Abstract
BackgroundHealth-related quality of life (HRQOL) is a patient-centered outcome measure used in assessing the individual’s overall functional health status but studies looking at HRQOL as a predictive tool are few. This work examines whether summary scores of HRQOL are predictive of all-cause hospitalization in the US Military HIV Natural History Study (NHS) cohort.MethodsThe Short Form 36 (SF-36) was administered between 2006 and 2010 to 1711 NHS cohort members whose hospitalization records we had also obtained. Physical component summary scores (PCSS) and mental component summary scores (MCSS) were computed based on standard algorithms. Terciles of PCSS and MCSS were generated with the upper terciles (higher HRQOL) as referent groups. Proportional hazards multivariate regression models were used to estimate the hazard of hospitalization for PCSS and MCSS separately (models 1 and 2, respectively) and combined (model 3).ResultsThe hazard ratios (HR) of hospitalization were respectively 2.12 times (95% CI: 1.59–2.84) and 1.59 times (95% CI: 1.19–2.14) higher for the lower and middle terciles compared to the upper PCSS tercile. The HR of hospitalization was 1.33 times (95% CI: 1.02–1.73) higher for the lower compared to the upper MCSS tercile. Other predictors of hospitalization were CD4 count < 200 cells/mm3 (HR = 2.84, 95% CI: 1.96, 4.12), CD4 count 200–349 cells/mm3 (HR = 1.67, 95% CI: 1.24, 2.26), CD4 count 350–499 cells/mm3 (HR = 1.41, 95% CI: 1.09, 1.83), plasma viral load > 50 copies/mL (HR = 1.82, 95% CI: 1.46, 2.26), and yearly increment in duration of HIV infection (HR = 0.94, 95% CI: 0.93, 0.96) (model 3).ConclusionAfter controlling for factors associated with hospitalization among those with HIV, both PCSS and MCSS were predictive of all-cause hospitalization in the NHS cohort. HRQOL assessment using the SF-36 may be useful in stratifying hospitalization risk among HIV-infected populations.
Highlights
Health-related quality of life (HRQOL) is a patient-centered outcome measure used in assessing the individual’s overall functional health status but studies looking at HRQOL as a predictive tool are few
A few studies have utilized HRQOL as a prognostic tool for predicting survival in people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWHA) [3,4,5,6], showing that HRQOL is useful as a risk stratification tool in HIV-infected individuals both in clinical trials and observational studies
The hazards of hospitalization were 2.12 and 1.59 times higher respectively in the lower and middle terciles compared to the upper tercile (Table 3, model 3 [after this, we report model 3, which is the combined Physical component summary scores (PCSS) and mental component summary scores (MCSS) model, unless there are obvious differences in the results of the three models])
Summary
Health-related quality of life (HRQOL) is a patient-centered outcome measure used in assessing the individual’s overall functional health status but studies looking at HRQOL as a predictive tool are few. Health-related quality of life (HRQOL) is primarily used as a patient-centered outcome measure to assess the individual’s overall functional health status and for evaluating therapeutic interventions in chronic diseases including human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) [1, 2]. The rate of hospitalization in the U.S Military HIV Natural History Study (NHS) cohort was previously reported to be as high as 137 per 1000 person years (PYs) [13] Given this high rate of hospitalization, it is important to evaluate factors that may predict hospitalization such as HRQOL, in the hope that appropriate interventions directed at modifiable risk factors such as CD4 count and medical/mental comorbidities that impact HRQOL can be instituted with the ultimate goal of reducing the high hospitalization rate
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