Changes in health-related quality of life in older patients with acute myocardial infarction or congestive heart failure: a prospective study

OBJECTIVES: To study changes in health-related quality of life (HR-QL) following acute myocardial infarction (AMI) or congestive heart failure (CHF) in older people (> or = 57 yr). DESIGN: Prospective cohort study. SETTING: Primary healthcare registers. PARTICIPANTS: Patients were enrolled on the basis of primary healthcare records. Eighty-nine AMI patients (mean age = 69.5) and 119 CHF patients (mean age = 74.5) were included for analysis. MEASUREMENTS: HR-QL was conceptualized and measured by means of physical (activities of daily living (ADL), instrumental activities of daily living (IADL)), psychological (depressive symptoms, anxiety), social, and role functioning. Premorbid data (TO) were available from a 1993 community-based survey. Incident AMI and CHF cases, developed after 1993, were prospectively followed for 12 months. Assessments were performed at 6 weeks (T1) and 6 (T2) and 12 months (T3) after diagnosis. RESULTS: At the premorbid assessment, AMI patients did not significantly differ on HR-QL from a reference group of older people, whereas CHF patients were on average older and had worse HR-QL compared to the reference group. Although CHF had not yet been diagnosed at TO, symptoms were already present and resulted in decreased levels of functioning. At T1, all HR-QL measures showed worse functioning compared with TO, except for depressive symptoms that presented later (at T2). In contrast to the delay in depressive symptoms, a significant increase in anxiety was already seen at T1. The effect of the somatic conditions was the largest on physical functioning. Effects on psychological and social functioning were less pronounced but still significant. Effects were maintained during the 12 months of follow-up. CONCLUSION: The negative consequences on HR-QL in both AMI and CHF patients are not temporary. No recovery of function was seen in AMI patients, and functioning of CHF patients continued to decline in the first year after diagnosis.     

Developing a senior healthcare practice using the chronic care model: effect on physical function and health-related quality of life

An ambulatory senior health clinic was developed using the chronic care model (CCM), with emphasis on an interdisciplinary team approach. To determine the effect of this care model approach in a nonprofit healthcare system, an observational, longitudinal panel study of community-dwelling Medicare beneficiaries was performed to examine the effect on physical function and health-related quality of life (HRQL). Participants in the study were recruited from a community sample of 6,864 eligible Medicare beneficiaries. Informed consent and baseline data were obtained from 1,709 individuals (recruitment response rate=25%) and complete data across 30 months from 1,307 (completion response rate=76%). Participants receiving care in the CCM-based senior healthcare practice (n=318) were compared with patients of primary care physicians supported by care managers (n=598) and a group without care managers (n=391). Self-reported data were collected over the telephone to measure physical function and HRQL at baseline and 6, 18, and 30 months. A multiple group mixture growth model was used to analyze physical function and HRQL across the 30 months. Physical function and HRQL mean scores decreased across time in all participants and were moderately correlated at each wave (correlation coefficient=0.74–0.79). Two latent growth classes were identified. In class 1, physical function decreased, and HRQL remained stable across time. In class 2, physical function and HRQL decreased in parallel. Ninety-seven percent of intervention group patients were in class 1, and 99% of patients in comparison groups 1 and 2 were in class 2. Despite physical function decline, patients in a senior health clinic care model maintained HRQL over time, whereas patients receiving traditional care had physical function and HRQL decline. An interdisciplinary team CCM approach appears to have a positive effect on HRQL in this population.     

Accidental falls,health-related quality of life and life satisfaction: A prospective study of the general elderly population

As the physical consequences of accidental falls in the elderly are well-researched, the long-term associations between falls and quality of life and related concepts are less known. The aim of this study was to prospectively examine the long-term relations between falls and health-related quality of life (HRQoL) and life satisfaction (LS) over six years in the general elderly population.     

Effect of tiotropium on health-related quality of life as a primary efficacy endpoint in COPD

Clinical manifestations of chronic obstructive pulmonary disease (COPD), including airflow limitation, dyspnea, and activity limitation, ultimately lead to impaired health-related quality of life (HRQoL). This 9-month, randomized, double-blind, multicenter study compared the effect of once-daily tiotropium 18 μg and placebo on HRQoL, spirometric parameters, and exacerbations in 554 patients with moderate-to-severe COPD. HRQoL was assessed using the St. George’s Respiratory Questionnaire (SGRQ) and the new 8-item Visual Simplified Respiratory Questionnaire (VSRQ), which is currently being validated. The primary efficacy endpoint was the proportion of patients achieving a reduction of at least 4 units in the SGRQ total score at study end (Month 9). Mean ± SD baseline SGRQ total score was 47.4 ± 18.1. Significantly more tiotropium-treated patients achieved a reduction of at least 4 units in the SGRQ score vs placebo at study end (59.1% vs 48.2%, respectively; p = 0.029). Tiotropium significantly improved spirometric parameters (forced expiratory volume in 1 second [FEV₁]: 0.11 ± 0.02 L vs 0.01 ± 0.02 L; between-group difference: 0.10 ± 0.03 L, p = 0.0001) and reduced exacerbations vs placebo. Maintenance treatment with tiotropium provided significant and clinically relevant improvements in HRQoL, as measured by the SGRQ.     

Effects of haemophilic arthropathy on health-related quality of life and socio-economic parameters

Summary. Although prophylactic treatment is advised for all children with severe haemophilia, the optimal regimen is still under discussion. Should all joint bleeds be prevented, or can a limited amount of arthropathy be tolerated in adulthood without loss of quality of life? To answer this question, the effect of haemophilic arthropathy on health‐related quality of life (HRQoL) needs to be quantified. In a retrospective study, the effect of arthropathy on HRQoL and socio‐economic parameters was assessed in a single‐centre cohort of 96 patients with severe and moderate haemophilia with a minimum age of 13 years. Arthropathy was measured by the radiological Pettersson score of the elbows, knees and ankles (maximum: 78 points). HRQoL was assessed by the Short Form 36 (SF36), measuring eight domains of health. Labourforce participation and medical consumption were assessed using a separate questionnaire. Patients were studied at a mean age of 28.6 years (range: 13–54), the mean time between evaluation and the last Pettersson score was 0.4 years (SD: 1.1). The overall median Pettersson score was 13 (range: 0–78). There was a trend towards lower quality of life with increasing Pettersson scores and age, especially in the physical domains of the SF36. An age‐adjusted analysis showed that arthropathy had a small but significant effect on HRQoL in the domain of ‘physical function’ of the SF36, but not on its other domains, or on labourforce participation and medical consumption. Thus suggesting that the SF36 can be used to assess the effects of haemophilic arthropathy, especially in the domain of ‘physical function’.     

HIV-related stigma and health-related quality of life among children living with HIV in Sweden

The relationship between HIV-related stigma and health-related quality of life (HRQoL) among children living with HIV infection is unknown. The objectives of this study were to describe HIV-related stigma and HRQoL among children with perinatal HIV living in Sweden, and to investigate the relationship between these two factors in the same infection group. In a cross-sectional nationwide survey, HIV-related stigma was measured with the 8-item HIV Stigma Scale for Children. HRQoL was measured with the 37-item DISABKIDS Chronic Generic Module. Structural equation modeling was used to explore the relationship between HIV-related stigma and HRQoL. Fifty-eight children participated, age 9–18 years (mean = 13.9). The HIV stigma general scale showed a mean score of 17.6 (SD = 5.0; possible range 8–32). DISABKIDS Chronic Generic Module general scale showed a mean score of 80.7 (SD = 14.1; possible range 0–100). HIV-related stigma was negatively associated with HRQoL (standardized β = ?0.790, p = .017). The results indicate that children's concerns related to disclosure of their HIV infection seem to be common (i.e. 75% agreed) which, together with the negative association between ratings of HIV-relatively stigma and HRQoL, might indicate that disclosure concerns would be a relevant target for interventions to decrease HIV-related stigma and increase HRQoL.     

Kenosha County falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention

OBJECTIVES: To decrease the rate of falls in high-risk community-dwelling older adults. DESIGN: Randomized, controlled trial. SETTING: Community-based. PARTICIPANTS: Three hundred forty-nine adults aged 65 and older with two falls in the previous year or one fall in the previous 2 years with injury or balance problems. INTERVENTION: Subjects received two in-home visits from a trained nurse or physical therapist who assessed falls risk factors using an algorithm. The intervention consisted of recommendations to the subject and their primary physician, referrals to physical therapy and other providers, 11 monthly telephone calls, and a balance exercise plan. Control subjects received a home safety assessment. MEASUREMENTS: The primary outcome was rate of falls per year in the community. Secondary outcomes included all-cause hospitalizations and nursing home admissions per year. RESULTS: There was no difference in rate of falls between the intervention and control groups (rate ratio (RR)=0.81, P=.27). Nursing home days were fewer in the intervention group (10.3 vs 20.5 days, P=.04). Intervention subjects with a Mini-Mental State Examination (MMSE) score of 27 or less had a lower rate of falls (RR=0.55; P=.05) and, if they lived with someone, had fewer hospitalizations (RR=0.44, P=.05), nursing home admissions (RR=0.15, P=.003), and nursing home days (7.5 vs 58.2, P=.008). CONCLUSION: This multifactorial intervention did not decrease falls in at-risk community-living adults but did decrease nursing home utilization. There was evidence of efficacy in the subgroup who had an MMSE score of 27 or less and lived with a caregiver, but validation is required.     

Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD

OBJECTIVE: The purpose of this study was to understand the outcomes for patients admitted to hospital for an acute exacerbation of COPD, and to determine the factors influencing quality of life and health service utilization of patients with COPD. METHODOLOGY: Hospital outcomes of 282 patients with moderate and severe COPD, for an acute exacerbation, were retrospectively evaluated. After 24 months of follow up, health-related quality of life (QoL) and health service utilization (emergency room (ER) visit and readmission) in 54 patients admitted previously, were surveyed by questionnaires. RESULTS: Of 282 COPD patients admitted for an acute exacerbation, 28 patients (9.9%) died during hospitalization, 241 patients (85.5%) were discharged home, and only 13 patients (4.6%) needed long-term care facilities. Although over 50% of the patients had survived over 2 years after discharge, their QoL was poor. Patients who frequently went to the ER or were admitted, were those with poor QoL, severe dyspnoea and frequent exacerbation. COPD exacerbation and dyspnoea were the main factors influencing QoL of the patients. Age, comorbidity, QoL, FEV1, frequency of COPD exacerbation, long-term oxygen therapy, and family doctor were the factors determining the likelihood of patients visiting the ER. Frequency of COPD exacerbation, family doctor and living alone were the factors determining which patients were likely to be admitted to hospital. CONCLUSION: The outcomes and QoL of patients admitted for an acute exacerbation of COPD were poor. The major factors influencing QoL were frequency of COPD exacerbation and severity of dyspnoea. Improvement of social and medical networks (e.g. reducing the number of patients living alone and providing family doctors for patients) may reduce health care service utilization.     

Agreement between patient and proxy responses of health-related quality of life after hip fracture

OBJECTIVES: To examine agreement between patient and proxy respondents on health-related quality of life (HRQL) over time during the 6-month recovery after hip fracture. DESIGN: Prospective longitudinal cohort study. SETTING: A healthcare region serving Edmonton, Alberta, and the surrounding area. PARTICIPANTS: Two hundred forty-five patients aged 65 and older, were treated for hip fracture, and had Mini-Mental State Examination scores greater than 17; 245 family caregivers participated as proxy respondents. MEASUREMENTS: Primary outcome was HRQL (Health Utilities Mark 2 and Mark 3). Interviews were completed within 5 days after surgery and at 1, 3, and 6 months. Agreement was evaluated using intraclass correlation coefficients (ICCs). RESULTS: Agreement was considered moderate to excellent for HRQL. ICC values ranged from 0.50 to 0.85 (P<.001) for physically based observable dimensions of health status and from 0.32 to 0.66 (P<.01) for less-observable dimensions. Agreement improved with time. Time and the number of days between patient and proxy interviews were significant factors in accounting for patient-proxy differences. CONCLUSION: Although proxy and patient responses are not interchangeable, proxy responses provide an option for assessing function and health status in patients who are unable to respond on their own behalf.     

Periodontal surgery improves oral health-related quality of life in chronic periodontitis patients in Asian population

The effect of periodontal surgery on patients' quality of life was investigated. Sixty patients received regenerative surgery or resective osseous surgery. Oral health-related quality of life and health-related quality of life instruments were used to assess the participants' quality of life before surgery and 4 weeks after surgery. Periodontal surgery can improve patients' quality of life by alleviating the physical pain and psychological discomfort. The scores were lower (more favorable) in the regenerative surgery group, and the functional limitations of the regenerative surgery group improved substantially compared with those of the resective osseous surgery group (P = 0.0421). The patients' oral health-related quality of life scores improved significantly after periodontal surgery. Clinicians can take advantage of the positive functional oral health-related quality of life impacts of regenerative surgery.     

Gender-associated differences in dyspnoea and health-related quality of life in patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES: Recent studies have reported several gender-associated differences among patients with COPD, but gender-associated differences in health-related quality of life (HRQoL) in patients with COPD have not yet been clarified. This study evaluated gender differences in dyspnoea and HRQoL in patients with COPD. METHODS: Study participants were 156 patients with COPD (men 117, women 39); men were individually matched to women by age and FEV(1)% predicted to give a ratio of 3:1 (male : female). Study participants were evaluated for dyspnoea and completed HRQoL questionnaires. An oxygen cost diagram (OCD) was used to assess the degree of dyspnoea and Morale Scale was used to assess subjective well-being. St. George's Respiratory Questionnaire (SGRQ) and SF-36 were used for HRQoL evaluation. The findings in the male and female groups were compared. RESULTS: The OCD and Morale Scale showed significantly lower values for female patients with COPD. Disease-specific HRQoL assessed by SGRQ was significantly worse, except for symptoms, in female patients with COPD. Generic HRQoL assessed by SF-36 was also significantly worse, except for general health and social functioning. Stepwise multiple regression showed OCD, Morale Scale and 6-min walking distance to be significantly associated with total SGRQ score in the male group, and Morale Scale and 6-min walking distance were significant associations in the female group. CONCLUSIONS: Gender differences exist in dyspnoea and HRQoL in patients with COPD. These need to be considered when designing treatment strategies for COPD patients.     

Obesity and health-related quality of life

Although it is well documented that obesity is strongly associated with morbidity and mortality, less is known about the impact of obesity on functional status and health‐related quality of life (HRQL). However, in recent years research has been conducted to estimate the impact of obesity on HRQL, and to determine the effects of weight reduction on HRQL. The majority of published studies indicate that obesity impairs HRQL, and that higher degrees of obesity are associated with greater impairment. Obesity‐associated decrements on HRQL tend to be most pronounced on physical domains of functioning. Studies of the effect of obesity surgery among morbidly obese patients indicate that this procedure produces significant and sustained improvements in the majority of HRQL indices; among mild‐to‐moderately obese persons, modest weight reduction derived from lifestyle modification also appears to improve HRQL, at least in the short term. Additional research is needed to (1) further characterize the effect that obesity has on HRQL; (2) estimate the short‐ and long‐term effects of various methods of weight reduction (e.g. surgery, lifestyle modification) on HRQL; 3 improve both the conceptualization and measurement of HRQL to incorporate the personal preferences and values of the patient; and 4 develop ways to enhance and sustain positive changes in HRQL, even if weight maintenance is elusive.     

Preference-weighted health-related quality of life measures and substance use disorder severity

Aims   Examine the validity of preference-weighted health-related quality of life measures in a sample of substance use disorder (SUD) patients. The implications of cost–utility analyses (CUAs) of SUD interventions are discussed.
Design   Cross-sectional analysis of subjects seeking SUD treatment.
Setting   Seven SUD treatment centers in a medium-sized Midwestern metropolitan area in the United States.
Participants   Data from 574 SUD subjects were analyzed from a study to test interventions to improve linkage and engagement with substance abuse treatment.
Measurements   Subjects completed the following preference-weighted measures: self-administered Quality of Well-Being scale (QWB-SA) and Medical Outcomes Study SF-12 (standard gamble weighted or SF-12 SG); and clinical measures: Addiction Severity Index (ASI) and a symptom checklist based on the DSM-IV.
Findings   In unadjusted analyses, the QWB-SA was correlated significantly with six of seven ASI subscales and the SF-12 SG was correlated with four of seven. In adjusted analyses, both preference-weighted measures were significantly correlated with diagnostic, physical health, mental health and drug use measures, but not with legal or alcohol use measures. The QWB-SA was also correlated with employment problems and the SF-12 SG was correlated with family/social problems.
Conclusions   This study generally supports the construct validity of preference-weighted health-related quality of life measures in SUD patients. However, the QWB-SA and SF-12 SG did not correlate with all ASI scales. Cost–benefit analysis may be preferable when policy-makers are interested in evaluating the full range of SUD intervention outcomes.     

The impact of dyspnoea and leg fatigue during exercise on health-related quality of life in patients with COPD

OBJECTIVE: COPD patients frequently complain of symptoms such as dyspnoea and leg fatigue during exercise. However, the impact of these symptoms on the health-related quality of life (HRQoL) is not known. This study tested whether dyspnoea and leg fatigue during exercise affects the HRQoL of patients with COPD. METHODs: In a cross-sectional study, 90 patients with stable COPD (mean age, 76.0+/-0.7 years; FEV(1), 1.11+/-0.04 L) completed the St. George's Respiratory Questionnaire (SGRQ), pulmonary function testing, arterial blood gas analysis, and a 6-min walking distance test (6MWD). Dyspnoea and leg fatigue during exercise were quantitated into 12 grades using the Borg scale (0--10). Correlations between the SGRQ and various variables were determined. In a longitudinal study, 22 patients with COPD (mean age, 71.5+/-1.1 years; FEV(1), 1.31+/-0.08 L) completed a pulmonary rehabilitation program, for which correlations between changes in the SGRQ as well as changes in both dyspnoea and leg fatigue, during the 6MWD before and 3 months after pulmonary rehabilitation, were examined. RESULTS: For the cross-sectional study, the total SGRQ score correlated significantly with the walking distance, dyspnoea and leg fatigue during the 6MWD and FEV(1), respectively. Stepwise multiple regression analysis showed that dyspnoea and leg fatigue during the 6MWD were independent variables for HRQoL measured by the SGRQ. For the longitudinal study, changes in the SGRQ correlated significantly with changes in dyspnoea and leg fatigue, before and 3 months after, pulmonary rehabilitation. CONCLUSIONS: Symptoms, such as the degree of dyspnoea and leg fatigue during exercise, are significant variables which influence the HRQoL of patients with COPD. In addition, the improvement in HRQoL following pulmonary rehabilitation may be due to improvements in dyspnoea and leg fatigue in patients with COPD.     

Health-related quality of life after elective surgery

Objective:  To examine the responsiveness of the 36-Item Short Form Health Survey (SF-36) to clinical changes in three surgical groups and to study how health-related quality of life (HRQL) changes with time among patients who undergo total hip arthroplasty, thoracic surgery for treatment of non-small-cell lung cancer, or abdominal aortic aneurysm (AAA) repair. Design:  Prospective cohort study with serial evaluations of HRQL preoperatively and at 1, 6, and 12 months after surgery. Setting:  University tertiary care hospital. Patients:  Of 528 patients, more than 50 years of age, who were admitted for these elective procedures, 454 (86%) provided preoperative health status data and are members of the study cohort. At 12 months after surgery, 439 (93%) of the cohort was successfully contacted and 390 (90%) provided follow-up interviews. Measurements and main results:  The Medical Outcomes Study SF-36, the Specific Activity Scale, five validated health transition questions, and a 0 to 100 scale measure of global health were used to assess changes in health status at 1, 6, and 12 months after surgery. Change in health status as measured by the SF-36 demonstrated that physical function and role limitations due to physical health problems were worse 1 month after these three surgeries. However, by 6 months after surgery, most patients experienced significant gains in the majority of the dimensions of health, and these gains were sustained at 12 months after surgery. Longitudinal changes in the SF-36 were positively associated with responses to the five health transition questions, to changes on the Specific Activity Scale and global health rating question, and to clinical parameters for persons who had AAA repair. These findings indicate that the SF-36 has evidence of validity and is responsive to expected changes in HRQL after elective surgery for these procedures. Conclusions:  For the total hip arthroplasty patients, responsiveness was greatest for the SF-36 scales that measure physical constructs. However, for the two other procedures and at various points of recovery, significant changes were observed for all eight subscales, suggesting that responsiveness was dependent on the type of surgery and the timing of follow-up, and that multidimensional measures are needed to fully capture changes in HRQL after surgery. Funded in part by a grant from the Agency for Health Care Policy and Research (1RO1-HS06573). Dr. Mangione is the recipient of a Clinical Investigator Award (1K08-AG00605) from the National Institute on Aging, and is an awardee of the Robert Wood Johnson Foundation Generalist Physicians Faculty Scholars Program (029250).     

Development and testing of a measure of health-related quality of life for men with urinary incontinence

OBJECTIVES: To describe the development and psychometric testing of male versions of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). DESIGN: Instrument development. SETTING: Urology clinic at a large urban Veterans Affairs Medical Center. PARTICIPANTS: Convenience sample of English-speaking community-dwelling male urology clinic patients who acknowledged concerns about urine leakage. MEASUREMENTS: Content experts and male clinic patients evaluated items for clarity and fit. Revised instruments were administered to 153 participants. Data were analyzed to examine issues of feasibility of administration, internal consistency reliability, and validity. RESULTS: Modal completion time for the Male Urogenital Distress Inventory (MUDI) (27 items) and Male Urinary Symptom Impact Questionnaire (MUSIQ) (32 items) was 20 minutes. Cronbach's coefficients were.89 for the MUDI and.95 for the MUSIQ. Total MUDI and MUSIQ scores were moderately correlated (r =.59, P <.001). Mean MUDI and MUSIQ scores varied significantly with self-reported desire for socialization, urine leakage, and depression. Principal components analyses suggested the presence of seven factors accounting for 65.4% of the variance in the MUDI and six factors accounting for 72.9% of the variance in the MUSIQ. CONCLUSIONS: It is feasible to use the MUDI and MUSIQ to measure health-related quality of life in men with continence problems. The scores appeared to be reliable and valid in this racially and educationally diverse sample. Use of the MUDI and MUSIQ may provide more sensitive measurement of the specific effect of urinary incontinence and related symptoms on health-related quality of life in men. Future research should determine reproducibility and responsivity and reexamine the construct validity of these instruments.     

Methodological aspects of health-related quality of life measurement and analysis in patients with multiple myeloma

Multiple myeloma (MM) is an incurable but treatment-sensitive cancer. For most patients, this means treatment with multiple lines of anti-myeloma therapy and a life with disease- and treatment-related symptoms and complications. Health-related quality of life (HRQoL) issues play an important role in treatment decision-making. Methodological challenges in longitudinal HRQoL measurements and analyses have been identified, including non-responses (NR) to scheduled questionnaires. Publications were identified for inclusion in a systematic review of longitudinal HRQoL studies in MM, focussing on methodological aspects of HRQoL measurement and analysis. Diversity in timing of HRQoL data collection and applied statistical methods were noted. We observed a high rate of NR, but the impact of NR was investigated in only 8/23 studies. Thus, evidence-based knowledge of HRQoL in patients with MM is compromised. To improve quality of HRQoL results and their implementation in daily practice, future studies should follow established guidelines.     

Impaired health-related quality of life and related risk factors among US adults with asthma

Objective: This study assessed health-related quality of life (HRQoL) and related risk factors among adults with asthma in the United States. Using the 2015 Behavioral Risk Factor Surveillance System (BRFSS), we examined the association between four domains of impaired HRQoL and selected explanatory factors. Methods: A BRFSS sample of 39,321 adults with asthma was used in this study. We examined the association between fair/poor health, ≥ 14 mentally unhealthy days, ≥ 14 physically unhealthy days, and ≥ 14 days of activity limitation and selected explanatory variables (sex, race/ethnicity, age, annual household income, healthcare coverage, physical activity, smoking status, body mass index (BMI), having a coexisting disease, and being diagnosed with depression) using multivariable logistic regression models. Results: Income, physical activity status, smoking status, coexisting diseases, and depression were strongly associated with all HRQoL domains. Blacks had significantly less ≥ 14 physically unhealthy days (23.4%; aPR = 0.82 [95% confidence interval (CI): 0.72, 0.92]) and ≥ 14 days of activity limitation (18.3%; aPR = 0.81 [0.70, 0.94]) and Hispanics had significantly more fair/poor health (38.4%; aPR = 1.31 [1.18, 1.45]) than whites. Underweight and obese had significantly more fair/poor health, and underweight significantly more ≥ 14 physically unhealthy days, compared with normal weight. Adults aged 55 years or older had significantly less ≥ 14 mentally unhealthy days than adults 18–24 years. Conclusions: Multiple factors were associated with impaired HRQoL. Providing strategies to address potential risk factors such as low income, physically inactive, smoker, and obese or underweight should be considered to improve HRQoL among adults with asthma.     

Cost and health-related quality of life for children hospitalized with respiratory syncytial virus in Central China

Background

The economic burden of respiratory syncytial virus (RSV) infection and its impact on health-related quality of life (HRQoL) are not well-understood in China. This study assessed total cost and HRQoL for children hospitalized with RSV in Central China.

Methods

Based on a prospective case series study in Henan Province in 2020–2021, inpatients aged 0–59 months with RSV-related acute respiratory infections (ARIs) were included into analysis. Total cost included direct medical cost (sum of medical cost before and during hospitalization), direct non-medical cost, and indirect cost. Direct medical cost during hospitalization data were extracted from the hospital information system. Other costs and HRQoL status were obtained from a telephone survey conducted in the caregivers of the enrolled patients.

Results

Among 261 RSV-infected inpatients, caregivers of 170 non-severe cases (65.1%, 170/261) were successfully interviewed. Direct medical cost per episode was 1055.3 US dollars (US$) (95% CI: 998.2–1112.5 US$). Direct non-medical cost and indirect cost per episode were 83.6 US$ (95% CI: 77.5–89.7 US$) and 162.4 US$ (95% CI: 127.9–197.0 US$), respectively. Quality adjusted life years (QALY) loss for non-severe RSV hospitalization was 8.9 × 10⁻³ (95% CI: 7.9 × 10⁻³–9.9 × 10⁻³). The majority of inpatients were <1 year of age comprising significantly higher cost and more QALY loss than older children.

Conclusions

RSV-associated hospitalization poses high economic and health burden in Central China particularly for children <1 year old. Our findings are crucial for determining the priority of interventions and allocation of health resources.