Comparing the self-perceived quality of life of multimorbid patients and the general population using the EQ-5D-3L.

Alexandra A N’Goran,Sven Streit,Lilli Herzig,Thomas Rosemann,Anouk Déruaz-Luyet,Andreas Zeller,Dagmar M Haller

doi:10.1371/journal.pone.0188499

Abstract

ObjectivesTo assess and compare the self-perceived Health Related Quality of Life (HRQoL) of multimorbid patients and the general population using health utilities (HU) and visual analogue scale (VAS) methods.MethodsWe analyzed data (n = 888) from a national, cross-sectional Swiss study of multimorbid patients recruited in primary care settings. Self-perceived HRQoL was assessed using the EQ-5D-3L instrument, composed of 1) a questionnaire on the five dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression (EQ-5D dimensions), and 2) a 0–100 (0 = worst- and 100 = best-imaginable health status) VAS. We described the EQ-5D dimensions and VAS and computed HU using a standard pan-European value set. HU and VAS are the two components of the overall HRQoL assessment. We examined the proportions of multimorbid patients reporting problems (moderate/severe) in each EQ-5D dimension, corresponding proportions without problems, and mean HU and VAS values across patient characteristics. To test differences between subgroups, we used chi-square tests for dichotomous outcomes and T-tests (ANOVA if more than two groups) for continuous outcomes. Finally, we compared observed and predicted HU and VAS values.ResultsAll 888 participants answered every EQ-5D item. Mean (SD) HU and VAS values were 0.70 (0.18) and 63.2 (19.2), respectively. HU and VAS were considerably and significantly lower in multimorbid patients than in the general population and were also lower in multimorbid patients below 60 years old and in women. Differences between observed and predicted means (SD) were -0.07 (0.18) for HU and -11.8 (20.3) for VAS.ConclusionsSelf-perceived HRQoL is considerably and significantly affected by multimorbidity. More attention should be given to developing interventions that improve the HRQoL of multimorbid patients, particularly women and those aged below 60 years old.

Highlights

Multimorbidity, commonly defined as the co-occurrence of two or more chronic conditions in one individual [1,2,3], is increasing due to improved living conditions, better medical care, and an aging population [4, 5]
More attention should be given to developing interventions that improve the health-related quality of life (HRQoL) of multimorbid patients, women and those aged below 60 years old
The present study showed that self-perceived health utilities (HU) and visual analogue scale (VAS) values were significantly lower in multimorbid patients in primary care than in Switzerland’s general population, i.e., self-perceived values of HU and VAS in our sample were lower than predicted values, with a considerably greater difference in the case of VAS

Summary

Introduction

Multimorbidity, commonly defined as the co-occurrence of two or more chronic conditions in one individual [1,2,3], is increasing due to improved living conditions, better medical care, and an aging population [4, 5]. Multimorbidity is associated with increased rates of mortality and disability, reduced levels of function, increased polypharmacy, poor health-related quality of life (HRQoL), and a greater utilization of healthcare resources (costs, number of physician visits, length of hospital stay) [6]. The cumulative effects of multiple chronic conditions on an individual are complex; specific combinations of conditions may have greater effects on functional status, quality of life (QoL), and mortality than others [9, 10]. Little is known about multimorbid patients’ self-perceived HRQoL in comparison with the general population and in different multimorbid patient age groups

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Conclusion