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

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

Health-related quality of life among adults with serious psychological distress and chronic medical conditions

Objective Determine the prevalence of serious psychological distress (SPD) among adults with and without chronic medical conditions and examine the association between SPD and health-related quality of life (HRQOL). Methods Cross-sectional data from the 2005 Los Angeles County Health Survey were used to estimate prevalence of SPD. The association between SPD and HRQOL was evaluated using logistic regression and analysis of covariance, adjusting for sociodemographic variables and number of chronic conditions. Results SPD was significantly associated with younger age, lower income, being unemployed or disabled, being unmarried, fair or poor health, and having one or more chronic conditions. Adults with three or more chronic conditions were six times as likely to have SPD as those with no conditions. Adults with SPD reported significantly more unhealthy days (mental and physical) and activity limitation days than adults without SPD. The adjusted mean number of unhealthy days was highest among adults with SPD (23.3), followed by adults with depression (14.1), and diabetes (10.6). Conclusions SPD is associated with decreased HRQOL and presence of chronic medical conditions. Mental health should be routinely assessed when addressing health needs of individuals and communities. Persons with chronic diseases may benefit from targeted mental health screening and programs that employ treatment approaches that jointly manage physical and mental health and provide improved links and access to services.     

Adaptive responses among Dutch elderly: the impact of eight chronic medical conditions on health-related quality of life.

OBJECTIVES: This study analyzed the impact of eight common chronic medical conditions on functional, social, and affective domains of health-related quality of life among community-based Dutch elderly (n = 5279). METHODS: Health-related quality of life was measured with six domains of the MOS Short-Form General Health Survey. The impact of the selected chronic conditions on health-related quality of life was analyzed by means of Student's t tests, analyses of variance, and multiple regression analyses. RESULTS: Compared with other domains of health-related quality of life, mental health was the least affected by chronic medical conditions. Back problems and rheumatoid arthritis/other joint complaints accounted for relatively high proportions of the variance in health-related quality of life (from 35.5% to 68.3%), except for health perceptions (22.6%), indicating that health-related quality of life is most affected by these two conditions. CONCLUSIONS: Subjective well-being is by far the domain least affected by chronic medical conditions, while physical functioning and health perceptions are most affected. Back problems and rheumatoid arthritis/other joint complaints affect health-related quality of life strongly.     

Differences in health-related quality of life in rural and urban veterans

OBJECTIVES: We sought to determine whether disparities in health-related quality of life exist between veterans who live in rural settings and their suburban or urban counterparts. METHODS: We determined health-related quality-of-life scores (physical and mental health component summaries) for 767109 veterans who had used Veterans Health Administration services within the past 3 years. We used rural/urban commuting area codes to categorize veterans into rural, suburban, or urban residence. RESULTS: Health-related quality-of-life scores were significantly lower for veterans who lived in rural settings than for those who lived in suburban or urban settings. Rural veterans had significantly more physical health comorbidities, but fewer mental health comorbidities, than their suburban and urban counterparts. Rural-urban disparities persisted in all survey subscales, across regional delivery networks, and after we controlled for sociodemographic factors. CONCLUSIONS: When compared with their urban and suburban counterparts, veterans who live in a rural setting have worse health-related quality-of-life scores. Policymakers, within and outside the Veterans Health Administration, should anticipate greater health care demands from rural populations.     

The association between physical exercises and health-related quality of life in subjects with mental disorders: results from a cross-sectional survey

OBJECTIVES: The present study examines the relationship between health-related quality of life and physical activity among adults with affective, anxiety, and substance dependence disorders. METHODS: Analyses were conducted among participants in the German National Health Interview and Examination Survey (GHS), a nationally representative multistage probability survey, conducted from 1997 to 1999. Multiple linear regression analyses were used to determine the relationship between health-related quality of life and physical activity among subjects with mental disorders. RESULTS: Affective, anxiety, and substance dependence disorders were associated with substantial impairment in health-related quality of life. Higher levels of physical activity were associated with higher health-related quality of life among persons with mental disorders. Even after controlling for sociodemographic characteristics, physically inactive subjects reported poorer quality of life. CONCLUSIONS: Physical activity can be considered as beneficial for people suffering from mental disorders. The promotion of a physically active lifestyle is an important public health objective.     

Associations between health-related quality of life and financial barriers to care among women veterans and women non-veterans

The authors of this study examined the association between health-related quality of life and financial barriers to care, defined as not getting the needed care due to cost considerations. To better understand health-related quality of life among women veterans, the authors compared women veterans to women non-veterans. The authors conducted cross-sectional analyses using data from the 2009 Behavioral Risk Factor Surveillance System survey. The authors assessed four health-related quality of life measures: (1) general health; (2) physical health; (3) mental health; and (4) functional status. The authors performed multinomial logistic regressions to examine the relationship between financial barriers to receiving healthcare and health-related quality of life measures after controlling for other independent variables. The authors included women veterans not in active military duty (N = 3,747) and a matched sample of women non-veterans (N = 3,747), selected using a propensity score method so that they would have distributions of demographic and socioeconomic characteristics similar to those of the veterans. Overall, 14% of women reported financial barriers. Women who reported financial barriers to receiving healthcare were more likely to have poor health-related quality of life in all four dimensions than those who did not report such barriers. Compared to women non-veterans, women veterans did not differ in reported financial barriers but were more likely to report poor health-related quality of life. Reporting financial barriers to receiving needed healthcare was significantly associated with poor health-related quality of life among women. Veteran status was also significantly associated with poor health-related quality of life. These findings suggest the need for healthcare policy makers and practitioners to align emerging new models of healthcare delivery to improve health-related quality of life for women veterans.     

Factors Associated With Health-Related Quality of Life Among an Older Population in a Largely Rural Western Region

CONTEXT: As elderly people become a larger proportion of the rural population, it is important to identify those at risk for poor health. Predictors of health-related quality of life can be useful in designing interventions. PURPOSE: One objective of the present study was to profile the health-related quality of life of community-dwelling, elderly people in a southwestern region of the United States. A related objective was to identify the principal factors associated with health-related quality of life, thereby identifying population subgroups in greatest need of health or social services. METHODS: A telephone survey of approximately 5,000 individuals 65 years and older collected data on need for assistance with activities of daily living, physical and mental health-related quality of life, and worry about health status measures. A modified version of the Behavioral Model was used to more clearly distinguish the different groups at risk for poor health. FINDINGS: Those groups of community-dwelling, elderly people in the poorest health were older than 75 years, had less than a high school education, were retired or unemployed, and had low household income. No differences were found by urban, rural, and frontier residence. CONCLUSIONS: To maintain the physical, social, and psychological health of older people residing in rural and urban areas, social services, medical care, and supportive services are needed, particularly among the most socially and economically disadvantaged.     

杭州市空巢老人身心健康和社会支持对生命质量的影响调查

目的探讨杭州市空巢老人身心健康状况和社会支持现状对生命质量的影响及交互作用,为提高空巢老人生命质量研究提供科学依据。方法利用分层整群随机抽样法抽取杭州市2个城区和3个郊县的992名空巢老人进行健康相关生活质量量表(ED-5Q)、社会支持量表(SSRS)以及老年抑郁量表(GDS-15)调查,分析不同特征空巢老人生命质量得分情况,根据各量表得分,利用Pearson相关性分析研究身心健康和社会支持与生命质量的相关关系。结果身体健康得分为(73. 41±13. 52)分,抑郁量表得分为(4. 11±1. 79)分;社会支持量表测得调查对象社会支持总分为(28. 79±6. 66)分,客观支持为(6. 09±2. 59)分,主观支持为(15. 92±4. 00)分,社会支持利用度得分为(6. 78±2. 28)分,EQ-5D效用值为(0. 75±0. 13)分。已婚组空巢老人生命质量得分高于离婚组和丧偶/单身组,差异有统计学意义(F=8. 462,P <0. 01);收入水平越高的空巢老人生命质量得分越高,差异有统计学意义(F=18. 329,P <0. 01);患有慢性病的空巢老人生命质量得分低于不患慢性病的空巢老人,差异有统计学意义(F=-2. 919,P <0. 01);担心养老的空巢老人生命质量得分低于不担心养老的空巢老人,差异有统计学意义(F=16. 78,P <0. 01)。经Pearson相关性分析,客观支持(r=0. 141)、主观支持(r=0. 291)、支持利用度(r=0. 071)和社会支持总得分(r=0. 254)与生命质量呈正相关,抑郁得分与生命质量呈负相关(r=-0. 252)。结论得到客观支持和主观支持越多,对社会支持的利用度越高,身心健康状况越好,空巢老人健康相关生命质量越优;减轻抑郁状况,有利于提高空巢老人健康相关生命质量。     

Assessing health-related quality of life data of building trade workers by means of the SF-36 questionnaire

The Lower Saxony statutory medical service of the building trade, the building trade association in Hanover and the statutory health insurance body of Lower Saxony have co-operated in the "ArGO" model project. The objective was to focus on the main areas of work-dependent health hazards and disorders. The SF-36 questionnaire was employed to ascertain how far the results obtained concerning health-related quality of life were suitable for this purpose. Hence, the data from industrial medical check-ups were compared with the additional findings for 4,334 building trade workers. Additional unfitness for work and medication data were available from the health insurance schemes for about one half of the group. The analyses revealed clear relationships between the subjectively experienced disorders on the one hand, and the stress and illness data on the other. In addition to age and the conventional stresses, e. g. strenuous physical work, the influence of psychosocial stress was also reflected in the assessment of the quality of life. The results obtained confirm the value of the SF-36 questionnaire for preventive medicine at an industrial level. It is suitable for identifying focal points of stress and can be employed for assessing preventative measures.     

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

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

Can patient satisfaction improve health among patients with angina pectoris?

OBJECTIVE: To identify and explore the components of patient satisfaction that have the strongest association with health-related quality of life among patients with angina. DESIGN: Cross-sectional study with postal questionnaires sent to patients 6 weeks after discharge from hospital, followed-up by one reminder. SETTING: The Central Hospital of Akershus in Norway. STUDY PARTICIPANTS: All 589 angina patients discharged between January 1 1995 and December 31 1996. The response rate was 67% (n=395). MAIN OUTCOME MEASURES: Physical and mental component summary scales in SF-36. RESULTS: When adjusted for relevant background factors such as age, sex, education, social network, health behaviour and sense of coherence, patient satisfaction explained 9% of the variation in the physical, and 7% of the variation in the mental component summary scales. In particular, satisfaction with medical treatment (P=0.002) and with information (P=0.003) were associated with improved physical and mental health-related quality of life. Patients who experienced their physicians as caring and competent were more likely to be satisfied with the medical treatment and with the information. Sense of coherence contributed to health-related quality of life both directly, and through improving patient satisfaction. CONCLUSION: This cross-sectional study supports the hypothesis that patient satisfaction contributes to both physical and mental health-related quality of life. Other research designs are needed to assess whether the associations identified are truly causal.     

Associations of self-reported oral health with physical and mental health in a nationally representative sample of HIV persons receiving medical care

Background: The impact of oral health on HIV patients has not been sufficiently documented. Objective: To estimate the associations between measures of oral and generic health-related quality of life in persons receiving medical care for HIV. Design: This is a longitudinal study of interview data collected in a probability sample of adults with HIV receiving health care in the US. The data were collected at three points in time. Patients: Two thousand eight hundred and sixty-four HIV-infected adults using medical care. Measurements: Physical and mental health were assessed using 28 items and oral health was assessed using seven items on oral-related pain and discomfort, worry, appearance, and function. Clinical measures included CD4 count, oral symptoms, physical symptoms, and stage of HIV. Physical functioning and emotional well-being were measured on a 0–100 scale with higher scores indicating better health. Oral health was measured using seven items with a five point scale. Results: In multivariate analyses, oral symptoms had the strongest association with oral health-related quality of life. Each additional oral symptom was associated with an average decrease in oral health (0–100 possible range) of 3.97 points (p = 0.000). In addition, oral health was significantly associated with both physical and mental health. A one-point increase in oral health was associated with a 0.05 (p = 0.000) increase in mental health and 0.02 increase in physical health (p = 0.031). Conclusions: Oral health is strongly associated with physical and mental health but provides noteworthy unique information in persons with HIV infection. Thus, physical and mental health measures of HIV patients should incorporate indicators of oral functioning and well-being.     

Mental Health Comorbidity Patterns and Impact on Quality of Life Among Veterans Serving During the First Gulf War

Purpose: To examine the patterns of coexisting (comorbid) mental disorders and whether comorbidity influences quality of life ratings in a sample of U.S. veterans. Patients and Methods: The Iowa Gulf War Study Case Validation study evaluated 602 military personnel, two-thirds of whom had symptoms of depression, cognitive dysfunction, or chronic widespread pain, who were activated or on active duty sometime during the first Gulf War (GW). Mental health disorders were defined using the SCID-IV, and the Health Utilities Index Mark 3 (HUI3) was used to measure health-related quality of life (HRQoL). Comorbidity was defined as having two or more mental disorders that spanned across at least two separate categories (e.g., depressive disorders and anxiety disorders). Results: Over 35% of veterans with a current mental disorder had at least one other comorbid mental disorder. Those with mental disorder comorbidity had lower HUI scores than veterans with only one or less mental disorders (mean 0.41 ± 0.30 vs. 0.72 ± 0.25, p < 0.0001). Conclusion: The co-occurrence of mental disorders that span at least two mental disorder categories is associated with impaired HRQoL in this veteran population. Early identification of mental health comorbidity may lead to interventions to enhance HRQoL among military personnel.     

Association between leisure-time physical activity and health-related quality of life changes over time

OBJECTIVE: This study aimed to assess whether changes in leisure-time physical activity over 3 years are associated with changes in health-related quality of life. METHOD: Among the adults enrolled in the Supplementation en Vitamines et Minéraux Antioxidants study in France, 3891 completed the Modifiable Activity Questionnaire to assess leisure-time physical activity and the Medical Outcomes Study 36-item Short-Form to assess health-related quality of life in 1998 and 2001. Multivariate analyses involving logistic and linear regressions determined the association between changes in leisure-time physical activity and changes in health-related quality of life. RESULTS: Over 3 years, increased leisure-time physical activity was associated with high scores in health-related quality of life dimensions: physical functioning, mental health, vitality for both sexes as well as social functioning for women only. An increase of 1 h per week of leisure-time physical activity was associated with a 0.17- and 0.39-point increase in the vitality dimension in men and women, respectively. The mental component score was also increased in women increasing their leisure-time physical activity. CONCLUSION: The long-term association between leisure-time physical activity and health-related quality of life changes is limited and has little clinical significance, especially for men and for the physical health-related quality of life dimensions. The long-term association needs to be further explored before formulating public health recommendations.     

Health and religiosity among Israeli Jews

BACKGROUND: The objective of this paper is to explore the connection between self-reported health and religiosity among Israeli Jews, using several self-reported health measures. METHODS: Data were collected by two health surveys covering 1999 individuals in 1993 and 2505 individuals in 2000, representing the population of Jewish Israelis aged 45-75 years residing in urban communities in those years. Self-reported health was measured by (i) reported chronic conditions, (ii) the SF-36 instrument, and (iii) a visual analogue scale of health-related quality of life. Religiosity was measured by a self-reported five-category scale. RESULTS: Controlling for a large array of socio-demographic characteristics, while no religiosity gradient was found in reported chronic morbidity, religious persons generally report worse health than secular persons on the other measures. The gap is larger in the SF-36's role-performance scales, and among women and Israelis from Asian-African origin. Discussion: The mixed results are consistent with the ambiguity of the religiosity effect on health reported in recent surveys. However, trying to reconcile between longer life expectancy of religious persons found in earlier Israeli and other research and poorer reported health found above, the paper emphasizes the possible differences in the perception of 'normal' life and roles, and argues that the SF-36 health measures might suffer from a religiosity-related reporting heterogeneity, distorting their association with mortality in the population.     

Children's health-related quality of life,neighbourhood socio-economic deprivation and social capital. A contextual analysis

Neighbourhood objective socio-economic indicators and community-reported subjective measures of social capital were examined in relation to children's health-related quality of life in the Netherlands. Three different data-sources were used: (1) objective neighbourhood socio-economic indicators, (2) subjective neighbourhood data on social capital, and (3) individual data of a family cohort study, including questions on children's health-related quality of life, and family socio-economic status. Multilevel analyses were conducted using both neighbourhood level and individual level data. Neighbourhood socio-economic status and social capital were associated. Measures of socio-economic deprivation and social capital were both non-specifically associated with children's general health and satisfaction, independent of possible individual-level confounders. However, children's mental health and behaviour were specifically associated with one aspect of social capital, the degree of informal social control in the neighbourhood.     

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

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

Are mental health problems associated with use of Accident and Emergency and health-related harm?

BACKGROUND: Previous findings indicate that mental health problems are common in Emergency departments; however, there are few studies of the extent of health-related problems and emergency service use in mental health populations as a whole. METHODS: Record linkage methods were used to map the association between mental health, age, gender, and health-related harm across total health and mental health care populations in one geographical area, over three years. By examining patterns of health-related harm, an accurate profile of mentally ill Emergency patients was generated enabling identification of factors that increased vulnerability to harm. RESULTS: Of the total population of 625 964 individuals, 10.7% contacted Accident and Emergency (A&E) over three years, this proportion rose to 28.6% among the total secondary care mental health population. Young men and older women were more likely to contact A&E, both overall and within mental health populations and were also more likely to be frequent attendees at A&E. Four distinct groups (typologies) of mental health patients attending A&E emerged: young, male frequent attendees with self-inflicted and other traumatic injuries; young females also presenting with self-harm; older patients with multiple medical conditions; and very old patients with cardiac conditions and fractures. CONCLUSION: The study indicates increased A+E service use and unmet health-related need within a total mental health population. It identifies specific 'care populations' particularly vulnerable to accidents and self-harm and highlights the need for targeted services for mentally ill groups who may not access traditional health and social care services effectively.     

Measuring the health burden of chronic disease and injury using health adjusted life expectancy and the Health Utilities Index

OBJECTIVES: To estimate the burden of illness from chronic disease and injury using a population based health survey, which contains both measures of chronic disease and a utility based health related quality of life (HRQOL) measure. DESIGN: An adapted Sullivan method was used to calculate cause deleted health adjusted life expectancies for chronic conditions. SETTING: Ontario, Canada, 1996/97. SUBJECTS: The 1996/97 Ontario Health Survey (n=35 527) was used to estimate the prevalence of chronic conditions. A cause deleted approach was used to estimate the impact of these conditions on the Health Utilities Index (HUI). Cause deleted probabilities of dying were derived with the cause eliminated life table technique and death data from vital statistics for Ontario 1996/97 (n=156 610). RESULTS: Eliminating cardiovascular disease and cancer will cause an "expansion of morbidity", while eliminating mental conditions and musculosketal disorders will result in a "contraction of morbidity". The HUI score varies depending on chronic condition, age, and sex-most of which were assumed not to vary in previous summary measures of population health. CONCLUSIONS: Health adjusted life expectancy estimated for chronic conditions using a utility based measure of health related quality of life from population health surveys addresses several limitations of previous studies that estimate the burden of disease using either a categorical measure of disability or expert opinion and related epidemiological evidence.     

Association between mental and physical health problems in high-risk adolescents: a longitudinal study

PURPOSE: This longitudinal study examined the relationship between mental and physical health problems in a sample of high-risk youth served in the public sector. METHODS: Participants included youth aged 9-18 years at baseline, randomly sampled from one of five public service sectors in San Diego County, California, and youths may have been active to more than one sector. Diagnoses for mood, anxiety, and disruptive disorders based on structured diagnostic interviews were determined at baseline and data regarding health-related problems were collected 2 years post-baseline. RESULTS: Mood and disruptive behavior disorders were related to cumulative health problem incidence, as well as aggregate measures of health problems and severe health problems. In addition mood disorder diagnosis was associated with higher rates of infectious diseases, respiratory problems, and weight problems. Disruptive disorder diagnosis was related to higher rates of risk behavior-related health problems. CONCLUSIONS: The present work extends the research on the relationship between mental and physical health problems to adolescents served in the public sector, who are at especially high risk for behavioral and emotional problems. Potential mechanisms by which mental health problems may impact health problems are discussed. We suggest the development of effective interagency cooperation between medical and mental health systems to improve the care of youth with comorbid mental and physical disorders.