Health-related quality of life inequity and influencing factors among urban and rural elderly hypertensive populations: baseline survey of the Northern China Lifestyle Medicine Cohort.

BackgroundThe role of artisanal and small-scale gold mining (ASGM) as a source of income is rapidly gaining importance in the economically difficult times in Zimbabwe. Besides limited epidemiological data, no data about the self-reported health-related quality of life (HRQoL) of artisanal and small-scale gold miners exist. The aim of the project was to access HRQoL of ASGM workers to improve the data base and compare the data to the urban Zimbabwean population.MethodsData from 83 artisanal and small-scale gold miners in Kadoma, Zimbabwe was analysed. The HRQoL was assessed using the EuroQol dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) accompanied by the cognition add-on questionnaire (EQ-5D-3L+C) and associated visual analogue scale (VAS). We described the EQ-5D dimensions and VAS values and computed health utility (HU) values using the Zimbabwean tariff. The proportions of miners reporting no problem in each EQ-5D dimension were compared with corresponding proportions reporting any problem (moderate or severe), and mean HU and VAS values were analysed across subgroups of the sample. To test differences between subgroups, Fisher’s exact test was used and between urban and mining population, Student’s t-test was used.ResultsThe reported health states of miners were homogenous, with a large amount (42%) reporting ‘full health’. Mean (SD) VAS and HU values were 81.0 (17.5) and 0.896 (0.13), respectively. Subgroup analysis showed that miners with a lower education reported significantly more problems in the dimension of daily activities and miners with mercury contact had more problems in the dimensions of pain/discomfort and cognition. Comparison between mining and urban population showed that in the oldest age group, self-rated VAS values of miners were significantly higher than of their urban counterparts.ConclusionsThere were no significant differences in the HRQoL of mining and urban populations. However, the reason might be adverse health effects faced by the urban population that do not apply to rural mining areas. A higher education level of miners can improve the HRQoL, which is especially impaired by problems in the cognition dimension.

Health Related Quality of Life Assessment After Radical Cystectomy: Comparison of Ileal Conduit with Continent Orthotopic Neobladder

Concerns have been raised globally regarding the long-term effects of the novel coronavirus disease 2019 (COVID-19). This study aimed to investigate the impact of long COVID on the health of patients recovering from acute COVID-19 in China. We conducted a cross-sectional questionnaire survey from 1 February to 9 March 2023. Propensity score matching (PSM) was used to understand the differences in health utility values between individuals with and without long COVID. Factors associated with health-related quality of life (HRQoL) were determined using a multiple linear regression model. A chi-square test was used to compare differences between the 2 groups for each dimension of the EuroQoL-5 Dimension-5 Level (EQ-5D-5L) scale. In total, 307 participants were included in the analysis, of which 40.39% exhibited at least 1 persistent symptom. The common symptoms of long COVID were fatigue/weakness, coughing, memory decline, poor concentration, and phlegm in the throat. Most patients with long COVID reported mild effects from their symptoms. After propensity score matching, the long-COVID group had lower health utility scores than the non-long-COVID group (0.94 vs 0.97). In the multivariable linear regression analysis, persistent symptoms and low annual household income were associated with lower health utility values (P < .05). Anxiety/depression and pain/discomfort were the major problems experienced by the participants with long COVID. Long-COVID symptoms following acute COVID-19 infection have a serious impact on health-related quality of life. Therefore, it is necessary to implement interventions to improve patient health after the recovery from acute COVID-19.

With population aging, individuals in underdeveloped areas may experience a higher prevalence of chronic non-communicable diseases (NCDs), a lower level of health-related quality of life (HRQoL), and distinct lifestyles. However, this triadic association remains inadequately studied, particularly regarding the role of health lifestyle. This study aims to examine the relationship between the number of NCDs and HRQoL, while considering the moderating effect of health lifestyle among middle-aged and older adults residing in resource-limited areas. This cross-sectional study was conducted in Yunnan Province from July to December 2022. Participants completed a self-report questionnaire related to socio-demographic information, NCDs conditions, health lifestyle status, and HRQoL, which was assessed using the EuroQol five-dimension five-level (EQ-5D-5L) scale. Hierarchical regression and simple slope tests were used to examine the moderating effect of health lifestyle. Out of the total 2704 participants, 57.91% presented at least one NCD. The mean scores for health lifestyle and health utility value were 11.109 and 0.944 respectively. The number of NCDs was negatively associated with health utility value, while positively correlated with the health lifestyle score (P<0.001). The results of hierarchical regression indicated that health lifestyle exerted a negative moderating effect on the relationship between the number of NCDs and HRQoL (β=0.006, P<0.001), which was also observed for specific health-related behaviors such as sleep duration (β=0.013, P<0.001), physical examination attendance (β=0.006, P<0.05) and physical activity (β=0.013, P<0.001). These findings highlight the crucial role of a healthy lifestyle in attenuating the association between the number of NCDs and HRQoL. Recognizing the potential modulating influence of a healthy lifestyle in this relationship could be pivotal for developing effective interventions for this population, even within resource-constrained rural settings.

Objective: There are over 3 million women in the United States living with breast cancer or who have a history of breast cancer. As the number of women undergoing treatments and surviving breast cancer grows, characterizing changes in health-related quality of life (HRQOL) is critical to ensuring patient-centered breast cancer care. Breast cancer risk and burden varies systemically between Black and White women. Black women are more likely to be diagnosed at younger ages and with more aggressive breast cancer tumors. Although racial disparities in HRQOL are well documented, less is known about differences in HRQOL at distinct phases of breast cancer care. Our objective was to assess racial disparities in HRQOL between active treatment and survivorship phases of the breast cancer care continuum. Methods: The study used data from the third phase of the Carolina Breast Cancer Study (CBCS-III). CBCS-III enrolled 3,000 women in North Carolina aged 20-74 years diagnosed with invasive, pathologically confirmed breast cancer between 2008 and 2013. HRQOL assessments occurred 5- and 25-months after diagnosis, respectively, representing distinct phases of care. The Functional Assessment of Cancer Therapy for Breast Cancer and the Functional Assessment of Chronic Illness Therapy for Spiritual Well-Being measured HRQOL. We implemented three approaches (Institute of Medicine, Residual Direct Effect and interactive effects of race and socioeconomic factors) to assessing racial disparities to better understand if racial disparities in HRQOL changes existed and to identify potential mediators of disparities in HRQOL. Analysis of covariance models assessed racial differences in changes in HRQOL between active treatment and survivorship. Adjusted models included demographic, socioeconomic, tumor and treatment characteristics. Results: The cohort included 2,142 Non-Hispanic White (52%) and Black (48%) women with breast cancer who completed both HRQOL assessments. During active treatment, White women reported significantly better physical and functional HRQOL than Black women, but spiritual HRQOL was 2 points higher for Black women. At 25-months post-diagnosis, White women reported HRQOL scores well above U.S norms across physical, social, emotional and functional well-being domains. Black women, however, continued to report physical well-being scores 1.2 points below the U.S norm and 2.3 points below their White breast cancer counterparts. Once demographic, socioeconomic, tumor and treatment characteristics were adjusted for, racial differences narrowed and were not considered clinically meaningful. Conclusions: Racial differences in physical and functional HRQOL may be mediated by socioeconomic factors. Psychosocial and spiritual HRQOL seem well supported, mitigating negative effects of breast cancer care, especially among Black women. These results inform opportunities for improving the quality and equity of supportive services for women with breast cancer. Citation Format: Laura C. Pinheiro, Cleo A. Samuel, Katherine E. Reeder-Hayes, Stephanie B. Wheeler, Andrew F. Olshan, Bryce B. Reeve. Understanding Racial Differences in Health-Related Quality of Life in a Diverse, Population-Based Cohort of Breast Cancer Survivors in North Carolina. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B25.

Introduction: Assessments of health-related quality of life (QoL) are increasingly important for stroke patients; however, such data are lacking for patients with intracerebral hemorrhage (ICH). Using EuroQol-5 Dimension-5 Level (EQ5D), we describe factors associated with QoL, and explore associations between QoL and functional outcomes in ICH patients. Methods: Our study is a multisite prospective cohort aiming to examine comparative effectiveness of treating ICH patients at various levels of care across Texas. Consented patients undergo QoL assessments - including EQ5D - in-hospital and 90 days post-discharge. EQ5D health utility values (HUV) were calculated using published utility weights for US population. HUVs range from -0.11 to 1.00, with 0.00 and 1.00 representing patient-perceived QoL equivalent to death and perfect health, respectively. Median and interquartile range (IQR) are reported. Quantile regression was used to evaluate factors associated with HUVs, and we report difference in median (DIM) and 95% confidence interval (CI) for the difference. Results: Thus far 158 patients have been enrolled in the study. EQ5D HUVs were obtained from 133 patients in-hospital and 62 patients at day 90. Median in-hospital and day-90 HUVs were significantly lower for patients with higher NIHSS and ICH scores. Patients with in-hospital complications, neurosurgical procedures, and longer length of stay also had lower HUVs (Table 1). There was a significant improvement in HUVs during 90-days post-discharge (DIM: 0.37; 95% CI: 0.24-0.51), and high day-90 HUVs were associated with good functional outcome (mRS 0-3) (Figure 1, DIM: 0.65, 95% CI: 0.51-0.78, p&lt;0.001). Enrollment continues; updated analyses to be presented. Conclusion: Our results indicate a correlation between QoL, and inpatient clinical parameters and functional outcomes. Assessment of QoL may be routinely conducted in ICH studies to generate evidence for comparative effectiveness.

Health-Related Quality of Life in Patients With Alzheimer Disease in Malaysia: Evidence From EQ-5D and QOL-AD.

Health-related quality of life (HRQoL) of breast cancer survivors has been extensively evaluated. However, HRQoL differences for women diagnosed by organized mammographic screening and women diagnosed due to symptoms have been sparsely described. We aimed to compare self-reported long-term HRQoL and quality adjusted life years (QALYs) between women with screen-detected breast cancer and women with symptomatic breast cancer, adjusting for histopathologic tumor characteristics and treatment. This study was nested within a cohort of women diagnosed with breast cancer by organized mammographic screening or due to symptoms 2006-2017 who responded a questionnaire measuring HRQoL (VAS, 0-100) and EQ-5D-5L 2019-2020. Responses to EQ-5D-5L were transformed into health utility values using a tariff based on preferences elicited in a national survey. Multivariable linear regression models were used to compare VAS-scores adjusting for tumor characteristics and treatment. QALYs were estimated by summing up the health utility values between the third and the fifth year since breast cancer diagnosis adjusting for breast cancer survival. Mean HRQoL (VAS) was 66.2 (standard deviation, SD: 21.1) for women with screen-detected breast cancer (n = 1141) and 62.5 (SD: 21.2) for women with symptomatic breast cancer (n = 1561). Women with screen-detected breast cancer had 3.8 (95 % confidence interval, CI, 2.3, 5.4) and 3.7 (95 %CI 2.1, 5.2) higher HRQoL VAS-scores compared to women with symptomatic breast cancer in the models adjusted for tumor characteristics and treatment, respectively. Women with screen-detected breast cancer and women with symptomatic breast cancer accrued 2.30 and 2.06 QALYs, respectively. Women with screen-detected breast cancer demonstrated higher estimates of long-term HRQoL and QALYs compared to women with symptomatic cancer. More favorable long-term quality of life outcomes were shown for women diagnosed with breast cancer by organized mammographic screening compared to women diagnosed due to symptoms.

Objective: To understand the health-related quality of life for patients of pneumoconiosis combined with tuberculosis and its main influencing factors. Methods: This was a cross-sectional study, and 951 patients of pneumoconiosis combined with tuberculosis from the pneumoconiosis survey in 27 provinces and autonomous regions in China from December 2017 to December 2021 were selected for the study. The nonparametric Mann-Whitney test and the Kruskal-Wallis H test were used to compare the health utility values, and multiple linear regression was used for multifactor analysis. AMOS 24.0 was used to establish a structural equation modeling. Results: The mean age of 951 patients of pneumoconiosis combined with tuberculosis was (59.3±12.4) years. The main types were silicosis combined with tuberculosis (62.2%, 591/951) and coal-worker's pneumoconiosis combined with tuberculosis (34.9%, 332/951), and other type pneumoconiosis-combined tuberculosis was 2.9% (28/951). The proportion of patients with stage Ⅰ, Ⅱ, Ⅲ, and unstaged clinical diagnosis was 27.4% (261/951), 26.6% (253/951), 32.5% (309/951) and 13.5% (128/951), respectively. 63.3% (602/951) of study participants suffered from other chronic diseases, and the percentage of patients combined the number of chronic diseases with 1, 2, and more than 3 respectively were 24.1% (229/951), 16.3% (155/951) and 22.9% (218/951). The median and quartiles of health utility values and the mean±standard deviation of self-rating scores of patients of pneumoconiosis combined with tuberculosis were 0.562 (0.482, 0.766) and (53.7±18.4), respectively, which were lower than patients of pneumoconiosis without tuberculosis (Z=-11.29, P<0.001; t=8.97, P<0.01). The health utility values and self-rating scores for patients of pneumoconiosis combined with tuberculosis were significantly different between urban and rural areas (Z= -2.22, P=0.027; t=4.85, P<0.01). Pain/discomfort was the most frequently reported problem in the five-dimensional distribution of problems, followed by daily activities and anxiety/depression, and the difference in the percentage reported by anxiety/depression between urban and rural areas was significant (χ(2)=30.28, P<0.01). The results of multiple linear regression showed that the survey area, body mass index, education level, age, employment status, annual personal income, stage of pneumoconiosis, number of multi-morbidities, hemoptysis, acute exacerbation of symptoms in two-week, social support and minimum living standard were the main influences on the health utility values of the patients of pneumoconiosis combined with tuberculosis (P<0.05). The results of structural equation model showed that economic security and health status directly affected the health-related quality of life among patients of pneumoconiosis combined with tuberculosis and played a chain-mediating effect in the influence of socioeconomic status on the health-related quality of life among patients of pneumoconiosis combined with tuberculosis. Conclusion: Health-related quality of life was poorer in patients of pneumoconiosis with tuberculosis, with pain and discomfort and anxiety/depression problems being more pronounced, and economic status and health status played multiple mediating roles in the influence of general socio-demographic characteristics on quality of life in pneumoconiosis.

BackgroundAlthough several studies have reported an association between tuberculosis and health-related quality of life, the change in health-related quality of life after pulmonary tuberculosis has been rarely studied. The purpose of this study was to investigate the effect of past history of pulmonary tuberculosis on health-related quality of life using a nationwide, cross-sectional, observational study in Korea.MethodsAmong 72,751 people selected using a stratified multi-stage sampling method, 7260 Korean participants were included using propensity score matching. Past history of pulmonary tuberculosis was defined as a previous diagnosis of pulmonary tuberculosis excluding patients with active pulmonary tuberculosis. The primary outcome, health-related quality of life, was assessed by EQ-5D disutility.ResultsBefore matching, the mean EQ-5D of individuals with pulmonary tuberculosis history was lower (0.066 vs. 0.056, p: 0.009). However, the difference was nullified after matching (0.066 vs. 0.062, p = 0.354). In multivariable Poisson regression analysis, EQ-5D disutility score was not associated with past pulmonary tuberculosis history. In subgroup analysis, past pulmonary tuberculosis history increased odds of low health-related quality of life in young (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.17–2.11, p = 0.003), unmarried (OR 1.98, 95% CI 1.05–3.73, p = 0.036), or separated patients (OR 1.30, 95% CI 1.02–1.66, p = 0.032). Age and marital status were modulating factors on the effect of past pulmonary tuberculosis history on health-related quality of life.ConclusionsThere was no difference in health-related quality of life between individuals with and without past pulmonary tuberculosis history. Young and unmarried groups had increased odds for low health-related quality of life after pulmonary tuberculosis due to modulating effects of age and marital status.

BackgroundPhysical inactivity, sitting behaviour, and mental health problems are detrimental to health-related quality of life but typically are considered as independent determinants. This study tested how these factors clustered together as profiles of subgroups of people and whether the clusters differed as a function of physical and mental health-related quality of life.MethodsIn 2012, Australian adults (N =1,014) self-reported their physical and mental health-related quality of life, physical activity, sitting time, depression, anxiety, and stress using a web-based survey. Cluster analysis was used to identify subgroups of health behaviour and mental health profiles, and ANOVA was used to test for between-cluster differences in health-related quality of life.ResultsThree subgroups were identified: people with higher psychological stress (n =13%), people with higher amounts of sitting time (n =45%), and people with lower amounts of sitting time (n =42%). There were no differences in mental health-related quality of life between subgroups; however people represented by the subgroup of higher amounts of sitting time had significantly lower physical health-related quality of life than the other two subgroups, F(2, 1011) =10.04, p < .01.ConclusionsInterventions should consider that (1) physical activity, sitting time, and psychological distress are aspects of multifaceted behavioural-psychological profiles, and (2) reductions of sitting time may have major impacts for physical health-related quality of life.

Health utility values (HUVs) are fundamental parameters in economic evaluations used to assess the value of healthcare interventions. However, patients living with breast cancer in low- and middle-income countries (LMICs) face distinct burdens compared with those in high-income countries (HICs), driven by profound disparities in resources, infrastructure, and cultural context. High reliance on HUVs from HICs risks misrepresenting the specific disease burden in LMICs, introducing uncertainty in local healthcare resource allocation. This protocol outlines the methods for a planned systematic review and meta-analysis to synthesize available evidence from LMICs to generate pooled EuroQol-5 Dimensions HUV estimates that are contextually appropriate for local decision making. By following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, this protocol is registered in PROSPERO (CRD420251208371). The initial literature search will be conducted in Cochrane CENTRAL, PubMed, Web of Science core collection and Scopus using keywords such as 'health-related quality of life', 'EuroQol-5 Dimensions', 'breast cancer' and 'low-middle-income countries'. Risk-of-bias assessment will be conducted using the Cochrane Risk-of-Bias Tool (RoB 2) and Newcastle-Ottawa Scale (NOS) depending on study designs. R packages (metaprop) will be used to pool the mean HUVs of people living with breast cancer using fixed-effect (inverse variance method) and random-effect models (Der Simonian-Laird method). Subgroup analysis will be conducted based on different categories of interest such as EQ-5D versions, country income level and clinical stagings. This protocol provides a systematic guide to synthesize EQ-5D utility values specific to breast cancer in LMICs. The anticipated findings will establish a critical evidence base for decision making in resource-constrained settings. By generating contextually relevant estimates, this will minimize parameter uncertainty and support more equitable resource allocation. Hence, it will contribute to health systems that are responsive not only to the clinical burden of the disease but also to the multidimensional well-being of the patient and families it affects.

Purpose: The purpose of this study is to determine the differences in Health-related quality of life by frequency of participation in each physical activity type of stroke disorders.<BR> Method: Using the 4th, 5th, and 6th health survey in the Korea National Health and Nutrition Examination Survey, the EQ-5D index according to the frequency of each type of physical activity was analyzed in a general linear model for people with stroke over 19 years.<BR> Results: First, there was a difference in health-related quality of life between men with stroke who did not walk and men with stroke who walked more than 5 days. Second, there was a difference in the quality of health-related quality of life between men with stroke who did not perform strength exercise at all and men with stroke who practiced on days 1 to 2 and 3 to 4 days. Third, there was a difference in the health-related quality of life between men with stroke who did not perform flexibility exercise at all and men with stroke who performed 1 to 2 days. Fourth, there was a difference in health-related quality of life between women with stroke who did not walk and women with stroke who took a walk 3 to 4 days and 5 days or more. Fifth, there was a difference in health-related quality of life between women with stroke who did not perform strength exercise at all and women with stroke who performed 1 to 2 days.<BR> Conclusion: In order to improve the health-related quality of life of stroke disabled people, it is necessary to provide support for men and women to practice the appropriate type and frequency of physical activity.

The purpose of this study is to compare women with cosmetic breast implants with population controls to examine health-related quality of life. A questionnaire including quality-of-life questions was mailed to 399 Finnish women who had had cosmetic breast implants during the years 1973-2002. The response rate of the study was 85. Results were compared with average Finnish women from a representative population sample. There were no differences in total score of health-related quality of life between women with breast implants and controls. Women with breast implants had lower health-related quality of life in dimensions of distress and sexual activity and partly also in dimensions of sleeping and mental function when compared with controls. On the other hand, operated women reported significantly less discomfort and symptoms than controls. Differences in health-related quality of life between women with breast implants and controls were largest in dimensions of distress, sexual activity, sleeping, and symptoms.

Increasing age with migration status might have a double risk of vulnerability to poor health outcomes. There is a lack of population-based studies on health-related quality of life (HRQoL) of older migrants in India. This study compares the HRQoL between older migrants and non-migrant populations in India and examines the role of migration-related factors. The Longitudinal Ageing Study in India (LASI) Wave-I data was used, and older persons aged 60 and above were selected for the study, which included 30,158 final samples. The HRQoL was measured based on a EuroQol Five-Dimension (EQ-5D) measure. The study used univariate and bivariate analysis to examine HRQoL differences between migrants and non-migrants, and logistic regression analysis was used to examine the association between HRQoL and migration status and other correlates of older persons. Over half of the older persons (55.9%) were growing older at destination places in India. The migrants showed a higher prevalence of poor HRQoL (44.5%) than non-migrants (34.8%). Further, the adjusted logistic regression result shows that migrants were likelier to have poor HRQoL [AOR 1.15; CI 1.09–1.22] than non-migrants. The migrants with 0–9 years of duration and migration at age 60 and above were significantly more likely to have poor HRQoL [AOR 1.20; CI 1.03–1.39] and [AOR 1.20; CI 1.04–1.39], respectively, than non-migrants. Moreover, the origin-destination place of migrants was also found to be significantly associated with poor HRQoL compared to non-migrants. The findings of our study reveal that persons with migration status had lower HRQoL than non-migrants. Some migration-related factors were significantly associated with HRQoL among migrants. However, this study predicts that migrants especially need separate health policies as they are in poorer health conditions than non-migrants. Policymakers should focus on the determinants of migrant health to achieve the goal of healthy ageing for all in India.