Abstract
PurposeTo evaluate the role of urbanization as an effect modifier for the association between specific chronic conditions and number of conditions with health-related quality of life (QOL).MethodsWe analyzed cross-sectional data from the CRONICAS Cohort Study conducted in Lima (highly urbanized), Tumbes (semi-urban), as well as rural and urban sites in Puno. Exposures of interest were chronic bronchitis, depressive mood, hypertension, type 2 diabetes, and a composite variable aggregating the number of chronic conditions (the four exposures plus heart disease and stroke). QOL outcomes were assessed with EuroQol’s EQ-5D visual analogue scale (EQ-VAS). We fitted linear regressions with robust variance to evaluate the associations of interest. Study site was assessed as a potential effect modifier using the likelihood-ratio (LR) test.ResultsWe evaluated data on 2433 subjects: 51.3% were female, mean age was 57.2 years. Study site was found to be an effect modifier only for the association between depressive mood and EQ-VAS score (LR test p < 0.001). Compared to those without depressive mood, participants with depressive mood scored −13.7 points on the EQ-VAS in Lima, −7.9 in urban Puno, −11.0 in semi-urban Tumbes, and −2.7 in rural Puno. Study site was not found to be an effect modifier for the association between the number of chronic conditions and EQ-VAS (LR test p = 0.64).ConclusionThe impact of depressive mood on EQ-VAS was larger in urban than in rural sites, while site was not an effect modifier for the remaining associations.
Highlights
Health-related quality of life (QOL) is defined as ‘‘an individual’s or a group’s perceived physical and mental health over time’’ [1]
Exposures of interest were chronic bronchitis, depressive mood, hypertension (HTN), type 2 diabetes (T2D), and, separately, a composite variable aggregating the number of chronic conditions
When evaluating the relationship between specific chronic conditions and EQ-5D visual analogue scale (EQ-VAS) score (Table 3), we found that participants with depressive mood and chronic bronchitis had significantly lower EQ-VAS scores than those without these conditions, while EQ-VAS scores in participants with HTN and T2D were not different compared with those without these conditions
Summary
Health-related quality of life (QOL) is defined as ‘‘an individual’s or a group’s perceived physical and mental health over time’’ [1]. Poorer QOL scores are observed with each additional chronic condition [4,5,6,7,8,9,10,11]. The impact of chronic conditions on QOL could be altered by urbanization level. Barriers to healthcare access may challenge clinical follow-up and disease management [14,15,16], translating to lower QOL scores than those in urban sites with more access to medical care. Individuals in rural areas do have higher indices of social support [17] which could promote better QOL and balance the effect of lower access to healthcare services in these areas.
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