Abstract
Abstract Background The association of health-related quality of life (HRQL) with total and cardiovascular (CVD) hospitalization was assessed in a population-based cohort of apparently healthy subjects; several pathways possibly accounting for such associations were also tested. Methods Longitudinal analysis on 16,849 subjects free from CVD and cancer from the Moli-sani Study, Italy (2005-2010). HRQL was performed by the 36-Item Short Form Health Survey including both mental and physical domains. First hospital admissions were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression. Results Over a median follow-up of 7.3 y, 6,061 all-cause, 1907 CVD, 431 IHD and 294 stroke hospital admissions were ascertained. The highest quintile of mental HRQL was associated with 23% (95%CI: 17% to 29%), 26% (15% to 36%) and 30% (5% to 48%) lower risk of total, CVD and IHD admissions to hospital, respectively, as compared to the lowest. Risk estimates for physical health were 0.60 (0.56-0.65 for Q5 vs Q1), 0.57 (0.50-0.65) and 0.73 (0.55-0.97) for total, CVD and IHD hospital admissions, respectively. A downward trend with stroke hospitalizations was found for both mental and physical HRQL. Healthy behaviours explained up to 13% of the association between mental HRQL and IHD risk; inflammatory markers (i.e. C-reactive protein and white blood cell count)) accounted for a significant proportion (34%) of the association of physical HRQL with IHD hospitalizations. Conclusions In a large sample of disease-free subjects, not only physical, but also higher mental HRQL is associated with lower risk of total and CVD hospitalizations. Key messages HRQL adds meaningful information beyond traditional risk factors to the prediction of hospitalization. HRQL assessment may be useful in stratifying hospitalization risk among a general population of healthy adults.
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