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.     

Methamphetamine use and oral health-related quality of life

Purpose

Methamphetamine (MA) is associated with adverse health effects, including the rampant tooth decay condition called “Meth Mouth.” However, the impact of MA use on oral health-related quality of life (OHRQOL) is unknown. This study assessed the relationship between MA use and self-reported OHRQOL.

Methods

This cross-sectional study uses information from 545 MA-using participants recruited from Los Angeles County, California. Dental examinations were performed by three calibrated dentists using National Health and Nutrition Examination Survey (NHANES) protocols. Data on socio-demographic, behavioral, and drug-use history were recorded using questionnaires. Participants were categorized as ‘light’ or ‘moderate/heavy’ users based on reported frequency of MA use in the past 30 days. Route of MA administration was categorized as ‘smoking’ or ‘other.’ Self-reported OHRQOL was based on the Oral Health Impact Profile scale.

Results

Majority of the participants were male (80.9%). Median age was 45.0 years (IQR-13.0). Median number of days of MA use was 10.0 (IQR-12.0). Smoking was the preferred route of MA use (70.2%). Root caries in ≥?3 teeth were reported in 78% of MA users. More than half of the participants reported having painful aching in mouth, avoidance of particular food items, feeling embarrassed, and discomfort while eating in the last 12 months. In unadjusted logistic models, moderate/heavy MA users were more likely to report an affected sense of taste [OR?=?1.58, 95% CI (1.10–2.27)] and avoidance of particular foods [OR?=?1.45, 95% CI (1.02–2.01)] than light users. Among individuals preferring other MA administration routes, moderate/heavy MA users were 3.09 times as likely to report an affected sense of taste than light users [OR?=?3.09, 95% CI (1.52?6.27)].

Conclusion

Oral health and OHRQOL appear to be worse among Methamphetamine users than in the US general population.

     

The influence of COPD on health-related quality of life independent of the influence of comorbidity

BACKGROUND/OBJECTIVES: The goal of this study was to determine the influence of chronic obstructive pulmonary disease (COPD) on health-related quality of life (HRQL) independent of comorbidity. METHODS: Patients with COPD in general practice, >/=40 years, were selected. To recruit controls, a random sample of persons without COPD and >/=40 years, was taken. HRQL was assessed with the SF-36 and comorbidity was determined by questionnaire. RESULTS: The influence of COPD on HRQL independent of comorbidity (represented by adjusted regression coefficients) was significant for physical functioning (-27.6), role functioning due to physical problems (-21.6), vitality (-14.4), and general health (-25.7), and was minor and not significant for social functioning (-5.6), mental health (-1.3), role functioning due to emotional problems (-2.7), and bodily pain (-2.5). Comorbidity contributed significantly to the HRQL of all domains (-7.6 to -27.1). CONCLUSIONS: COPD patients can be impaired in all domains of HRQL. However, impairments in physical functioning, vitality, and general health are related to COPD and to some extent to comorbidity, while impairments in social and emotional functioning do not seem to be related to COPD, but only to comorbidity.     

Impact of hypertension-related comorbidity on health-related quality of life: a population-based survey in South Korea

The aim of this study was to examine the impact of the most prevalent comorbid chronic diseases in hypertensives on health-related quality of life (HRQOL) in the general representative Korean population using the EuroQOL-5D (EQ-5D) and to assess this impact by sex and after controlling for sociodemographic factors. The effects of hypertension and comorbidity on HRQOL were examined using multiple linear regression models with Fourth Korean National Health and Nutrition Examination Survey data. In a total of 5736 adults, the prevalence of hypertension alone was 20.8%, and the prevalence rates of hypertension comorbid with diabetes mellitus (DM), cardiovascular disease (CVD), and musculoskeletal (MS) disease were 9.5%, 3.8%, and 33.5%, respectively. Females with hypertension and other comorbidity showed worse HRQOL scores, with the exception of hypertension and CVD, where males scored worse for HRQOL. After adjustment, subjects with comorbid DM, CVD, or MS experienced EQ-5D scores decreasing by 0.01, 0.09, and 0.05, respectively. Since comorbidity impairs HRQOL in hypertensives, health providers should consider comorbid diseases in hypertensives when developing methods of intervention to effectively manage hypertension.     

The effect of comorbidity on health-related quality of life for injury patients in the first year following injury: comparison of three comorbidity adjustment approaches

Background  

Three approaches exist to deal with the impact of comorbidity in burden of disease studies - the maximum limit approach, the additive approach, and the multiplicative approach. The aim of this study was to compare the three comorbidity approaches in patients with temporary injury consequences as well as comorbid chronic conditions with nontrivial health impacts.     

Body mass index and health-related quality of life in apparently healthy individuals

Purpose

Obesity is known to be associated with a range of chronic medical comorbidities, but little is known about the impact of overweight and obesity on health-related quality of life (HRQoL) in persons without chronic diseases. The aim of this study was to assess HRQoL, body mass index (BMI) and health behavior patterns in a community sample of subjects who had no long-lasting medical comorbidities

Methods

We assessed HRQoL in 1,187 apparently healthy individuals (mean age 57 ± 7 years), of whom 24 % were classified as normal weight, 49 % as overweight, 20 % as obese and 7 % as very obese. Two different instruments of HRQoL were used: the generic Short-Form Health Survey (SF-36) questionnaire and the preference-based instrument EuroQol (EQ-5D).

Results

All physical components of the SF-36 decreased linearly according to BMI categories in women. In men, only poorer physical functioning scale showed linearity with rising BMI. Scores on the mental components of the SF-36 did not differ by BMI categories in either gender. The EQ-5D index and EuroQol visual analogue scale scores decreased linearly with rising BMI only in women.

Conclusions

In apparently healthy middle-aged subjects, physical HRQoL decreases with increasing level of BMI and more so in women than in men. Mental components of HRQoL do not differ between the categories of BMI in either gender.     

The impact of comorbidity on the relationship between life stress and health-related quality of life for Chinese- and Korean-American breast cancer survivors

Objective: The current study aimed to (1) identify the occurrence of comorbidities among Chinese- and Korean-American breast cancer survivors (BCS), (2) examine whether health-related quality of life (HRQOL) scores varied with the occurrence of specific comorbidities, and (3) investigate the mediating effect of comorbidities on the relationship between life stress and HRQOL.

Design: Data were drawn from the parent study, a cross-sectional study investigating HRQOL in 86 Chinese- and 71 Korean-American BCS in Southern California. Two comorbidity-related variables, the occurrence of the specific comorbidity and the total number of comorbidities, were used to comprehensively reflect the characteristics of comorbidity.

Results: Approximately 60% of participants had at least one comorbid disease, and osteoporosis was the most prevalent comorbidity. HRQOL differences based on the occurrence of a specific comorbidity were evident for arthritis, eye/vision problems, dental and gum problems, lymphedema, and psychological difficulties. Structural equation modeling demonstrated that the nature of the outcome variable, either physical or mental HRQOL, influenced the overall patterns of the findings. For example, life stress was significantly associated with the total number of comorbidities and in turn influenced physical HRQOL. In terms of mental HRQOL, arthritis, dental and gum problems, chronic pain, heart disease, lymphedema, and psychological difficulties mediated the relationship between life stress and mental HRQOL.

Conclusion: The current study adds to the existing literature by examining the mediating effects of comorbidity on the relationship between life stress and HRQOL. The findings support the need for health care professionals to clearly assess physical and psychological comorbidities when providing survivorship care for cancer survivors.     

Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life

Background  

Measures of multimorbidity are often applied to source data, populations or outcomes outside the scope of their original developmental work. As the development of a multimorbidity measure is influenced by the population and outcome used, these influences should be taken into account when selecting a multimorbidity index. The aim of this study was to compare the strength of the association of health-related quality of life (HRQOL) with three multimorbidity indices: the Cumulative Illness Rating Scale (CIRS), the Charlson index (Charlson) and the Functional Comorbidity Index (FCI). The first two indices were not developed in light of HRQOL.     

欧洲五维健康量表(EQ-5D)中文版应用介绍

  目的  了解上海市老年人健康相关生命质量及其影响因素,为提高老年人生存质量提供参考依据。  方法  收集上海市2013年第五次国家卫生服务调查数据,对上海市17个区县11 103名老年人的健康相关生命质量及其影响因素进行分析。  结果  上海市11 103名老年人中,欧洲五维健康量表（EQ-5D）健康描述系统行动能力、自我照顾能力、日常活动能力、疼痛或不舒服、焦虑或抑郁5个维度均没有任何困难者8 136人（73.28 %）,有极度困难者16人（0.14 %）。上海市老年人EQ-5D量表视觉模拟标尺（EQ-VAS）得分为0～100分,25 %分位数为70分,中位数为80分,75%分位数为85分。多因素分位数回归分析结果显示,婚姻状况已婚和丧偶、每天吸烟、饮酒 ≥ 1次/周、体育锻炼 ≥ 1次/周和1年内进行健康体检的EQ-VAS得分Q₅老年人得分较高,年龄 ≥ 70岁和患慢性病的EQ-VAS得分Q₅老年人得分较低;婚姻状况已婚和丧偶、饮酒 ≥ 1次/周、体育锻炼 ≥ 1次/周和1年内进行健康体检的EQ-VAS得分Q₂₅老年人得分较高,农业户口、年龄 ≥ 70岁、患慢性病和体育锻炼 < 1次/周的EQ-VAS得分Q₂₅老年人得分较低;女性、饮酒 ≥ 1次/周和体育锻炼 ≥ 3次/周的EQ-VAS得分Q₅₀老年人得分较高,年龄 ≥ 70岁和患慢性病的EQ-VAS得分Q₅₀老年人得分较低;婚姻状况已婚、离异和丧偶的EQ-VAS得分Q₇₅老年人得分较高,年龄 ≥ 70岁和患慢性病的EQ-VAS得分Q₇₅老年人得分较低;农业户口和患慢性病的EQ-VAS得分Q₉₅老年人得分较低。  结论  上海市老年人健康相关生命质量较好,户籍类型、年龄、婚姻状况、是否患慢性病、吸烟情况、饮酒情况、体育锻炼和1年内是否进行健康体检是该地区老年人健康相关生命质量的主要影响因素。     

Psychiatric comorbidity and quality of life in South African alcohol use disorder patients

Background

Understanding the psychopathology accompanying alcohol use disorder (AUD) is important as it impacts negatively on quality of life (QoL) with subsequent implications for treatment and recovery. We evaluated the association of psychiatric comorbidity with QoL among treatment-seeking South African AUD patients.

Methods

Cross-sectional assessment of 101 (Male, n?=?65; 64.5%) patients with AUD was done using the World Health Organisation Quality of Life (WHOQoL)-Bref, the World Health Organisation Disability Assessment Scale (WHODAS) and Mini-International Neuropsychiatric Interview (MINI) to collect QoL, disability and psychopathology data, respectively.

Results

Psychiatric comorbidity was noted in 63 (62.3%) of the patients with most (55.6%) having more than one disorder. Mood (39; 61.9%) and anxiety (33; 52.4%) were the most common co-occurring disorders. Disability scores were not significantly different between comorbidity and gender groups However, QoL scores were significantly lower for participants with comorbidity in three of the four WHOQOL domains and declined with increasing number of psychiatric disorders. Focussing on the two main psychopathologies, participants with anxiety alone consistently had the lowest QoL scores compared to those with neither or both disorders (p?<?0.05).

Conclusion

The results confirm the well-known high rate of psychiatric comorbidity in patients with AUD and the negative impact it has on QoL. The results should alert clinicians managing AUD patients to screen for comorbid psychopathology and include findings into their treatment plan as this may impact on the patient’s QoL.

     

Development of a health-related quality of life instrument for use in children with spina bifida

The objective of this study was to develop a spina bifida health-related quality of life (HRQOL) instrument. Items were generated through semi-structured interviews, and reduced by frequency- importance product ranking. Validity was assessed by correlating the HRQOL score with a global question concerning the child's well-being using the Spearman's rank coefficient, and the Piers-Harris Children's Self-Concept Scale (P-H) using the Pearson correlation coefficient. Reproducibility was assessed at 2-week intervals using the intra-class correlation coefficient (ICC). Field testing was undertaken in a larger sample to evaluate item-total correlation, internal consistency and construct validity. Patients taking part in the study were 329 children and adolescents with spina bifida attending two treatment centres. Over 600 items were generated. These were reduced to 47 questions and 50 questions, for children and adolescents respectively. The correlation between the HRQOL score and the global question was r=0.57, and with the P-H was 0.26 (children). These values for adolescents were 0.63, and 0.89, respectively. Reproducibility was ICC=0.78 (children) and 0.96 (adolescents). Following field testing, the questionnaire was further reduced to 44 questions (children) and 47 questions (adolescents) by eliminating questions with an item-total correlation less than 0.20. Cronbach's alphas for the final instrument were 0.93 (children) and 0.94 (adolescents), and construct validity correlations were 0.63 (children) and 0.37 (adolescents). The spina bifida HRQOL instrument has good measurement properties and may be used as a discriminative instrument. Assessment of responsiveness is necessary before using it to evaluate therapy in clinical trials.     

常用糖尿病特异性生存质量量表分析

糖尿病作为一种高发病率和高致死率的慢性疾病,严重影响患者的生活质量。本研究以检索词"糖尿病(diabetes)""生存质量(health-related quality of life)"于中国知网、PubMed等数据库检索国内外相关文献,围绕国内外糖尿病特异性生存质量量表的研制和信效度调研发现,糖尿病相关生存质量评估量表(audit of diabetes-dependent quality of life,ADDQoL)、糖尿病生存质量量表-39(diabetes 39,D-39)、糖尿病痛苦量表(diabetes distress scale,DDS)、糖尿病特异性生存质量量表(diabetes-specific quality-of-life scale,DSQoLS)、糖尿病问题量表(problem areas in diabetes scale,PAID)和中国糖尿病患者生存质量特异性量表(diabetes specific quality of life scale,DSQL)信效度较好,应用较多。本研究对11种常用量表的测评维度、条目数、计分方法、信效度及耗时等进行总结,其中大多数国外量表是否适合国内人群还有待进一步验证。本研究就目前常用的糖尿病特异性生存质量量表加以介绍,旨在为量表的临床应用提供参考。     

Associations between body mass index and health-related quality of life among Australian adults

Objectives  

To assess the relationship between body mass index (BMI) and health-related quality of life (HQoL), as measured by the Short Form Health Survey (SF-36) within a sample with broad population coverage.     

Dizziness impairs health-related quality of life

Purpose

Relatively little is known about the level of impairment in patients with dizziness.

Research question

How much does dizziness impair the quality of life of patients referred to a multidisciplinary dizziness unit?

Patients and methods

All 2,252 patients completed the Dutch version of the Dizziness Handicap Inventory (DHI-D; score 0?C100 with higher scores representing more impairment). The results were classified into three categories: mild, moderate, and severe impairment. The three domains in the DHI representing physical, functional, and emotional aspects of dizziness were compared, as well as DHI scores of men versus women, between diagnoses, and the relationship between DHI and age.

Results

A total of 2,242 patients (64% women, mean age 54?years) completed the DHI with a mean score of 40.6. Almost 70% of patients had moderate or severe complaints. The handicap perceived by patients was primarily caused by physical and functional factors and less by emotional factors. Female patients and patients with hyperventilation syndrome and/or anxiety disorder had significantly higher DHI scores on all subscales. There was an S-shaped relationship between DHI score and age, and older patients reported more impairment.

Conclusion

Dizziness has considerable impact on health-related quality of life of dizzy patients.     

A health-related quality of life measure for use in patients with onychomycosis: a validation study

Onychomycosis is a common nail disorder associated with pain, discomfort and varying degrees of physical impairment and loss of dexterity. Psychological and social limitations result from reactions of others to visible impairment. The goal of this research is to validate a questionnaire to measure the impact of toenail onychomycosis on health-related quality of life (HRQoL). One hundred and fifty onychomycosis patients were enrolled in an observational study at eight sites in the US. Attending physicians reported information on clinical status at enrolment. Patients completed a questionnaire covering HRQoL that included general and disease-specific items measuring the impact of onychomycosis on activities and appearance, plus problems and symptoms associated with toenail infection. The subscales of the instrument showed high internal consistency reliability (range=0.63–0.95). Construct validity reflected the close association of physical functioning scores with onychomycosis impairment. Test–Retest reliability was good to excellent for all scales (ICC=0.52–0.89). Discriminant validity was evidenced by persons who are younger and female reporting worse disease-specific HRQoL. Responsiveness to clinical change was noted for all disease-specific scale scores for improved patients. This instrument has demonstrated reliability, validity and responsiveness for use in observational and clinical studies of toenail onychomycosis patients. Data indicate that onychomycosis patients report significant pain and discomfort reflecting the need for HRQoL measurement.     

哈尔滨市农村癫痫患者健康相关生命质量评价研究

目的 评价哈尔滨市农村癫痫患者健康相关生命质量并分析其影响因素。方法 通过简单随机抽样方法,随机选取哈尔滨市236例惊厥型癫痫患者,基于中国人群的EQ-5D效应值积分体系计算癫痫患者健康效应值,采用秩和检验和Tobit回归模型方法对癫痫患者健康水平影响因素进行分析。结果 调查的236名癫痫患者在5个维度有困难者占比排序为:焦虑或沮丧（42.74%）、疼痛或不适（30.77%）、日常活动（28.63%）、自己照顾自己（18.80%）、行动（16.67%）,基于中国积分体系计算癫痫患者健康效应值为0.85,Tobit回归模型结果表明,职业（95%CI = 0.004～0.313,P = 0.045）、体育运动（95%CI = 0.001～0.438,P = 0.049）、最近一次发作时间（95%CI = - 0.316～- 0.020,P = 0.027）、总病程（95%CI = - 0.051～- 0.387,P = 0.011）对癫痫患者的健康效用值得分有统计学差异。结论 癫痫对患者心理方面的影响程度大于生理方面,应加大对癫痫患者心理方面的关注。脑力劳动者、体育运动的癫痫患者健康效用值相对较高,发作时间在0～3个月内、总病程较长的癫痫患者健康效用值相对较低。