Abstract
BackgroundChronic diseases are highly prevalent and cluster in individuals (multimorbidity). This study investigated the association between multimorbidity and Health-Related Quality of Life (HRQoL), assessing the combination of chronic diseases highly correlated with this outcome.MethodsWe conducted a household survey in 2015 in a random sample of 2912 South Australian adults (48.9 ± 18.1 years; 50.9% females), obtaining information on sociodemographics, lifestyle, and 17 chronic conditions clustered in four different groups (metabolic, cardiovascular, gastrointestinal, and musculoskeletal). Information on physical (PCS) and mental components scores (MCS) of HRQoL were assessed using the SF-12 questionnaire. Multivariable linear regression models considering individual diseases (mutually adjusted) and clusters within- and between-groups were used to test the associations.ResultsOnly 41% of the sample was negative for all the investigated diseases. The most prevalent conditions were osteoarthritis, obesity and hypertension, which affected one in every four individuals. PCS was markedly lower among those reporting stroke, heart failure, and osteoarthritis, but they were not associated with MCS. Direct-trend relationships were observed between the number of chronic conditions (clusters within- and between-groups) and PCS, but not with MCS. The strongest association with PCS was for musculoskeletal conditions (difference between those affected by 2+ conditions and those free of these conditions −6.7 95%CI -8.5;-5.4), and lower PCS were observed in any combination of clusters between-group including musculoskeletal diseases.ConclusionIn the context of multimorbidity, musculoskeletal diseases are a key determinant group of PCS, amplifying the association of other chronic conditions on physical but not on mental health.
Highlights
Chronic diseases are highly prevalent and cluster in individuals
A further reduction of the differences between categories was observed when the chronic conditions were mutually adjusted (Model 2), and only nine conditions remained associated with a lower Physical component score (PCS): obesity, diabetes, atrial fibrillation, stroke, heart failure, gastroesophageal reflux, irritable bowel syndrome, osteoarthritis, and osteoporosis
The increasing prevalence of chronic diseases [1, 29] in South Australia (SA) during the last two decades could explain the progressive reduction in PCS [from 49.8 (95%CI 49.4–50.2) in 1997 to 48.6 (95%CI 48.2–49.0) in 2015], while mental components scores (MCS) has remained constant [30]. This hypothesis should be explored in future longitudinal studies. These results suggest new challenges for the Australian health care system, considering Health-Related Quality of Life (HRQoL) is closely related to the adherence to health management, hospitalisations, and mortality among individuals affected by chronic
Summary
Chronic diseases are highly prevalent and cluster in individuals (multimorbidity). This study investigated the association between multimorbidity and Health-Related Quality of Life (HRQoL), assessing the combination of chronic diseases highly correlated with this outcome. HRQoL is a patient-centered outcome that assesses the impact of health conditions on daily living, based on the self-perception of the individuals, and considers their social and cultural context [4, 6]. To investigate the relationship between multimorbidity (clusters of different NCDs affecting the same individual) [5] and the different domains of HRQoL is relevant for public health purposes, considering this outcome is closely related to the adherence to health management, hospitalisations, and mortality [6, 9]. NCDs tend to generate an overall state of immune suppression and/or inflammation, increasing the risk of developing other chronic diseases [5]
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