Abstract
Previous research has demonstrated that lower health-related quality of life (HRQoL) is associated with higher morbidity and mortality, especially in-patient groups. The association of HRQoL with all-cause mortality in community samples requires further investigation. This study aimed to examine whether HRQoL predicts all-cause mortality in older healthy community-dwelling people from Australia and the United States (U.S.) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. We also explored whether this association varies by gender or country. A prospective cohort of 19,106 individuals aged 65-98years, who were without a dementia diagnosis or a known major life-limiting disease, and completed the 12-item short-form-HRQoL at recruitment (2010-2014). They were followed until June 2017. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours and clinical measures. Hazards ratios were estimated for every 10-unit increase in PCS or MCS. There were 1052 deaths over a median 4.7-years (interquartile range 3.6-5.7) of follow-up, with 11.9 events per 1000 person-years. Higher PCS was associated with lower all-cause mortality (HR 0.83, 95% CI 0.77, 0.89) in the entire sample, while higher MCS was associated with lower mortality among U.S. participants only (HR 0.78, 95% CI 0.63, 0.95). Gender differences in the association of either PCS or MCS with mortality were not observed. Our large study provides evidence that HRQoL is inversely associated with all-cause mortality among initially healthy older people.
Highlights
Assessment of the association between health-related quality of life (HRQoL) and all-cause mortality among initially healthy older males and females is still limited
This study aimed to examine whether HRQoL predicts allcause mortality in older healthy community-dwelling people from Australia and the United States (U.S.) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial
The aim of this study was to examine whether the physical (PCS) or mental component scores (MCS) of HRQoL predict all-cause mortality among community-dwelling older people and to determine whether these associations differ by gender
Summary
Assessment of the association between HRQoL and all-cause mortality among initially healthy older males and females is still limited. In that review, less than two thirds (28 studies) focused exclusively on older people aged 65 years and above [10]. Among the studies conducted in older people, only eight studies had a very large sample size >10,000 older people or national sample) [10] and the majority of these (n=5) had a strong gender imbalance Gender difference plays an important role in the social consequences of illness and wellbeing including health-care seeking behaviours and the availability of support by their family and society [12]. Given that mortality risk varies by gender [13] and women often have lower HRQoL than men [14], it is important to understand the association between HRQoL and mortality by gender. The previous systematic review did not evaluate whether the associations differed by gender [10].
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