Frequent Activity Limitation Research Articles

COVID-19's Unequal Toll: Differences in Health-Related Quality of Life by Gendered and Racialized Groups.

We examine whether the COVID-19 pandemic was associated with changes to daily activity limitations due to poor physical or mental health and whether those changes were different within and between gendered and racialized groups. We analyze 497,302 observations across the 2019 and 2020 waves of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System survey. Among White men and women, the COVID-19 pandemic was associated with fewer days of health-related activity limitations and decreased frequent activity limitation (≥14 days in the past month) compared to the prepandemic period. By contrast, Latina and Black women experienced increased days of activity limitation and greater likelihood of frequent activity limitation, and these changes were significantly different than for White women. These findings are robust to the inclusion of structural inequality measures and demonstrate how systemic racism and sexism likely exacerbate a myriad of pandemic-related health problems.

Physical activity and body mass index were interactively related to health-related quality of life among older adults

PurposeThe purpose of this study was to examine how meeting physical activity (PA) guidelines (i.e., moderate-to-vigorous aerobic activity, muscle strengthening activity) and weight status were interactively related to health-related quality of life (HRQoL) among older adults. MethodsA cross-sectional analysis was conducted using data from 87,495 older adults aged 65+ years who participated in the U.S. 2019 Behavioral Risk Factor Surveillance System. PA, weight status, and HRQoL were assessed by validated questionnaires via phone interviews. Binomial logistic regression models were used to examine the interactive effects of meeting PA guidelines and weight status on the odds of having poor HRQoL after controlling for key confounders. ResultsCompared to participants meeting both PA guidelines and with normal weight, both underweight and obese older adults had significantly higher odds of having poor general health (OR= 1.55–6.16) regardless of meeting PA guideline status, and those meeting muscle strengthening activities only or meeting neither PA guideline reported higher odds of poor physical health (OR= 1.83–6.22) regardless of weight status. Similarly, those meeting neither PA guideline had significantly higher odds of having poor mental health (OR= 1.69–2.78) regardless of weight status, and those meeting muscle strengthening activities only or meeting neither PA guideline reported higher odds of having frequent activity limitation days (OR= 2.18–7.05). ConclusionsThe positive associations between moderate-to-vigorous aerobic PA and HRQoL indicate the need to promote aerobic PA in older adults. Both sex and weight status should be considered when designing PA interventions to improve HRQoL among older adults.

Maternal body composition and gestational weight gain in relation to asthma control during pregnancy.

Poor asthma control is common during pregnancy and contributes to adverse pregnancy outcomes. Identification of risk factors for poor gestational asthma control is crucial. Examine associations of body composition and gestational weight gain with asthma control in a prospective pregnancy cohort (n = 299). Exposures included pre-pregnancy body mass index (BMI), first trimester skinfolds, and trimester-specific gestational weight gain. Outcomes included percent predicted forced expiratory volumes (FEV1, FEV6), forced vital capacity (FVC), peak expiratory flow (PEF), FEV1/FVC, symptoms (activity limitation, nighttime symptoms, inhaler use, and respiratory symptoms), and exacerbations (asthma attacks, medical encounters). Linear and Poisson models examined associations with lung function (β (95% confidence interval (CI)), asthma symptom burden (relative rate ratio (RR (95%CI)), and exacerbations (RR (95%CI)). Women with a BMI ≥ 30 had lower percent predicted FVC across pregnancy (βThirdTrimester: -5.20 (-8.61, -1.78)) and more frequent night symptoms in the first trimester (RR: 1.66 (1.08, 2.56)). Higher first trimester skinfolds were associated with lower FEV1, FEV6, and FVC, and more frequent night symptoms and inhaler use across pregnancy. Excessive first trimester gestational weight gain was associated with more frequent activity limitation in the first trimester (RR: 3.36 (1.15, 9.80)) and inhaler use across pregnancy (RRThirdTrimester: 3.49 (1.21, 10.02)). Higher adiposity and first trimester excessive gestational weight gain were associated with restrictive changes in lung function and symptomology during pregnancy.

Prevalence and Characteristics of Subjective Cognitive Decline Among Caregivers, 2015-2019

Approximately 20% of U.S. adults provide unpaid care to family members and friends with a health condition or disability, and 20% of caregivers reported being in fair or poor health themselves. Much of the assistance caregivers provide have cognitive components, such as medication or financial management, yet little is known about caregivers’ cognitive functioning. Subjective cognitive decline (SCD), or self-reported worsening of memory over the past year, among caregivers could impact the quality of care they provide. This study assessed prevalence of SCD by caregiving status and, among caregivers, the distribution of sociodemographic and other characteristics by SCD status. The study included 93,851 community-dwelling adults aged ≥45 years in 22 states who completed both the Behavioral Risk Factor Surveillance System Cognitive Decline and Caregiving modules during 2015-2019. All data were weighted; comparisons are based on modified Rao-Scott chi-square tests (α=0.05). Among caregivers (n=21,238), 12.6% (95%CI:11.7-13.5) reported SCD, compared with 10.2% (95%CI:9.7-10.7) of non-caregivers (p<0.0001). Caregivers with SCD had more chronic health conditions, lower educational attainment, and were less likely to be married or employed than caregivers without SCD, despite a similar age distribution. Caregivers with SCD were also more likely than caregivers without SCD to report fair or poor health, frequent mental distress, a history of depression, and frequent activity limitations. SCD may negatively impact caregivers’ health, function, and ability to provide care. With the anticipated increases in the need for caregiving, it is critical to understand the cognitive health of caregivers to better support caregivers and care recipients.

Prevalence and Characteristics of Subjective Cognitive Decline Among Unpaid Caregivers Aged ≥45 Years - 22 States, 2015-2019.

Approximately 20% of U.S. adults are unpaid caregivers (caregivers) (1) who provide support to a family member or friend with a health condition or disability. Although there are benefits to caregiving, it can negatively affect caregivers' physical and mental health (2-4). Much of the assistance caregivers provide, such as administering medications or financial management, relies on cognitive ability, but little is known about caregivers' cognitive functioning. Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent confusion or memory loss over the past year (5), could affect caregivers' risk for adverse health outcomes and affect the quality of care they provide. CDC analyzed SCD among caregivers aged ≥45 years through a cross-sectional analysis of data from 22 states in the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS). Among adults aged ≥45 years, SCD was reported by 12.6% of caregivers who provided care to a family member or friend with a health condition or disability in the past 30 days compared with 10.2% of noncaregivers (p<0.001). Caregivers with SCD were more likely to be employed, men, aged 45-64 years, and have chronic health conditions than were noncaregivers with SCD. Caregivers with SCD were more likely to report frequent mental distress, a history of depression, and frequent activity limitations than were caregivers without SCD. SCD among caregivers could adversely affect the quality of care provided to care recipients. Understanding caregivers' cognitive health and the types of care provided is critical to maintaining the health, well-being, and independence of the caregiving dyad. Health care professionals can support patients and their patients' caregivers by increasing awareness among caregivers of the need to monitor their own health. The health care team can work with caregivers to identify potential treatments and access supports that might help them in their caregiving role and compensate for SCD.

Determining the Clinical Course of Asthma in Pregnancy

Asthma is the most common chronic disease affecting pregnancy, and poor asthma control has been associated with adverse pregnancy outcomes. However, the trajectory of asthma control during pregnancy is not well understood or characterized. To identify and characterize trajectories of gestational asthma control in a US-based prospective pregnancy cohort. A k-means algorithm for joint longitudinal data was used to cluster pregnant women with and without asthma into gestational asthma control trajectories on the basis of daily activity limitation, nighttime symptoms, inhaler use, and respiratory symptoms. Among 308 women with asthma, 2 trajectories of gestational asthma control were identified and labeled "same" (n= 184; 59.5%) or "worse" (n= 124; 40.5%). Contrary to previous studies, we did not observe women with better asthma control in pregnancy. Women belonging to the "worse" trajectory experienced frequent and stable activity limitation and inhaler use, as well as frequent and increasing nighttime symptoms (∼3 d/gestational week) and respiratory symptoms (∼5 times/wk). Women belonging to the "same" trajectory experienced infrequent and stable activity limitation, inhaler use, and respiratory symptoms, as well as infrequent and slightly increasing (∼1 d/gestational week) nighttime symptoms. Results from pregnant women without asthma (n= 107) suggest that pregnancy alone was not responsible for changes in symptoms over time. In this US-based obstetric cohort receiving care according to standard clinical practice, gestational asthma control worsened for about 40% of women.

Latent Health Risk Classes Associated with Poor Physical and Mental Outcomes in Workers with COPD from Central Appalachian U.S. States.

Adults who work in the Central Appalachian region of the United States (U.S.) are disproportionately affected by Chronic Obstructive Pulmonary Disease (COPD). While there is a socio-demographic profile of adults with COPD who are at increased risk for physical and mental distress, the risk factors that uniquely affect the health-related quality of life (HRQoL) of Central Appalachian workers with COPD are unknown. Therefore, we conducted a latent class analysis of 2016 and 2017 Behavioral Risk Factor Surveillance System data from 1326 currently employed adults with COPD living in four U.S. states (KY, NC, TN, and WV) within the Central Appalachian Region. Drawing from the social ecological model, we identified associations between theoretically informed risk indicators—comorbid health conditions, substance use and abuse, and limited access to healthcare—on three HRQoL variables, including infrequent (0–13 days) or frequent (≥14 days) physical distress, mental distress, and limited activity due to poor health over the past 30 days. Workers at high risk for comorbid conditions reported more frequent physical distress, mental distress, and activity limitations as compared to those at low risk. Workers reporting difficulty accessing healthcare were no more likely to report physical or mental distress when compared to workers with adequate access to healthcare; however, those with limited healthcare access did report more frequent activity limitation due to poor health. Interestingly, workers with COPD at high risk for substance use and abuse were no more likely to report poor HRQoL outcomes compared to those at low risk. Our findings have important implications for addressing indicators of poor health among Central Appalachian workers with COPD, especially those living with multiple comorbidities.

Abstract LB-154: Disruption of essential services after Hurricanes Irma and Maria and quality of life among women with gynecological cancer receiving care in Puerto Rico

Abstract Objectives: Cancer patients have increased risk of poor outcomes after disasters. On September 2017 Hurricanes Irma and María affected Puerto Rico (PR), causing the population to experience major stressors. We describe the disruption of essential services among women with gynecologic cancer in PR after hurricanes Irma and Maria and its impact on quality of life (QoL). We also compare QoL of these women before and after the hurricanes. Methods: This ongoing cross-sectional study is recruiting women aged ≥21 years diagnosed between September 2016-September 2018 and receiving care in PR; we have conducted 110 phone interviews from September 2019-December 2019. Patients' interviews address stressors (including disruptions and time in essential services such as power, electricity and telecommunications) and multilevel responses experienced by the women in the aftermath of the hurricanes. QoL was measured by using a scale from the BRFSS, which includes six items within two domains: physical and mental health; these items were assessed at two time periods (30 days and 3 months) before and after the hurricanes. The association between disruption of essential services and QoL was evaluated with the Chi-square test. Paired McNemar's test was used to compare women's QoL before and after the hurricanes. Results: Mean age of study participants is 63.7±12.1 years; 64.5% of women had a diagnosis of endometrial cancer, 15.5% cervical, 15.5% ovarian, 3.6% vulvar, and 1.0% vaginal. 100% of patients reported disruptions in electric power, 84.5% in potable water, and 75.2% in telecommunications. On average, patients endured 114 days (±88.8) without electric power, 63 days (±62.8) without potable water, and 62 days (±56.3) without telecommunications. We did not find significant differences between the disruption of essential services and QoL indicators (p&amp;gt;0.05). Nonetheless, QoL indicators were worst after the hurricanes than before. Frequent activity limitations (before=22.3% vs. after=39.1%), frequent mental distress (before=26.4% vs. after= 59.1%) and feeling dissatisfied/very dissatisfied with life (before=6.2% vs. after= 21.7%) increased (p&amp;lt;0.001). Frequent physical distress (33.6% vs. 40.9%) and fair/poor general health status (33.9% vs. 50.9%) also increased after the hurricanes, these results were marginally significant (p&amp;lt;0.10). Conclusion: Most of the patients experienced long interruptions in essential services, after hurricanes. The fact that all patients experienced some kind of disruption may explain the lack of association of these variables with QoL. Nonetheless, this study shows that participant's QoL worsened after the hurricanes. Study results should guide the development of a disaster management plan for cancer patients that focuses on minimizing the adverse effects on QoL in the aftermath of a catastrophic event. Acknowledgement: NCI Grant #R21CA239457 Citation Format: Ana P. Ortiz, Sandra García-Camacho, Andrea Pacheco-Díaz, William Calo, Sharee A. Umpierre, Pablo Méndez-Lazaro, Istoni DaLuz-Santana, Lianeris Estremera-Rodriguez, Mirza Rivera, Guillermo Tortolero-Luna. Disruption of essential services after Hurricanes Irma and Maria and quality of life among women with gynecological cancer receiving care in Puerto Rico [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-154.

Associations of sleep duration with patient-reported outcomes and health care use in US adults with asthma

BackgroundAsthma contributes to considerable morbidity and health care utilization in adults. Insufficient and excessive sleep duration have known adverse effects on health. Little is known regarding the effect of sleep duration on health outcomes in adults with asthma. ObjectiveTo examine associations between sleep duration, patient-reported outcomes, and health care use in adults with asthma from the National Health and Nutrition Examination Survey. MethodsCross-sectional data from the 2007 to 2012 National Health and Nutrition Examination Survey were analyzed. Asthma was identified by self-report. Habitual hours of sleep duration were categorized as short (≤5), normal (6-8), and long (≥9). Multivariate regression analyses were used to examine the associations between sleep duration and patient-reported outcomes and health care use. ResultsOf the 1389 adults with asthma, 26% reported short sleep duration, 66% reported normal sleep duration, and 8% reported long sleep duration. Those with short sleep duration had increased asthma attacks (adjusted odds ratio [aOR] 1.58; 95% confidence interval [CI] 1.13-2.21), coughing (aOR 1.95; 95% CI 1.32-2.87), and overnight hospitalizations (aOR 2.14; 95% CI 1.37-3.36) compared with those having normal sleep duration. They also reported worse health-related quality of life, including days of poor physical health, mental health, and inactivity because of poor health (P values < .05). Those with long sleep had more activity limitations because of wheezing compared with those with normal sleep (aOR 1.82; 95% CI 1.13-2.91). ConclusionCompared with adults having asthma and normal sleep duration, those having short sleep duration experience more frequent asthma attacks, increased health care use, and worse health-related quality of life, whereas those with long sleep duration experience more frequent activity limitation.

Health-Related Quality of Life Among Lesbian, Gay, and Bisexual Adults: The Burden of Health Disparities in 2016 Behavioral Risk Factor Surveillance System Data.

Purpose: Health-related quality of life (HRQoL) measures assess the burdens imposed by mental and physical health problems. We studied whether HRQoL disparities existed among lesbian, gay, and bisexual (LGB) adults. Methods: We examined HRQoL of LGB and heterosexual adults in 25 states (n = 195,378) using data from the 2016 Behavioral Risk Factor Surveillance System survey. We examined the number of days that mental or physical health was not good and days with activity limitations. We also examined frequent (≥14 days per month) mental and physical distress, frequent activity limitations (FALs), and general health status. Chi-square, linear regression, and logistic regression analyses were performed. Results: LGB adults reported significantly more days that their mental health was not good compared with heterosexual adults. Lesbian and bisexual females reported significantly more days with activity limitations than did heterosexual females. Bisexual females reported significantly more days that their physical health was not good; gay males reported significantly fewer days that their physical health was not good. Furthermore, gay and bisexual adults had significantly higher odds of reporting frequent mental distress (FMD). Specifically, gay and bisexual males had 1.6 and 1.7 higher odds of reporting FMD. Bisexual females had higher odds of reporting FMD (adjusted odds ratio [AOR] = 2.67), frequent physical distress (AOR = 1.32), FAL (AOR = 1.78), and poor or fair health (AOR = 1.55), compared with heterosexual females. Conclusions: These HRQoL analyses documented notable burdens of health disparities across sexual orientation identity, especially among bisexual females.

Health-Related Quality of Life of an adult population sample in Barranquilla, Colombia.

The aim of this study was to estimate values of health-related quality of life (HRQOL) by focusing on the physical and mental health of an adult population sample in the city of Barranquilla, Colombia. Cross-sectional study with 368 adults representing an adult population. The questionnaires included the health-related quality of life "CDC-Healthy Days", the Zung Self-Rating Depression Scale, and the Overall Disability Sum Score. The prevalence of fair or poor health status (FPH), frequent physical distress (FPD), frequent mental distress (FMD), and frequent activity limitation (FAL) was estimated according to socio-demographic characteristics, presence of depression, and physical disability. The mean age of 368 adults was 45.6 ± 18.3 years; 55.7% were males. Only 21% of this population considered their general health to be fair or poor. The prevalence of FPH, FPD, FMD and FAL was higher in women than in men, and increased with greater severity of depression and higher physical disability. Moreover, 12% of the population presented with mild depression, 3.8% with moderate depression, and less than 1% with severe depression. 94% of this population did not have an arms or legs disability. This study provides HRQOL values for an adult sample of the population of Barranquilla, Colombia. Overall, the HRQOL of this population, with subtle differences, is similar to other reports from Colombia. In general, women and people with depression and physical disabilities had a worse quality of life.

Health and Access to Care among Reproductive-Age Women by Sexual Orientation and Pregnancy Status.

A large body of research has documented disparities in health and access to care among sexual minority populations, but very little population-based research has focused on the health care needs among pregnant sexual minority women. Data for this study came from 3,901 reproductive-age (18-44years) women who identified as lesbian or bisexual and 63,827 reproductive-age women who identified as heterosexual in the 2014-2016 Behavioral Risk Factor Surveillance System. Logistic regression models were used to compare health care access, health outcomes, and health behaviors by sexual orientation and pregnancy status while controlling for demographic characteristics and socioeconomic status. Approximately 3% of reproductive-age sexual minority women were pregnant. Pregnant sexual minority women were more likely to have unmet medical care needs owing to cost, frequent mental distress, depression, poor/fair health, activity limitations, chronic conditions, and risky health behaviors compared with pregnant heterosexual women. Nonpregnant sexual minority women were more likely to report barriers to care, activity limitations, chronic conditions, smoking, and binge drinking compared with nonpregnant heterosexual women. Health outcomes were similar between pregnant and nonpregnant sexual minority women, but pregnant sexual minority women were more likely to smoke cigarettes every day compared with other women. This study adds new population-based research to the limited body of evidence on health and access to care for pregnant sexual minority women who may face stressors, discrimination, and stigma before and during pregnancy. More research and programs should focus on perinatal care that is inclusive of diverse families and sexual orientations.

Health-Related Quality of Life of an adult population sample in Barranquilla, Colombia

Objective The aim of this study was to estimate values of health-related quality of life (HRQOL) by focusing on the physical and mental health of an adult population sample in the city of Barranquilla, Colombia.Materials and methods Cross-sectional study with 368 adults representing an adult population. The questionnaires included the health-related quality of life “CDC-Healthy Days”, the Zung Self-Rating Depression Scale, and the Overall Disability Sum Score. The prevalence of fair or poor health status (FPH), frequent physical distress (FPD), frequent mental distress (FMD), and frequent activity limitation (FAL) was estimated according to socio-demographic characteristics, presence of depression, and physical disability.Results The mean age of 368 adults was 45.6 ± 18.3 years; 55.7% were males. Only 21% of this population considered their general health to be fair or poor. The prevalence of FPH, FPD, FMD and FAL was higher in women than in men, and increased with greater severity of depression and higher physical disability. Moreover, 12% of the population presented with mild depression, 3.8% with moderate depression, and less than 1% with severe depression. 94% of this population did not have an arms or legs disability.Discussion This study provides HRQOL values for an adult sample of the population of Barranquilla, Colombia. Overall, the HRQOL of this population, with subtle differences, is similar to other reports from Colombia. In general, women and people with depression and physical disabilities had a worse quality of life.

Relationship between sleep duration and self-reported health-related quality of life among US adults with or without major chronic diseases, 2014

ObjectivesTo assess the association between sleep duration and health-related quality of life (HRQOL) among adults with or without chronic conditions. MethodsUsing the 2014 Behavioral Risk Factor Surveillance System, we analyzed self-reported data from adult respondents aged ≥18 years with (n=277,757, unhealthy group) and without (n=172,052. healthy group) reported history of any of nine chronic conditions (coronary heart disease, stroke, cancer, chronic obstructive pulmonary disease, diabetes, asthma, arthritis, depression, chronic kidney disease). Multivariable logistic regressions were separately constructed to assess the associations between sleep duration and four self-reported HRQOL measures after adjustment for sociodemographics, leisure-time physical activity, body mass index, and smoking status among unhealthy and healthy adults. ResultsThe prevalence of poor/fair health, frequent physical distress, frequent mental distress, frequent activity limitation, and short sleep duration was 27.9%, 19.3%, 17.0%, 13.6%, and 38.3% in the unhealthy group and 6.9%, 4.0%, 5.3%, 2.1%, and 31.0% in the healthy group, respectively. U-shaped relationships of sleep duration to all four HRQOL indicators were observed among the unhealthy group and to poor/fair health, frequent mental distress, and frequent activity limitation among the healthy group. The relationships further varied by sex, age, race/ethnicity, and BMI category among the healthy group. ConclusionsRelationships between extreme sleep duration and HRQOLs were observed among both healthy and unhealthy groups. These results can help inform public awareness campaigns and physician-counseling regarding the importance of sleep for mental health and well-being.

Differences in Mental, Cognitive, and Functional Health by Sexual Orientation Among Older Women: Analysis of the 2015 Behavioral Risk Factor Surveillance System.

This study addresses a gap in the knowledge base regarding whether there are differences in mental, cognitive, and functional health between sexual minority women aged 65 and older and their heterosexual counterparts, as well as whether disparities are moderated by age, socioeconomic status, and race/ethnicity. This study analyzes 2015 Behavioral Risk Factor Surveillance System data from 21 states. Multivariate logistic regression is used to test the hypotheses. Compared to heterosexual women, lesbian/gay women aged 65 and older report worse functional health and bisexual women report worse cognitive health and more difficulties with instrumental activities of daily living. Disparities are particularly present for women in their late 60s and those in their 70s. While the likelihood of a depression diagnosis tends to be lower for heterosexual women with higher income, the inverse is true of sexual minority women. Additionally, sexual minority women with less education have lower odds of frequent mental distress and activity limitations than those with some college education. Sexual minority women of color have significantly lower odds of frequent mental distress, activity limitations, and use of special equipment compared to white sexual minority women. Findings indicate a need for gerontological services that provide support to older sexual minority women, particularly in relation to cognitive and functional health. Future research is needed to understand risk and protective factors contributing to these disparities, including forms of resilience that occur among older sexual minority women of color.

How do patients describe their disabilities? A coding system for categorizing patients' descriptions

BackgroundTo provide care that meets the values and preferences of patients with disabilities, health care providers need to understand patients' perceptions and understanding of their disability. No studies have explored patients' definitions of disability within the healthcare setting. ObjectiveThe aim of the study was to understand how patients' define their disability in the healthcare setting and to develop a coding system for categorizing how they describe their disability. MethodsIn 2000 all new outpatients at Mayo Clinic, Rochester, MN completed a form that inquired if they had a disability and if so, to write in the disability. The research team categorized the responses by disability type (e.g.: visual or physical) and how the patient described his disability or “disability narrative” (e.g.: diagnosis or activity). ResultsWithin 128,636 patients, 14,908 reported a disability. For adults, lower limb (26%) and chronic conditions (24%) were the most frequent disability type and activity limitations (56%) were the most frequent disability narrative category. For pediatric patients, developmental disabilities (43%) were the most frequently reported disability type and diagnoses (83%) were the most frequent disability narrative category. Patients used different disability narrative categories to describe different disability types. For example, most adults reporting a mental health listed a diagnosis (97%), compared to only 13% of those with lower limb disabilities. ConclusionsPatients had diverse descriptions of their disabilities. In order for providers and healthcare organizations to provide high-quality care, they should engage patients in developing a consistent, patient-centered language around disability.

Health-Related Quality of Life Among US Workers: Variability Across Occupation Groups.

To examine the health-related quality of life among workers in 22 standard occupation groups using data from the 2013-2014 US Behavioral Risk Factor Surveillance System. We examined the health-related quality of life measures of self-rated health, frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days by occupation group for 155 839 currently employed adults among 17 states. We performed multiple logistic regression analyses that accounted for the Behavioral Risk Factor Surveillance System's complex survey design to obtain prevalence estimates adjusted for potential confounders. Among all occupation groups, the arts, design, entertainment, sports, and media occupation group reported the highest adjusted prevalence of frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days. The personal care and service occupation group had the highest adjusted prevalence for fair or poor self-rated health. Workers' jobs affect their health-related quality of life.

Self-reported general health, physical distress, mental distress, and activity limitation by US county, 1995-2012

BackgroundMetrics based on self-reports of health status have been proposed for tracking population health and making comparisons among different populations. While these metrics have been used in the US to explore disparities by sex, race/ethnicity, and socioeconomic position, less is known about how self-reported health varies geographically. This study aimed to describe county-level trends in the prevalence of poor self-reported health and to assess the face validity of these estimates.MethodsWe applied validated small area estimation methods to Behavioral Risk Factor Surveillance System data to estimate annual county-level prevalence of four measures of poor self-reported health (low general health, frequent physical distress, frequent mental distress, and frequent activity limitation) from 1995 and 2012. We compared these measures of poor self-reported health to other population health indicators, including risk factor prevalence (smoking, physical inactivity, and obesity), chronic condition prevalence (hypertension and diabetes), and life expectancy.ResultsWe found substantial geographic disparities in poor self-reported health. Counties in parts of South Dakota, eastern Kentucky and western West Virginia, along the Texas-Mexico border, along the southern half of the Mississippi river, and in southern Alabama generally experienced the highest levels of poor self-reported health. At the county level, there was a strong positive correlation among the four measures of poor self-reported health and between the prevalence of poor self-reported health and the prevalence of risk factors and chronic conditions. There was a strong negative correlation between prevalence of poor self-reported health and life expectancy. Nonetheless, counties with similar levels of poor self-reported health experienced life expectancies that varied by several years. Changes over time in life expectancy were only weakly correlated with changes in the prevalence of poor self-reported health.ConclusionsThis analysis adds to the growing body of literature documenting large geographic disparities in health outcomes in the United States. Health metrics based on self-reports of health status can and should be used to complement other measures of population health, such as life expectancy, to identify high need areas, efficiently allocate resources, and monitor geographic disparities.

Health-related quality of life among online university students.

Online university students are a growing population whose health has received minimal attention. The purpose of this cross-sectional Internet survey was to identify risk factors for the health status among online university students. This online survey collected data from 301 online university students through a large, US-based participant pool and LinkedIn. Health status was measured using 3 elements of health-related quality of life (HRQOL): self-rated overall health (SRH), unhealthy days, and recent activity limitation days. All 3 measures were dichotomized. The odds of poor SRH were higher for people who reported a body mass index in the overweight and obese categories (odds ratio [OR] = 2.99, P < .05) and for those who reported being smokers (OR = 2.52, P = .03). The odds of frequent unhealthy days were lower for those who made more than $35 000 compared with those who reported making less (OR = 0.50, P = .03) and those who exercised 4 or more times a week compared with those who exercised less (OR = 0.28, P < .05). The odds of frequent activity limitation were lower for those who reported an income of more than $35 000 (OR = 0.29, P = .04) and higher for persons who reported belonging to "other" race (OR = 14.75, P = .00). Universities might fruitfully target health promotion programs for online students who are low income, in disadvantaged racial groups, who are overweight, smoke, and who do not exercise.

An Examination of Adverse Asthma Outcomes in U.S. Adults with Multiple Morbidities

More Americans are managing multiple chronic conditions. Little is known regarding combinations of multiple chronic conditions with asthma. To examine the prevalence and demographic distribution of five common chronic conditions (arthritis, heart disease, cancer, diabetes, and hypertension) in adults with and without asthma and the adverse asthma outcomes associated with multiple chronic conditions. Cross-sectional interview data from the National Health and Nutrition Examination Survey were analyzed (n = 22,172) between 2003 and 2010. Bivariate analysis methods and multivariate generalized linear regression were used to examine associations. Of the 10% of subjects with asthma, 54% had one or more coexisting health condition(s). The prevalence of two or three or more other chronic conditions was greater among those with asthma compared with those without (P < 0.001). Common comorbidities with asthma were hypertension (34%) and arthritis (31%). For every additional comorbid chronic condition, there was an increase in the prevalence of reported asthma symptom episodes (prevalence ratio [PR], 1.06; 95% confidence interval [CI], 1.00-1.13), frequent activity limitation (PR, 1.14; 95% CI, 1.04-1.25), sleep disturbances (PR, 1.22; 95% CI, 1.04-1.43), and emergency department visit for asthma (PR, 1.45; 95% CI, 1.19-1.76) when adjusted for socioeconomic and demographic factors and body mass index. The population-attributable risk for emergency department visits for asthma among individuals with asthma who have other chronic comorbidities was 19.5%. Half of the adult population with asthma in the United States suffers from comorbid conditions, which are associated with adverse asthma-related outcomes and account for up to 20% of emergency room visits for asthma.