Abstract
PurposeWhile socioeconomic inequalities in health-related quality of life are well documented in the scientific literature, research has neglected to look into the reasons for these inequalities. The purpose of this study is to determine in what way social inequalities in health-related quality of life among patients with the same chronic disease could be explained by variations in disease severity.MethodsWe used the data of 748 people aging with HIV in Germany who took part in the nationwide study 50plushiv and provided self-report data on socioeconomic status, health-related quality of life (SF-12) and various markers of disease severity (comorbidity, falls, late presentation and AIDS diagnosis). Regression analyses were applied to determine the impact of SES on HRQOL after adjusting for disease severity variables.ResultsThe mental and physical subscales of the SF-12, comorbidity burden and falls were significantly related to SES. SES explained 7% of the variance in PCS scores and 3% of the variance in MCS scores after adjusting for age and time since diagnosis. Markers of disease severity explained 33% of the variance in PCS scores and 14% of the variance in MCS scores. After adjusting for disease severity SES was still significantly related to PCS and MCS scores.ConclusionsThe diverse sample of people aging with HIV showed social inequalities regarding HRQOL and most of the disease severity markers. SES was significantly related to mental and physical HRQOL after adjusting for disease severity. Possible explanations for this phenomenon are discussed.
Highlights
Social inequalities in health-related quality of life (HRQOL) are well documented (e.g. [1,2,3,4,5,6]), but they are rarely in the focus of empirical studies [7]
Mielck et al demonstrated that educational attainment as an indicator of socioeconomic status (SES) is even among patients diagnosed with the same chronic disease significantly related to HRQOL, with patients from the lowest SES group assessing their HRQOL worse than patients from the higher SES groups [7]
Insofar as disease severity and comorbidity burden are varying according to SES and are influencing HRQOL, these factors are likely explaining a great amount if not all of the social inequalities in HRQOL among people living with a chronic disease
Summary
Social inequalities in health-related quality of life (HRQOL) are well documented (e.g. [1,2,3,4,5,6]), but they are rarely in the focus of empirical studies [7]. Two factors that are known to correlate with HRQOL are disease severity [12,13,14,15] and comorbidity burden [16]. Insofar as disease severity and comorbidity burden are varying according to SES and are influencing HRQOL, these factors are likely explaining a great amount if not all of the social inequalities in HRQOL among people living with a chronic disease. Studies on these relationships between disease severity, comorbidity burden, socioeconomic status and HRQOL among patients with the same chronic disease are scarce
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