Do differences in methods for constructing SF-36 physical and mental health summary measures change their associations with chronic medical conditions and utilization?

Background and objective: Various approaches have been employed to derive physical health and mental health summary scores for the SF-36 and the RAND-36, but head-to-head comparisons of alternative scoring algorithms are rare. We determined whether the associations of the physical and mental health summary scores with chronic medical conditions and utilization would differ depending on the scoring algorithm used. Methods: We examined 5701 patients receiving medical care from an independent association of 48 physician groups located primarily in the western United States and compared SF-36 and RAND-36 scoring of physical health and mental health summary scores. Associations with the presence of diabetes, heart disease, and kidney disease, as well as with utilization of medical care and mental health care were compared using bivariate and multivariate analysis. To examine the relationship between SF-36 and RAND-36 scores, we regressed the SF-36 physical and mental health composite scores on the RAND-36 physical and mental health summary measures and vice versa. Results: We found that the SF-36 and RAND-36 summary scores generally yielded results similar to one another across measures of heart disease, diabetes, and kidney disease, as well as measures of utilization. However, for each chronic medical condition, the RAND-36 showed a slightly larger decrement in mental health than did the SF-36. Conclusions: Differences between the two sets of summary scores were consistent with their respective conceptual and analytic approaches. Where comparisons of results between the SF-36 and RAND-36 summary scores are desirable in future studies, they can be estimated using the regression equations derived in this study.     

Health-related quality of life: gender differences in childhood and adolescence

Summary. Objectives: To assess whether gender and age differences can be found in different aspects of health-related quality of life (HRQOL) of children and adolescents, and to what extent these results correspond to theoretical and empirical findings from developmental psychology. Methods: A newly developed HRQOL questionnaire was completed by 3 710 youths aged nine to 17 years in seven European countries. The “Kidscreen 52” questionnaire consists of 10 scales operationalising aspects of the physical, psychological and social dimensions of HRQOL. With the use of ANOVA and effect sizes, the influence of age and gender on aspects of HRQOL is reported. Results: Children report a very good quality of life largely independent of gender. After 12 years, HRQOL decreases in the majority of aspects. In the physical and psychological dimensions, a stronger decrease is found for females than for males. Conclusions: Children have higher HRQOL than adolescents in many aspects. With increasing age, HRQOL is frequently worse for females than for males. Examination of the individual aspects leads to a differentiation of the results with relevance for public health.

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Zusammenfassung. Gesundheitsbezogene Lebensqualit?t: Geschlechtsunterschiede in Kindheit und Jugend Fragestellung: Die Studie geht der Frage nach, in welchen Aspekten der gesundheitsbezogenen Lebensqualit?t (HRQOL) von Kindern und Jugendlichen Geschlechts- und Altersunterschiede zu finden sind und wie weit sie damit theoretischen und empirischen entwicklungspsychologischen Erkenntnissen entsprechen. Methode: Ein neu entwickelter HRQOL-Fragebogen wurde von 3 710 Kindern und Jugendlichen von neun bis 17 Jahren aus sieben europ?ischen L?ndern beantwortet. Der “Kidscreen 52”-Fragebogen besteht aus 10 Skalen, welche Aspekte der physischen, psychischen und sozialen Dimensionen der HRQOL operationalisieren. Der Einfluss von Alter und Geschlecht auf die verschiedenen HRQOL-Aspekte wird mit Hilfe von ANOVA und Effektst?rken detailliert berichtet. Ergebnisse: Kinder bis zum Alter von etwa 12 Jahren berichten weitgehend unabh?ngig vom Geschlecht über eine sehr gute Lebensqualit?t. Danach sinkt die Lebensqualit?t in der Mehrheit ihrer Aspekte. In der k?rperlichen und psychischen Dimension ist für die weiblichen Jugendlichen eine st?rkere Abnahme zu beobachten als für die m?nnlichen Jugendlichen, was bei den ?lteren Jugendlichen zu einem bedeutend weniger guten Befinden der jungen Frauen führt. Schlussfolgerung: Die HRQOL von Kindern ist in vielen Aspekten h?her als jene der Jugendlichen, mit zunehmendem Alter ist die HRQOL von weiblichen Jugendlichen h?ufig weniger gut als jene der m?nnlichen Jugendlichen. Eine Betrachtung der einzelnen Aspekte führt zu einer Differenzierung der Ergebnisse mit konkreter Relevanz für Public Health.

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Résumé. Qualité de vie en lien avec la santé: différences entre les sexes chez les enfants et les adolescents Objectifs: Analyser l’effet du genre et de l’age sur différents aspects de la qualité de vie en lien avec la santé (HRQOL). Voir dans quelle mesure ces résultats correspondent à des connaissances théoriques et empiriques issues de la psychologie développementale. Méthodes: 3 710 enfants et adolescents de neuf à 17 ans de sept pays européens ont répondu à un questionnaire indiquant la HRQOL. Cet instrument, ?Kidscreen 52?, se compose de 10 échelles qui mesurent des aspects des dimensions physiques, psychiques et sociales de la HRQOL. L’influence de l’age et du sexe sur les différents aspects de HRQOL est analysée à l’aide de ANOVA. Résultats: Les enfants rapportent une qualité de vie très bonne jusqu’à l’age de 12 ans environ, indépendamment du sexe. Ensuite la qualité de vie baisse. En ce qui concerne les aspects physiques et psychiques, une diminution plus forte est observée chez les jeunes femmes que chez les jeunes hommes. La qualité de vie est ensuite nettement moins bonne chez les jeunes femmes plus agées. Conclusion: La HRQOL des enfants est globalement meilleure que celle des adolescents. Avec l’age, la HRQOL est fréquemment moins bonne pour les jeunes femmes que pour les jeunes hommes. Il faut tenir compte de ces différents aspects pour des actions de santé publique.

     

A new comorbidity index: the health-related quality of life comorbidity index

Objective

To derive and validate the health-related quality of life comorbidity index (HRQL-CI).

Study Design and Setting

Of 261 clinical classification codes (CCCs) in the 2003 Medical Expenditure Panel Survey (MEPS), 44 were identified as adult, gender-neutral, chronic conditions. The least absolute shrinkage and selection operator (LASSO) procedure identified CCCs significantly associated with the Short Form-12 physical component summary (PCS) and mental component summary (MCS) scores. Regression models were fitted with the selected CCCs, resulting in two subsets corresponding to PCS and MCS, collectively called the HRQL-CI. Internal validation was assessed using 10-fold cross-validation, whereas external validation in terms of prediction accuracy was assessed in the 2005 MEPS database. Prediction errors and model R² were compared between HRQL-CI models and models using the Charlson-CI.

Results

LASSO identified 20 CCCs significantly associated with PCS and 15 with MCS. The R² for the models, including the HRQL-CI (0.28 for PCS and 0.16 for MCS) were greater than those using the Charlson-CI (0.13 for PCS and 0.01 for MCS). The same pattern of higher R² for models using the HRQL-CI was observed in the validation tests.

Conclusion

The HRQL-CI is a valid risk adjustment index, outperforming the Charlson-CI. Further work is needed to test its performance in other patient populations and measures of HRQL.     

Sense of coherence,health locus of control,and quality of life in obese adults: physical limitations and psychological normalcies

OBJECTIVES: To assess differences between overweight and normal-weight adults in sense of coherence (SOC), health locus of control (HLOC), and health-related quality of life (HQOL). METHODS: Cross-sectional population study (Augsburg, Germany). Random sample aged 25-74 (N=947). Body mass index (BMI) was categorized into four groups (normal-weight: 18.5-25; pre-obesity: 25-29.9; moderate obesity: 30-34.9; severe obesity: > or =35). The associations between obesity classification and SOC-13T, MHLOC-Scales, and SF-12 summary scores were estimated via analysis of covariance. RESULTS: Adjusted for age and socio-economic status, no differences across BMI-groups related to SOC, internal HLOC, external HLOC-'chance', and SF-12-'mental health'. HLOC-'doctors' was marginally elevated in obese women. Larger differences pertained to SF-12-'physical health' in that it was considerably reduced in obese women and severely obese men. CONCLUSIONS: In this adult population sample, obesity is not associated with SOC, HLOC, and HQOL in terms of mental health, but is associated with poorer physical health, which was reported by all groups of obese women, and by severely obese men. These results underline the need to treat and prevent obesity to restore and promote physical HQOL, and to distinguish moderate vs. severe obesity in obesity research.     

Alcohol drinking patterns and health-related quality of life reported in the Spanish adult population

Objectives

To examine the association between alcohol drinking patterns and health-related quality of life (HRQL).

Methods

Population-based cross-sectional study was conducted in 2008–2010 among 12,715 adult individuals in Spain. HRQL was assessed with the SF-12 questionnaire and alcohol intake with a diet history. The threshold between average moderate drinking and average heavy drinking was ≥ 40 g/day of alcohol in men and ≥ 24 g/day in women. Binge drinking was defined as the intake of ≥ 80 g in men and ≥ 60 g in women at any drinking session during the preceding 30 days. Analyses were performed with linear regression and adjusted for the main confounders.

Results

Compared to non-drinkers, all types of average drinkers reported better scores on the SF-12 physical component: β = 1.42 (95% confidence interval 1.03 to 1.81) in moderate drinkers and β = 1.86 (1.07 to 2.64) in heavy drinkers. In contrast, average alcohol consumption was not associated with the mental component of the SF-12. The number of binge drinking episodes and most types of beverage preference showed no association with physical or mental HRQL.

Conclusions

Alcohol drinkers, including those with heavy drinking, reported better physical HRQL than non-drinkers.     

Equivalence of Chinese and US–English Versions of the SF-36 Health Survey

This study evaluated the equivalence of Chinese and US–English versions of the SF-36 Health Survey in a convenience sample of 309 Chinese nationals bilingual in Chinese and English living in a US city. Snowball sampling was used to generate sufficient sample size. Internal consistency, test–retest, and equivalent-forms reliability were estimated. Patients were randomized to one of four groups: (1) English version completed first, followed by Chinese version (same occasion); (2) Chinese version completed first, followed by English version (same occasion); (3) English version completed once and then again 1-week later; (4) Chinese version completed once and then again 1-week later. Internal consistency reliability estimates for the Chinese and US–English versions of the SF-36 scales ranged from 0.60 to 0.88; test–retest reliability estimates (1 week time interval) ranged from 0.67 to 0.90. Reliability estimates for corresponding Chinese and US–English SF-36 scales tended to be similar and not significantly different. Equivalent-forms reliability estimates (product–moment correlations) ranged from 0.81 to 0.98. Mean SF-36 scale scores were comparable for both versions of the instrument. This study provides support for the equivalence of the Chinese and US–English versions of the SF-36.     

Gender Differences in Effects of Physical Activity on Quality of Life and Resource Utilization

Background: Physical activity is associated with health-related quality of life (HRQOL) in the general population, but the effects may be different between sexes. In addition, the effects on resource utilization are not well elucidated. Methods: A population-based cross-sectional survey was conducted in a rural town, and follow-up data were obtained after 1 year. Physical activity was measured in two ways: amount and maximum intensity. The association between physical activity and the MOS Short Form-36 (SF-36) at baseline, and hospitalization, sick days, and medications in the following year were assessed by multiple regression models. Results: Among 4018 adult residents eligible, 3529 (62.4%) had completed the follow-up questionnaire. A greater amount of exercise was positively correlated with all domains of the SF-36: 2.4–9.5 increase in 100-scale at baseline, but association between maximum intensity and SF-36 was observed in only women. It was also associated with a 20–50% higher utilization of over-the-counter drugs in the following year in both sexes, but the effects of maximum intensity on sick days had different directions for men (relative risk, 2.0–2.4) and women (relative risk, 0.3–0.5). Conclusion: The amount of physical activity had positive effects on HRQOL for both men and women, but women had more preferable effects of maximum intensity on HRQOL and resource utilization than men.     

Is adherence to drug treatment correlated with health-related quality of life?

Background: Adherence to drug treatment and health-related quality of life (HRQL) are two distinct concepts. Generally one would expect a positive relationship between the two. Objectives: The purpose of this study was to assess the relationship between adherence and HRQL. Methods: HRQL was measured using the physical and mental summary measures of the RAND-12 (PHC-12, MHC-12), the SF-12 (PCS-12, MCS-12), HUI-2 and HUI-3. Adherence was assessed using Morisky's instrument. Three longitudinal datasets were used. One dataset included 100 hypertensive patients. Another dataset covered 199 high risk community-dwelling individuals. The third dataset consisted of 365 elderly patients. Spearman's correlation coefficients were used to assess association. Subgroup analyses by type of medication and inter-temporal analyses were also performed. Results: Correlation between adherence and PHC-12 ranged from 0.08 (p = 0.26) to 0.22 (p < 0.01). Correlations between adherence and MHC-12 ranged from 0.11 (p = 0.11) to 0.15 (p < 0.01). Similar results were observed using HUI-2, HUI-3, and SF-12 as well as by type of medication and in the lagged analyses. Conclusions: Correlations between HRQL and adherence were positive but typically weak or negligible in magnitude.     

Cross-cultural differences in health-related quality of life of people with epilepsy: Findings from a European study

Purpose: To examine between-country differences in health-related quality of life (HRQOL) of adults with epilepsy across a large number of European countries. Methods: Self-completion postal questionnaire sent to large sample of adults with epilepsy, recruited from epilepsy support groups or epilepsy outpatient clinics. The questionnaire was developed in English and translated. Back-translations from each language were checked for accuracy. The questionnaire sought information on clinical and socio-demographic details, and contained a number of previously validated scales of psychosocial well-being (the SF-36, the perceived impact of epilepsy scale, and a feelings of stigma scale). Results: Controlling for socio-demographic and clinical characteristics, significant between-country differences were found in scores on the perceived impact of epilepsy scale, on seven of the eight SF-36 domains, and on the feelings of stigma scale. Respondents in Spain and the Netherlands fared consistently better, whilst those in France fared poorest, compared to those in other countries in terms of the various HRQOL measures used. Conclusion: Several possible reasons for the cross-cultural differences in HRQOL are proposed. Clearly, there is no single explanation and there may also be reasons which we have overlooked. This study emphasises the need for further comprehensive research in order that the position of people with epilepsy in different countries be more thoroughly understood in the social context.     

Association between ambient air pollution and health-related quality of life in Japan: ecological study

To assess the association between air pollution and health-related quality of life (HRQOL), we performed an ecological study by a two-stage stratified random sampling of the Japanese general population. A total of 3395 subjects, aged 16 and older, filled out questionnaires, including the Medical Outcomes Study Short Form-36 Health Survey (SF-36). Air pollutants examined in this study were nitrogen oxides (NOx) and suspended particulate matter (SPM). We used analysis of covariance to estimate the mean differences for each SF-36 domain among four groups categorized according to concentrations of air pollutants to which they were exposed. We observed a significant linear trend of a lower 'vitality' domain score in the SF-36 in groups exposed to higher concentrations of NOx (p = 0.013). The results of the present study are important for, and needed by, public health policy makers, because assessing the health effects of air pollution by measuring the HRQOL would provide a new method for formulating air pollution policies.     

Deteriorating health status in Stockholm 1998–2002: results from repeated population surveys using the EQ-5D

Rationale, aim and methodology In order to measure the change in health status in Sweden, the generic health-related quality of life instrument, the EQ-5D, was included in the 1998 (n = 4,950) and 2002 (n = 49,914) cross-sectional postal Public Health Surveys, a representative sample (21–84 years) of the Stockholm County population, with response rates about 63% in both years. The EQ-5D provides data on five dimensions of health as well as an overall index value (1 = full health; 0 = dead). Results Over time the health index decreased statistically significantly from 0.858 to 0.841 for men and from 0.833 to 0.797 for women. Women had significantly more health problems in 2002 in four out of the five dimensions, with the largest increase in the dimensions anxiety/depression (33–43%) and pain/discomfort (47–53%). The health index was significantly lower in all age-groups for women. Men had significantly more health problems 2002 in two dimensions, and the largest increase in anxiety/depression (24–31%). The health index decreased significantly over time for younger men. Conclusion The observed deterioration in health status over time gives reason for concern. Investigation of reasons for the declining health status should be a research priority. The 1998 and 2002 Public Health Surveys in Stockholm County     

成都市流动人口生命质量两领域影响因素分析比较研究

目的 了解成都市流动人口生命质量状况,分析比较其生理健康领域和心理健康领域生命质量的影响因素,为改善流动人口健康状况相关政策制定提供依据。方法 本研究采用应答推动抽样（RDS）方法在成都市抽取了2549名≥16岁的非成都市户籍务工人员进行问卷调查,采用SF-12量表评估调查对象生命质量状况。结果 成都市流动人口生命质量生理健康总评（PCS）和心理健康总评（MCS）分别为51.35±7.27分和49.48±10.37分。多分类logistic回归分析结果显示:以高水平PCS为对照,16~37岁（OR=0.204,P<0.001）、近一年医疗费用支出＜100元（OR=0.384,P=0.004）、与雇主关系好（OR=0.445,P=0.007）发生低水平PCS的风险更低;目前没有工作（OR=5.612,P<0.001）、近一年应住院未住院（OR=5.702,P=0.020）、两周内患病（OR=2.164,P<0.001）发生低水平PCS的风险更高;自评收入比成都市平均水平差者发生中等水平PCS的风险更高（OR=1.834,P=0.006）。以高水平MCS为对照,与雇主关系好发生低水平MCS的风险更低（OR=0.562,P=0.010）,16~37岁（OR=2.307,P=0.002）、就业身份为自营劳动者（OR=2.603,P=0.038）和其他（OR=3.009,P=0.031）、对居住环境不满意（OR=1.567,P=0.003）、近一年应住院未住院（OR=3.665,P=0.004）、健康知识得分≤6分（OR=2.623,P<0.001）、两周内患病（OR=2.417,P<0.001）、邻里互助较少（OR=1.648,P=0.007）、对成都不适应（OR=3.115,P=0.044）发生低水平MCS的风险更高。结论 成都市流动人口的生命质量与个人和社会层面的多种因素有关,且生理健康和心理健康两领域影响因素存在差异,今后关于流动人口健康管理和服务的政策需从社区卫生服务、居住环境、劳动保障等方面重点完善。     

Using the SF-36 and Euroqol on an elderly population

An important methodological issue in measuring health-related quality of life is whether instruments such as SF-36 and EQ can be used on an elderly population. This paper aims to test the completion, reliability and validity of the SF-36 and Euroqol on an elderly female population, and to compare them with the OPCS Disability Survey. Three hundred and eighty women aged 75 and over participated in a randomized controlled trial of the use of clodronate provided the sample. As part of the trial, patients were asked to complete the UK SF-36 and Euroqol, and the OPCS disability survey instrument administered by interview in a hospital clinic at baseline. A random subsample of respondents were retested six months later. The SF-36 achieved poorer levels of completion by dimension (68.1%–88.9%) than the OPCS (99.2%) and Euroqol (84%–93.5%) instruments. There were no major floor effects in the distribution of scores, except for the role dimensions of SF-36. Correlation between test-retest were significant for all instruments, but lower for the role dimensions and social functioning of SF-36, and these dimensions also had 95% Cls for the mean differences in excess of 10 points. There was substantial agreement between the three instruments, and evidence for their construct validity against age and recent use of health services. The sensitivities of the instruments were tested through hypothetical changes in health status. There was some evidence of greater sensitivity to lower levels of morbidity in the SF-36. Where brevity is required and the health changes are expected to be substantial, then EQ may be sufficient. For greater sensitivity SF-36 seems to have an advantage, however lower completion rates and problems with consistency suggest it requires adaptation. One solution would be to use interviewer administration. Another would be to change the SF-36 to make it more suitable for use in elderly people, although this may reduce its usefulness as a generic instrument.     

Gender and age differences in the metabolism of inorganic arsenic in a highly exposed population in Bangladesh

Although genetic polymorphisms have been shown to explain some of the large variation observed in the metabolism of inorganic arsenic there may be several other factors playing an important role, e.g. nutrition. The objective of this study was to elucidate the influence of various factors on current arsenic exposure and metabolism in Matlab, a rural area in Bangladesh, where elevated water arsenic concentrations and malnutrition are prevalent. In total 1571 individuals, randomly selected from all inhabitants above 5 years of age, were investigated by measuring arsenic in urine and drinking water. In a subset of 526 randomly selected individuals, arsenic metabolites were speciated using HPLC coupled to inductively coupled plasma mass spectrometry (HPLC-HG-ICPMS). A significant association was observed between arsenic in urine and drinking water (R2=0.41). The contribution to urinary arsenic from arsenic exposure from food and other water sources was calculated to be almost 50microg/L. The individuals in the present study had remarkably efficient methylation, in spite of high exposure and prevalence of malnutrition. Gender and age were major factors influencing arsenic metabolism in this population with a median of 77microg/L of arsenic in urine (range: 0.5-1994microg/L). Women had higher arsenic methylation efficiency than men, but only in childbearing age, supporting an influence of sex hormones. Overall, exposure level of arsenic, gender and age explained at most 30% of the variation in the present study, indicating that genetic polymorphisms are the most important factor influencing the metabolism of inorganic arsenic.     

Health ratings in relation to illnesses,physical functioning,general mental health and well-being: Self-reports of college alumnae,ages <40–80 and older

Objectives: This paper examines health perception as an outcome in relation to physician-diagnosed illnesses, vitality, mental health and well-being, physical activities, and social and behavioral factors among women, ages late 30's to 80 and older, whose responses were obtained in non-medical settings. Subjects and methods: 3940 college alumnae responded to a self-administered mailed questionnaire, which covered personal and behavioral factors; physical activity; diet; medical history; mental health; physical limitations, and health perception. Results: The prevalence of medical diagnoses, physical limitations, and health rating (good, fair, poor vs. excellent, very good) increased by age. Measures of low vitality and psychological distress varied by age, but not linearly. Stress declined dramatically by age. Irrespective of age, vitality and psychological distress were important predictors of health rating. The multivariate odds ratios (ORs) were, respectively, OR: 3.3, 95% CI (2.6, 4.1), and OR: 1.6, 95% CI (1.3, 2.0). Other predictors of health rating included physical limitations and medical diagnoses of breast and reproductive cancers, respiratory conditions, and chronic back problems. Conclusion: For women across the age span, who rated their health and health-related quality of life in a non-medical setting, having low vitality was a major factor in predicting their perceived health, even when adjusting for medical conditions and physical limitations.     

Sex differences in physical and mental functioning of Japanese civil servants: explanations from work and family characteristics

Poor physical and mental functioning are more common among women than men and those with disadvantaged work and family characteristics. This study aims to clarify whether sex differences in health functioning can be explained by sex differences in work and family characteristics. The subjects were 3787 civil servants (2525 men and 1262 women), aged 20-65, working in a local government on the west coast of Japan. A questionnaire survey was conducted in January 2003. Low employment grade, high demands, long work hours, shift work, being unmarried, having no young children, high family-to-work conflict and high work-to-family conflict were more common among women than men and were independently associated with poor physical and mental functioning. The age-adjusted odds ratios (ORs) of women for poor health functioning were 1.80 for poor physical functioning and 1.77 for poor mental functioning. When adjusted for employment grade and work characteristics (control, demand, support, work hours, and shift work), the sex differences in health functioning attenuated. When adjusted for family characteristics (family structure and work-family conflicts), the sex differences in health functioning further attenuated and were no longer statistically significant. Sex differences in family characteristics contributed more to sex difference in mental functioning than sex differences in work characteristics. Japan belongs to conservative welfare regimes. In such countries, men are able to concentrate on their work with relative freedom from their family tasks and responsibilities, whereas women feel difficulties in maintaining their work-life balances. Such sex differences in work- and family-related stresses may contribute to sex difference in health. Longitudinal research is necessary to clarify the causal nature of these associations.     

Gender differences in social support and leisure-time physical activity

OBJECTIVE

To identify gender differences in social support dimensions’ effect on adults’ leisure-time physical activity maintenance, type, and time.

METHODS

Longitudinal study of 1,278 non-faculty public employees at a university in Rio de Janeiro, RJ, Southeastern Brazil. Physical activity was evaluated using a dichotomous question with a two-week reference period, and further questions concerning leisure-time physical activity type (individual or group) and time spent on the activity. Social support was measured with the Medical Outcomes Study Social Support Scale. For the analysis, logistic regression models were adjusted separately by gender.

RESULTS

A multinomial logistic regression showed an association between material support and individual activities among women (OR = 2.76; 95%CI 1.2;6.5). Affective support was associated with time spent on leisure-time physical activity only among men (OR = 1.80; 95%CI 1.1;3.2).

CONCLUSIONS

All dimensions of social support that were examined influenced either the type of, or the time spent on, leisure-time physical activity. In some social support dimensions, the associations detected varied by gender. Future studies should attempt to elucidate the mechanisms involved in these gender differences.     

Factors associated with health-related quality of life: the role of social relationships among the elderly in an Italian region

OBJECTIVES: This study examines the association between social relationships and health-related quality of life (HRQL) in the elderly in Lazio Region, Italy, a Mediterranean country where the shape and role of social links has dramatically changed. METHODS: Data were extracted from a national cross-sectional survey in Italy, representative of the non-institutionalised population aged 60 years and over resident in Lazio Region during 1999--2000. HRQL was measured with the Short Health Survey Questionnaire (SF-12). Data analysis was performed using multiple linear regression models using adjustment for the main confounders. RESULTS: Among the sample, 40.4% of the elderly were not married and 27.1 % were living alone. While being married and not living alone were associated with higher scores in the physical and mental quality-of-life components (P-value<0.001), more frequent visiting/seeing friends was likely to be associated with higher scores in both the physical and the mental health components (P-value<0.05). Multiple logistic regression analysis demonstrated that low physical health scores were associated with a low frequency of meeting with relatives and with living far from relatives. CONCLUSIONS: In a region covering 9.2% of the whole Italian population, only a small proportion of the elderly lack frequent social ties, yet low frequency of relationships with friends is associated with a decline in quality of life measured through mental and physical scores. Our findings will be useful for drawing up welfare strategies both at the national and at the Mediterranean level, in countries, like Italy, where the primacy of family support of the elderly has been decreasing in recent years.