-cause mortality in this aged cohort.     

Factors Associated with Health-Related Quality of Life Among Overweight and Obese Korean Women

Health-related quality of life (HRQOL) tends to be lower among individuals who are overweight and obese than those of normal weight, and women may be more vulnerable to lower HRQOL associated with obesity than men. Identifying factors associated with HRQOL may be crucial for improving HRQOL for overweight/obese women. We aimed to determine the factors associated with obesity-specific HRQOL among overweight/obese Korean women. A cross-sectional study was conducted with 125 women aged 20–64 years, who comprised a baseline sample in the Community-based Heart and Weight Management Trial. The data were collected from September 2010 to November 2011. The Weight Efficacy Lifestyle, Beck Depression Inventory-II, Interpersonal Social Evaluation List, and Impact of Weight on Quality of Life (IWQOL)–Lite scales were used to measure self-efficacy for weight control, depressive symptoms, social support, and HRQOL, respectively. Increased body mass index, lower self-efficacy for weight control, and higher levels of depressive symptoms were significantly associated with greater impairment in total IWQOL in the regression models. However, social support was not significantly associated with IWQOL. Along with weight loss strategies, other strategies for improving self-efficacy and alleviating depressive symptoms may be essential for improving HRQOL among overweight and obese women.     

Health-Related Quality of Life Among Japanese Women With Iron-Deficiency Anemia

Iron-deficiency anemia (IDA) is a common disease in females of childbearing age. Although iron supplementation quickly improves laboratory-measured parameters, its effect on health-related quality of life is unknown. Here, we conducted a prospective follow-up study to evaluate health-related quality of life in pre-menopausal women diagnosed with IDA. A convenience sample of 92 patients who visited Tokai University Hospital and three other affiliated hospitals were asked to fill out the Medical Outcome Study 36-item short-form health survey (SF-36) during the course of treatment (baseline, and 1 and 3 months after the start of treatment). At baseline, vitality and general health scores were significantly lower than the Japanese national norms. After the start of therapy, however, a significant improvement was seen in all domain scores except role emotional (RE), and at 3 months all eight scores were comparable to or greater than the national norms. In particular, physical functioning and vitality scores of patients with a lower hemoglobin level ( < 9.0 g/dl) at baseline showed a dramatic improvement. Iron supplementation in IDA patients improves not only hemoglobin levels, but also physical function, vitality, and general health perception. Address for correspondence: Kiyoshi Ando, Department of Hematology and Oncology, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan Phone: +81-463-93-1121; Fax: +81-463-92-4511 E-mail: andok@keyaki.cc.u-tokai.ac.jp     

武义县农村老年人群生命质量相关因素分析

目的 探索武义县农村老年人群的生命质量(QOL)及其相关因索.方法 2007年10～12月,运用横断面研究方法随机调查了2441名60周岁以上的武义县农村老年人,包含有中文版SF-36量表的调查查问卷用于评价其生命质量,采用t检验和Logistic回归等统计方法分析其影响因素.结果 年龄、性别、年收入在单因素分析中除MH维度外都有统计学意义(P＜0.05).多因素Logistic回归显示,年龄(P＜0.001)、年收入(P=0.005)、饮酒(P=0.001)、喝茶(P=0.015),慢病(P＜0.001)与农村老年人生命质量有关.结论 年龄、年收入、饮酒、喝茶、慢病与农村老年人生命质量关系密切,年收入、慢病是影响农村地区老年人生命质量的重要因素.     

Factors Associated With Sleep Quality Among Operating Engineers

Blue collar workers generally report high job stress and are exposed to loud noises at work and engage in many of risky health behavioral factors, all of which have been associated with poor sleep quality. However, sleep quality of blue collar workers has not been studied extensively, and no studies have focused Operating Engineers (heavy equipment operators) among whom daytime fatigue would place them at high risk for accidents. Therefore, the purpose of this study was to determine variables associated with sleep quality among Operating Engineers. This was a cross-sectional survey design with a dependent variable of sleep quality and independent variables of personal and related health behavioral factors. A convenience sample of 498 Operating Engineers was recruited from approximately 16,000 Operating Engineers from entire State of Michigan in 2008. Linear regression was used to determine personal and related health behavior factors associated with sleep quality. Multivariate analyses showed that personal factors related to poor sleep quality were younger age, female sex, higher pain, more medical comorbidities and depressive symptoms and behavioral factors related to poor sleep quality were nicotine dependence. While sleep scores were similar to population norms, approximately 34 % (n = 143) showed interest in health services for sleep problems. While many personal factors are not changeable, interventions to improve sleep hygiene as well as interventions to treat pain, depression and smoking may improve sleep quality resulting in less absenteeism, fatal work accidents, use of sick leave, work disability, medical comorbidities, as well as subsequent mortality.     

Factors Influencing Food Choices Among Older Adults in the Rural Western USA

Nutrition is an essential component in promoting health and quality of life into the older adults years. The purpose of this qualitative research is to explore how the rural food environment influences food choices of older adults. Four focus groups were conducted with 33 older adults (50 years of age and older) residing in rural Montana communities. Four major themes related to factors influencing food choices among rural older adults emerged from this study: perception of the rural community environment, support as a means of increasing food access, personal access to food sources, and dietary factors. The findings from this current study warrant further research and promotion of specifically tailored approaches that influence the food choices of older adults in the rural western USA, including the developing and expanding public transportation systems, increasing availability of local grocers with quality and affordable food options, increasing awareness and decreasing stigma surrounding community food programs, and increasing nutrition education targeting senior health issues.     

Factors Associated With Emergency Department Use Among the Rural Elderly

Context: Emergency Department (ED) use among the rural elderly may present a different pattern from the urban elderly, thus requiring different policy initiatives. However, ED use among the rural elderly has seldom been studied and is little understood. Purpose: To characterize factors associated with having any versus no ED use among the rural elderly. Methods: A cross‐sectional and observational study of 1,736 Medicare beneficiaries age 65 and older who live in nonmetropolitan areas. The data are from the 2002 to 2005 Medical Expenditure Panel Survey (MEPS). A logistic regression model was estimated that included measures of predisposing characteristics, enabling factors, need variables, and health behavior as suggested by Anderson's behavioral model of health service utilization. Findings: During a 1‐year period, 20.8% of the sample had at least 1 ED visit. Being widowed, more educated, enrolled in Medicaid, with fair/poor self‐perceived physical health, respiratory diseases, and heart disease were associated with a higher likelihood of having any ED visits. However, residing in the western and southern United States and being enrolled in Medicaid managed care were associated with lower probability of having any ED visits. While Medicaid enrollees who reported excellent, very good, good, or fair physical health were more likely to have at least 1 ED visit than those not on Medicaid, Medicaid enrollees reporting poor physical health may be less likely to have any ED visits. Conclusion: Policy makers and hospital administrators should consider these factors when managing the need for emergency care, including developing interventions to provide needed care through alternate means.     

Rural–Urban Analyses of Health-Related Quality of Life Among People With Multiple Sclerosis

ABSTRACT:  Context: Health-related quality of life (HRQOL) is a multi-dimensional construct including aspects of life quality or function that are affected by physical health and symptoms, psychosocial factors, and psychiatric conditions. HRQOL gives a broader measure of the burden of disease than physical impairment or disability levels. Purpose: To identify factors associated with HRQOL among people with multiple sclerosis (MS) utilizing the SF-8 Health Survey. Methods: Data presented in this study were collected in a survey of 1,518 people with MS living in all 50 states. The survey sample was randomly selected from the database of the National Multiple Sclerosis Society, using ZIP codes to recruit the survey sample. A multiple linear regression model was employed to analyze the survey data, with the Physical Component Summary and the Mental Component Summary of the SF-8 the dependent variables. Independent variables were demographic characteristics, MS-disease characteristics, and health services utilized. Findings: People with MS in rural areas tended to report lower physically related HRQOL. Worsening MS symptoms were associated with reduced physical and mental dimensions of HRQOL. In addition, people with MS who received a diagnosis of depression tended to have reduced physical and mental dimensions of HRQOL. Receiving MS care at an MS clinic was associated with better physically related HRQOL, while having a neurologist as principal care physician was associated with better mental-related HRQOL. Conclusion: The challenge is to increase the access that people living with MS in rural areas have to MS-focused specialty care.     

Professional Quality of Life and Associated Factors Among Ugandan Midwives Working in Mubende and Mityana Rural Districts

Objective To explore the professional quality of life and associated factors among Ugandan midwives working in Mubende and Mityana rural district to recommend interventions to improve professional well-being and outcomes of midwifery care. Background Professional quality of life of midwives working in rural areas may be influenced by several personal and work setting factors of care professionals often impacting the quality and outcomes of patient care. Methods A cross-sectional study design was used to collect data from 224 midwives working in two rural districts of Uganda. Findings The majority of participants were female (80 %), with an associate degree in midwifery (92 %). The mean age and years of experience were 34 ± 6.3 and 4 ± 2.1 years, respectively. The mean scores on the professional quality of life scale showed average compassionate satisfaction (19 ± 4.88), burnout (36.9 ± 6.22) and secondary traumatic stress (22.9 ± 6.69). The midwives’ compassion satisfaction was related to psychological well-being (p < 0.01) and job satisfaction (p < 0.01). Conversely, their burnout levels and secondary traumatic stress were associated with education level (p < 0.01), marital status (p < 0.01), involvement in non-midwifery health care activities (p < 0.01), and physical well-being (p < 0.01). Conclusion and Implication to practice Midwives working in rural areas of resourcepoor countries have moderate professional quality of life and tend to experience moderate to high levels of burnout, secondary traumatic stress and compassion satisfaction in their professional work. Therefore, employers need to provide deliberate work based services such as counselling, debriefing, training and social support to enhance midwives professional quality of life and quality of midwifery care and practice.     

Health-Related Quality of Life Among Pregnant Women With and Without Depression in Hubei, China

The role of prenatal depression on physical and mental health among women in mainland China has not been previously investigated. The aim of this research was to (a) calculate the prevalence of depression during pregnancy, (b) explore the relationship between depression sample characteristics and quality of life and (c) identify predictors of physical and mental health among pregnant women. This study was designed as a cross-sectional and exploratory survey. A total of 454 pregnant women participated in the study between December 2009 and June 2010 in central China. The data was collected using the Medical Outcomes Study short form 36 v2 and the Edinburgh Postnatal Depression Scale. Participants were recruited at outpatient departments of obstetrics and gynecology. Findings show that almost 40% of pregnant women experience prenatal depression. Depression was significantly associated with physical and mental health-related quality of life (HRQoL). Depression, increased age, higher gestational age, being employed and married were significant predictors of lower physical HRQoL. Depression, lower BMI and having an unintended pregnancy were significant predictors of lower mental HRQoL. Prenatal depression is very common in women from mainland China. Depressed women suffer from impaired physical and mental health; prenatal depression has a negative impact on women's HRQoL. We recommend that antenatal services integrate screening for depression into routine antenatal care.     

Use of ACE-inhibitors and Quality of Life in an Older Population

Background

Improved ability to treat chronic diseases have increased the interest in measuring health-related quality of life (HRQoL) in older adults. Hypertension and heart failure have been associated with decreased HRQoL.

Hypothesis

The aim of this study was to assess the association between health-related quality of life and use of angiotensin converting enzyme inhibitors in unselected community-dwelling elderly.

Methods

We analyzed data of all 387 subjects aged 75+ living in a rural Italian town, without exclusion criteria. HRQoL was assessed using the Health Utility Index Mark 3, which allows formal cost-effectiveness calculations. The association of the HRQoL score with use of ACE-I was analyzed by multivariable linear and logistic regression.

Results

The median HUI3 score was 0.31, and 186 participants (48%) reported a score above the median value. Use of ACE-I was reported by 34 (9%) participants, and confirmed by general practitioners. Use of these agents was associated with significantly better HRQoL (B=.16, 95% CI=.02 -.30; P=.025). Also, use of ACE-I was associated with increased probability of better HRQoL in logistic regression (OR=2.83; 95% CI=1.03 - 7.78; P=.044) after adjusting. No associations were found between the HRQoL score and use of calcium antagonists or beta-blockers.

Conclusions

Use of ACE-I, but not of other antihypertensives, is associated with better HRQoL among community-dwelling older adults. ACE-inhibitors might therefore present with the best cost-effectiveness ratio for the treatment of older populations.

     

Associations Between Nutritional Status,Frailty and Health-Related Quality of Life Among Older Long-Term Care Residents in Helsinki

The aim of this study was to examine how nutritional status modifies the association between frailty and health-related quality of life (HRQoL) among older nursing home residents. We also investigated how residents’ energy intake is linked to frailty score. A total of 486 older (> 65 years of age) nursing home residents living in Helsinki, Finland were included to this cross-sectional study. We collected data on the residents’ background information, HRQoL by 15D, nutritional status by Mini Nutritional Assessment (MNA), frailty status (Fried’s phenotype criteria; pre-frail: 1–2 criteria and frail: 3–5) and energy intake (one- or two-day food records). The frail residents were more often malnourished and had lower HRQoL than those in the prefrail group. Energy and protein intakes were significantly lower among frail women than prefrail women. Energy intake was linearly associated with frailty points. When residents in the frail and prefrail groups were divided according to their nutritional status, both nutritional status and frailty were associated with HRQoL, but there was no interaction. Both nutritional status and frailty were associated with HRQoL, and lower energy intake indicated a higher frailty score. An adequate energy intake may promote residents’ HRQoL and prevent frailty in long-term care.     

Assessing Health-Related Quality of Life Among Children With Special Health Care Needs in the United States

The objectives of this article were to examine the differences in health-related quality of life (HRQOL) between children with and without special health care needs, and identify the risk factors associated with HRQOL in children with special health care needs (CSHCN). Data from the National Survey of Children's Health 2003 were used (N = 66,416). Results showed that the HRQOL summary scores were lower among CSHCN than children without special health care needs. Regression analyses revealed that having multiple (3 or more) special health care needs was the strongest predictor of lower HRQOL. In addition, younger age, lower socioeconomic status, health care access barriers, and poor maternal health were all factors associated with lower HRQOL. Implications for practice and policy are discussed.     

Racial/Ethnic Differences in Risk Factors Associated With Severe COVID-19 Among Older Adults With ADRD

ObjectiveTo examine racial/ethnic differences in risk factors, and their associations with COVID-19–related outcomes among older adults with Alzheimer’s disease and related dementias (ADRD).DesignObservational study.Setting and ParticipantsNational Medicare claims data and the Minimum Data Set 3.0 from April 1, 2020, to December 31, 2020, were linked in this study. We included community-dwelling fee-for-service Medicare beneficiaries with ADRD, diagnosed with COVID-19 between April 1, 2020, and December 1, 2020 (N = 138,533).MethodsTwo outcome variables were defined: hospitalization within 14 days and death within 30 days of COVID-19 diagnosis. We obtained information on individual sociodemographic characteristics, chronic conditions, and prior health care utilization based on the Medicare claims and the Minimum Dataset. Machine learning methods, including lasso regression and discriminative pattern mining, were used to identify risk factors in racial/ethnic subgroups (ie, White, Black, and Hispanic individuals). The associations between identified risk factors and outcomes were evaluated using logistic regression and compared across racial/ethnic subgroups using the coefficient comparison approach.ResultsWe found higher risks of COVID-19–related outcomes among Black and Hispanic individuals. The areas under the curve of the models with identified risk factors were 0.65 to 0.68 for mortality and 0.61 to 0.62 for hospitalization across racial/ethnic subgroups. Although some identified risk factors (eg, age, gender) for COVID-19–related outcomes were common among all racial/ethnic subgroups, other risk factors (eg, hypertension, obesity) varied by racial/ethnic subgroups. Furthermore, the associations between some common risk factors and COVID-19–related outcomes also varied by race/ethnicity. Being male was related to 138.2% (95% CI: 1.996–2.841), 64.7% (95% CI: 1.546–1.755), and 37.1% (95% CI: 1.192–1.578) increased odds of death among Hispanic, White, and Black individuals, respectively. In addition, the racial/ethnic disparity in COVID-19–related outcomes could not be completely explained by the identified risk factors.Conclusions and ImplicationsRacial/ethnic differences were detected in the likelihood of having COVID-19–related outcomes, specific risk factors, and relationships between specific risk factors and COVID-19–related outcomes. Future research is needed to elucidate the reasons for these differences.     

Health-Related Quality of Life in People Living with Psychotic Illness and Factors Associated with Its Variation

Objectives

To establish whether the four-dimensional Assessment of Quality of Life (AQoL-4D) produces robust utility values in adults with psychotic illness, and identify health inequalities compared with the general population.