Abstract
BackgroundMultimorbidity has a negative impact on health-related quality of life (HRQL). Previous studies included only a limited number of conditions. In this study, we analyse the impact of a large number of conditions on HRQL in multimorbid patients without preselecting particular diseases. We also explore the effects of these conditions on the specific dimensions of HRQL.Materials and MethodsThis analysis is based on a multicenter, prospective cohort study of 3189 multimorbid primary care patients aged 65 to 85. The impact of 45 conditions on HRQL was analysed. The severity of the conditions was rated. The EQ-5D, consisting of 5 dimensions and a visual-analogue-scale (EQ VAS), was employed. Data were analysed using multiple ordinary least squares and multiple logistic regressions. Multimorbidity measured by a weighted count score was significantly associated with lower overall HRQL (EQ VAS), b = −1.02 (SE: 0.06). Parkinson’s disease had the most pronounced negative effect on overall HRQL (EQ VAS), b = −12.29 (SE: 2.18), followed by rheumatism, depression, and obesity. With regard to the individual EQ-5D dimensions, depression (OR = 1.39 to 3.3) and obesity (OR = 1.44 to 1.95) affected all five dimensions of the EQ-5D negatively except for the dimension anxiety/depression. Obesity had a positive effect on this dimension, OR = 0.78 (SE: 0.07). The dimensions “self-care”, OR = 4.52 (SE: 1.37) and “usual activities”, OR = 3.59 (SE: 1.0), were most strongly affected by Parkinson’s disease. As a limitation our sample may only represent patients with at most moderate disease severity.ConclusionsThe overall HRQL of multimorbid patients decreases with an increasing count and severity of conditions. Parkinson’s disease, depression and obesity have the strongest impact on HRQL. Further studies should address the impact of disease combinations which require very large sample sizes as well as advanced statistical methods.
Highlights
In ageing societies multimorbidity is becoming an increasingly common phenomenon
The overall health-related quality of life (HRQL) of multimorbid patients decreases with an increasing count and severity of conditions
Parkinson’s disease, depression and obesity have the strongest impact on HRQL
Summary
Multimorbidity refers to the coexistence of more than one chronic condition in an individual, a phenomenon much more common in subjects aged 65 years and above than in younger subjects [1,2]. Rates of prevalence were found to be higher in primary-care based study populations than in samples drawn from the general population [4], and may depend on the number of conditions taken into consideration [5]. In a German study based on claims data from a large sample, van den Bussche et al [6] found a prevalence of 62.1% for multimorbidity, defined as three or more conditions, among subjects aged 65 years or older and a mean number of 5.8 chronic conditions among these multimorbid subjects. We analyse the impact of a large number of conditions on HRQL in multimorbid patients without preselecting particular diseases. We explore the effects of these conditions on the specific dimensions of HRQL
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