Reduction In Health-related Quality Of Life Research Articles

Sleep quality is associated with reduced quality of life in inflammatory bowel disease through its interaction with pain.

Quality of life is reduced in people with inflammatory bowel disease (IBD) and poor sleep is prevalent in people with IBD. This study aimed to investigate the influence of sleep on quality of life (QoL) in people with inflammatory bowel disease. An online questionnaire was administered through three tertiary IBD centers, social media, and through Crohn's Colitis Australia. The questionnaire included the EQ-5D-5L measures of health-related QoL, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index (PSQI), and validated IBD activity and mental health scores. There were 553 responses included with a diagnosis of Crohn's disease (62.2%), with over half on biologic therapy (53.1%). Poor sleep and clinically significant insomnia were associated with lower QoL (EQ-5D-5L scores: EQVAS, utility score, P < 0.001 for all). Sleep quality scores correlated with the EQ-5D-5L domains of "pain" (ρ 0.35, P < 0.001), "usual activities" (ρ 0.32, P < 0.001), and "depression-anxiety" (ρ 0.37, P < 0.001). After adjusting for demographic variables, IBD activity, and depression and anxiety via multivariate regression, the "pain" domain continued to be associated with PSQI components "sleep quality" (P < 0.001), "sleep disturbance" (P < 0.001), and "sleep duration" (P < 0.001). Clinically significant insomnia was associated with a reduction in QoL (EQVAS, utility score) independent of IBD activity (P < 0.001) and of a similar magnitude to that seen with IBD activity. Health-related QoL in IBD is influenced by aspects of sleep quality irrespective of IBD activity and mental health conditions. The presence of insomnia is associated with a reduction in health-related QoL. Consideration should be given to sleep targeting interventional studies in an IBD population.

Change in Functional Status During Hospital Admission and Long-Term Health-Related Quality of Life Among Pediatric Septic Shock Survivors.

To investigate whether change in functional status from pre-hospitalization baseline to hospital discharge is associated with long-term health-related quality of life (HRQL) among children surviving septic shock. Secondary analysis of Life After Pediatric Sepsis Evaluation (LAPSE), a prospective cohort study of children with community-acquired septic shock, enrolled from January 2014 to June 2017. Twelve U.S. academic PICUs. Children, 1 month to 18 years, who survived to hospital discharge and had follow-up data for HRQL at 3 and/or 12 months. None. Functional Status Scale (FSS) was assessed around enrollment to ascertain baseline status (pre-hospitalization) and at 28 days or hospital discharge. Two measures of HRQL were utilized: children with significant development delay were measured with the Functional Status II-R (FSII-R); typically, developing children were measured with the Pediatric Quality of Life Inventory (PedsQL). Each group was analyzed separately with multivariable regression modeling to determine the association between change in FSS from baseline to day 28 and HRQL at 3 and 12 months from PICU admission. Of the original 389 LAPSE participants, 224 (58%) are included. Among children with developmental delay ( n = 88), worsened FSS was associated with lower FSII-R at 3 months from PICU admission (-2.02; 95% CI, -3.34 to -0.0.71; p = 0.003), but not 12 months. Among developmentally typical children ( n = 136), worsened FSS was associated with lower PedsQL at both 3 and 12 months. Developmentally typical children with a neurologic insult during the PICU stay had the largest decrement in PedsQL at 12 months (-14.04 mo; 95% CI, -22.15 to -5.94 mo; p < 0.001). However, worsened FSS remained associated with poor HRQL-PedsQL at 3 and 12 months, after controlling for neurologic events (both p < 0.001). Change in FSS during hospitalization for septic shock is associated with long-term reductions in HRQL and could serve as a useful tool for identifying children at risk for this sequela.

P201 Sleep disturbance in early rheumatoid arthritis and fibromyalgia and its association with mood and quality of life

Abstract Background/Aims Rheumatoid arthritis (RA) and fibromyalgia (FM) are common musculoskeletal conditions associated with pain, mood and sleep disturbance, functional limitations and poor health-related quality of life (QOL). Studies report sleep problems in 50-75% established RA and 70-90% FM. The aim of this study is to quantify the presence of sleep disturbance amongst patients with newly diagnosed RA or FM, to describe any association with measures of anxiety or depression, and to investigate the impact of sleep disturbance on QOL in this patient group. Methods Patients with a clinical diagnosis of early RA or FM were recruited from Rheumatology clinics over 12 months (ethics reference: IRAS Project 252762). Patients completed baseline patient reported outcome measures prior to commencing treatment: Insomnia Severity Scale (ISS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Physical Activity Calculator (PAC) and the Short Form-36 Health Survey (SF-36). Students t-test, Mann-Whitney and Chi-squared test were used to compare normal, non-normal and binary data respectively. Regression modelling was used to investigate the association between sleep disturbance and the general health subscale of SF-36 (GHSF-36), adjusting for age, sex and rheumatic condition. Results 161 participants were recruited: 84 had a diagnosis of early RA and 77 had FM, mean age 50 (16) years, 118 (73%) females. Moderate-to-severe insomnia was present in 34/84 (41%) of early RA patients and 56/77 (72%) of FM patients. Table 1 shows further baseline characteristics according to rheumatological diagnosis. Overall, there was a significant relationship between insomnia severity and general health (r=-0.39, p &amp;lt; 0.001), anxiety (r = 0.49, p &amp;lt; 0.001) and depression (r = 0.64, p &amp;lt; 0.001). Regression analysis confirmed an association between baseline sleep disturbance and general health after adjusting for age, sex and diagnosis (ß=-0.79, 95% CI -1.22 to -0.36, p &amp;lt; 0.001). Conclusion Although there is greater sleep and mood disturbance in patients with FM, 41% of patients with early RA also reported moderate-to-severe insomnia at the time of diagnosis. Activity levels remain similar between the two groups and insomnia severity was significantly associated with reduced health related QOL. This highlights the importance of addressing sleep, and mood, in Rheumatology clinics to help improve health related QOL. Disclosure A.J.W. Wall: None. A. Delmestri: None. N.W.I.L. Silva: None. A. Soni: None.

Assessment of Patient Health-Related Quality of Life and Functional Outcomes in Pediatric Acute Respiratory Distress Syndrome.

To describe health-related quality of life (HRQL) and functional outcomes in pediatric acute respiratory distress syndrome (ARDS) and to determine risk factors associated with poor outcome defined as death or severe reduction in HRQL at 28 days or ICU discharge. Prospective multisite cohort-outcome study conducted between 2019 and 2020. Eight academic PICUs in the United States. Children with ARDS based on standard criteria. Patient characteristics and illness severity were collected during PICU admission. Parent proxy-report measurements were obtained at baseline, day 28/ICU discharge, month 3, and month 9, utilizing Pediatric Quality of Life Inventory and Functional Status Scale (FSS). A composite outcome evaluated using univariate and multivariate analysis was death or severe reduction in HRQL (>25% reduction in the Pediatric Quality of Life Inventory at day 28/ICU discharge. This study enrolled 122 patients with a median age of 3 years (interquartile range, 1-12 yr). Common etiologies of ARDS included pneumonia ( n = 63; 52%) and sepsis ( n = 27; 22%). At day 28/ICU discharge, half (50/95; 53%) of surviving patients with follow-up data reported a greater than 10% decrease in HRQL from baseline, and approximately one-third of participants ( n = 19/61; 31%) reported a greater than 10% decrease in HRQL at 9 months. Trends in FSS were similar. Of 104 patients with data, 47 patients (45%) died or reported a severe decrease of greater than 25% in HRQL at day 28/ICU discharge. Older age was associated with an increased risk of death or severe reduction in HRQL (odds ratio, 1.08; CI, 1.01-1.16). Children with ARDS are at risk for deterioration in HRQL and FSS that persists up to 9 months after ARDS. Almost half of children with ARDS experience a poor outcome including death or severe reduction in HRQL at day 28/ICU discharge.

Home confinement during COVID-19 pandemic reduced physical activity but not health-related quality of life in previously active older women

ABSTRACT We investigate the effect of COVID-19 home confinement on levels of physical activity, sedentary behavior, and health-related quality of life (HRQL) in older women previously participating in exercise and educational programs. Our hypothesis was that home confinement would result in a reduction in levels of physical activity, an increase in sedentary behavior, and a reduction in HRQL. Sixty-four older women (age = 72 ± 5 yrs) under home confinement who participated in a physical exercise/educational program had their levels of physical activity, sedentary behavior, and HRQL assessed before and during (11 to 13 weeks after the introduction of government recommendations to reduce virus transmission) COVID-19 pandemic. There were significant reductions in total physical activity (−259 METs/week, P = .02), as a result of a ~17.0% reduction in walking (−30.8 min/week, P = .004) and ~41.8% reduction in vigorous-intensity activity (−29.6 min/week, P < .001). Sedentary behavior also increased (2.24 h/week, P < .001; 1.07 h/week days, P < .001; and 1.54 h/weekend days, P < .001). However, no significant change occurred in moderate-intensity physical activity, and HRQL domains and facets, except for an improvement in the environment domain. Home confinement due to COVID-19 pandemic decreased levels of physical activity and increased levels of sedentary behavior in previously active older women. However, there were no significant changes in HRQL. These results suggest that educational programs promoting healthy behaviors may attenuate the impact of home confinement in older women.

Association of Allergic Conjunctivitis With Health-Related Quality of Life in Children and Their Parents

Allergic conjunctivitis (AC) is one of the most common allergic diseases and is especially problematic in children and adolescents. The course of AC is generally prolonged and often recurs. Understanding the health-related quality of life (QOL) of both children with AC and their parents would be useful. To evaluate the association between AC and health-related QOL in children and their parents. A prospective case-control study was conducted at Zhongshan Ophthalmic Center, a single tertiary referral center, from November 16, 2019, through January 20, 2020. Participants comprised 92 children aged 5 to 18 years with AC and their parents and 96 healthy, age-matched children who served as controls and their parents. The 92 children in the AC group were subdivided into cohorts with vernal keratoconjunctivitis (VKC) (23 [25.0%]) or atopic keratoconjunctivitis (AKC) (7 [7.6%]) and seasonal allergic conjunctivitis (SAC) (26 [28.3%]) or perennial allergic conjunctivitis (PAC) (36 [39.1%]). Allergic conjunctivitis. Pediatric Quality of Life Inventory, version 4.0 (PedsQL), scores for children and their parents. Scores range from 0 to 100, with higher scores indicating better health-related QOL and fewer negative aspects. In the AC group, 77 of 92 (83.7%) participants were boys, and 67 (72.8%) of the parents were women. Of the individuals in the control group, 55 of 96 (57.3%) of the children were girls and 76 (79.2%) of the parents were women. Median total PedsQL scores were reduced in both children with AC (69.6 [interquartile range [IQR], 66.3-72.8 vs 96.7; IQR, 92.7-98.9; P < .001) and their parents (68.8; IQR, 63.9-71.4 vs 96.5; IQR, 95.1-97.9; P < .001). The reduction in health-related QOL was more severe in children with VKC/AKC than in those with SAC/PAC (difference, -3.3; 95% CI, -5.4 to -1.1; P = .004) and their parents (difference, -4.3; 95% CI, -7.1 to -2.1; P < .001). In the AC group, a higher corneal fluorescein staining score was associated with lower QOL in children (β, -1.16; 95% CI, -1.80 to -0.52; P = .001); higher corneal fluorescein staining scores (β, -1.12; 95% CI, -1.74 to -0.50; P = .001) and multiple clinical consultations (β, -3.96; 95% CI, -7.34 to -0.57; P = .02) were associated with lower QOL in parents. The parents' QOL scores were correlated with their children's QOL scores (correlation coefficient, r = 0.59; P < .001). These findings suggest AC has a negative association with health-related QOL for children and their parents, especially in children with VKC/AKC or higher corneal fluorescein staining scores.

Burden of illness of hip fractures in elderly Dutch patients

SummaryPatients with hip fractures experience reduced health-related quality of life and have a reduced life expectancy. Patients’ utilization of healthcare leads to costs to society. The results of the study can be used in future economic evaluations of treatments for hip fractures.PurposeHip fractures are associated with high mortality, reduced quality of life, and increased healthcare utilization, leading to an economic burden to society. The purpose of this study is to determine the burden of illness of hip fractures in elderly Dutch patients for specific time periods after surgery.MethodsPatients with a hip fracture above the age of 65 were included in the study. In the 1-year period after surgery, patients were asked to complete a set of questionnaires pre-injury (retrospectively), and 1 week, 1 month, 3 months, 6 months and 12 months after surgery. The set of questionnaires included the Euroqol 5D (EQ-5D-3L), the iMTA Medical Consumption Questionnaire (iMCQ) and iMTA Productivity Cost Questionnaire (iPCQ). Health-related quality of life was calculated using Dutch tariffs. Costs were calculated using the methodology described in the Dutch costing manual.ResultsApproximately 20% of patients with a hip fracture died within 1 year. Health-related quality of life was significantly reduced compared to pre-injury values, and patients did not recover to their pre-injury values within 1 year. Total costs in the first year after injury were €27,573, of which 10% were due to costs of the procedure (€2706). Total follow-up costs (€24,876) were predominantly consisting of healthcare costs. Monthly costs decreased over time.ConclusionsHip fractures lead to a burden to patients, resulting from mortality and health-related quality of life reductions, and to society, due to (healthcare) costs. The results of this study can be used in future economic evaluations.

Impact of comorbidity on health-related quality of life among type 2 diabetic patients in primary care.

Health-related quality of life (HRQL) is an important outcome for chronic diseases such as diabetes mellitus that is associated with complications, comorbidities, and lifelong care. The present study aims to explore the impact of comorbidities on the different dimensions of HRQL among type 2 diabetic patients attending primary care. A total of 912 type 2 diabetic patients attending primary care centers in India were assessed using a predesigned and pretested questionnaire - Diabetes Comorbidity Evaluation Tool in Primary Care. The HRQL was measured by physical and mental health summary scores [physical component summary (PCS) and mental component summary (MCS)] of the Short Form Health Survey 12. The associations of sociodemographic variables and clinical variables with PCS and MCS were assessed, and a minimal difference of 5 in the scores (on a scale of 0-100) was kept as clinically relevant difference for this study. Mean differences in mental (MCS) and physical (PCS) scores of quality of life by number and type of comorbid conditions in type 2 diabetic patients were calculated. The presence of comorbid conditions was associated with lower scores of PCS and MCS (P < 0.001). Significant reduction in HRQL was found with increase in number of comorbid conditions, and negative association was established between the number of comorbidities and the PCS (r = -0.25, P < 0.0001) and MCS scores (r = -0.21, P < 0.0001). Among comorbidities, acid peptic disease, chronic lung disease, visual impairment, depression, and stroke had significantly and clinically relevant reduced scores. Duration of diabetes, use of insulin, and obesity were also associated with poor HRQL. Comorbidities considerably impair the HRQL among type 2 diabetic patients. National programs designed for diabetes management should also take into account the challenges of coexisting chronic conditions and its substantial effect on HRQL.

Caregiver burden and quality of life 2years after attendance at a memory clinic.

We aimed to describe (1) the burden and health-related quality of life (HRQL) of informal caregivers of new patients attending a memory assessment service (MAS), (2) changes in these outcomes over 2years, and (3) satisfaction with services. Informal caregivers of patients attending one of 73 MASs throughout England completed questionnaires at the patient's first appointment, and 6 and 12months later. Participants from 30 of these MASs were also followed up at 24months. Questionnaires covered caregivers' sociodemographic characteristics, Zarit Burden Interview, EQ-5D-3L, and satisfaction with services. We used multivariable linear regression to assess relationships between burden, HRQL, and caregiver and patient characteristics. Of 1020 caregivers at baseline, 569 were followed up at 6months, 452 at 12months, and 187 at 24months. There was a small increase in caregiver burden over 2years (effect size 0.30 SD). These changes were not associated with most caregiver or patient characteristics, except socio-economic deprivation, which was associated with larger increases in burden at 2years. Caregivers' HRQL was weakly associated with burden and showed a small reduction over time (0.2 SD). Most caregivers were satisfied with services, but caregivers who were not satisfied with the services they received reported greater increases in burden. Increases in caregiver burden and reductions in HRQL appear to be small over the first 2years after attending a MAS. However, the longer term impact on caregivers and those they care for needs investigating, as do strategies to reduce their burden.

Russian Health-related Quality of Life Assessment According to Comq-12 in Patients with Different Forms of Chronic Otitis Media

Background: Chronic otitis media is a widespread disease that affects up to 2% of the population. The Chronic Otitis Media Questionnaire-12 was developed to assess the patient-reported health-related quality of life reduction due to chronic otitis media. The aim of this study is to evaluate the characteristics of the chronic otitis media questionnaire-12 among various groups of chronic otitis media patients. Materials and methods: The Russian version of the questionnaire was obtained through translation and back-translation. 108 patients with different forms of COM completed the Russian version of the questionnaire. The internal consistency of this questionnaire was evaluated using Cronbach’s alpha coefficient. Results: The average score was 19.4 (standard deviation 8.3). The internal consistency of the Russian version of the questionnaire was high, with a Cronbach’s alpha value of 0.860. Conclusions: Russian version of the Chronic Otitis Media Questionnaire-12 is a reliable tool for assessment of health-related quality of life in chronic otitis media patients. It can be used in the future to determine a plan of surgical treatment and forecasting of results.

Relative impact of COPD and comorbidities on generic health-related quality of life: a pooled analysis of the COSYCONET patient cohort and control subjects from the KORA and SHIP studies.

BackgroundHealth-related quality of life (HRQL) is an important patient-reported outcome measure used to describe the burden of chronic obstructive pulmonary disease (COPD) which is often accompanied by comorbid conditions.MethodsData from 2275 participants in the COPD cohort COSYCONET and from 4505 lung-healthy control subjects from the population-based KORA and SHIP studies were pooled. Main outcomes were the five dimensions of the generic EQ-5D-3 L questionnaire and two EQ-5D index scores using a tariff based on valuations from the general population and an experience-based tariff.The association of COPD in GOLD grades 1–4 and of several comorbid conditions with the EQ-5D index scores was quantified by multiple linear regression models while adjusting for age, sex, education, body mass index (BMI), and smoking status.ResultsFor all dimensions of the EQ-5D, the proportion of participants reporting problems was higher in the COPD group than in control subjects. COPD was associated with significant reductions in the EQ-5D index scores (-0.05 points for COPD grades 1/2, -0.09 for COPD grade 3, -0.18 for COPD grade 4 according to the preference-based utility tariff, all p < 0.0001). Adjusted mean index scores were 0.89 in control subjects and 0.85, 0.84, 0.81, and 0.72 in COPD grades 1-4 according to the preference-based utility tariff and 0.76, 0.71, 0.68, 0.64, and 0.58 for control subjects and COPD grades 1-4 for the experience-based tariff respectively. Comorbidities had additive negative effects on the index scores; the effect sizes for comorbidities were comparable to or smaller than the effects of COPD grade 3. No statistically significant interactions between COPD and comorbidities were observed. Score differences between COPD patients and control subjects were most pronounced in younger age groups.ConclusionsCompared with control subjects, the considerable reduction of HRQL in patients with COPD was mainly due to respiratory limitations, but observed comorbidities added linearly to this effect. Younger COPD patients showed a greater loss of HRQL and may therefore be in specific need of comprehensive disease management.Trial registrationNCT01245933

Comparative study of quality of life in breast cancer patients receiving two different chemotherapy regimens using European Organization for Research and Treatment of Cancer Quality of Questionnaire-Core 30 questionnaire module; for tolerability and safety

Background: Breast cancer is one of the most frequent occurring cancers in women and burgeoning worldwide. It is the second most common malignancy in India after carcinoma of the uterine cervix. In clinical trials, quality of life (QOL) outcome measurements is an important as endpoints with improving subjects physical, emotional, and social well-being. Methods: In this study, we were evaluated the comparison of the QOL in breast cancer patients on anthracycline-based regimen (six cycles of 5-fluorouracil, adriamycin, and cyclophosphamide [FAC] for a period of 18 weeks) and taxane-containing regimen (four cycles of adriamycin and cyclophosphamide [AC] followed by four cycles of paclitaxel [PTX] for a period of 24 weeks) using European Organization for Research and Treatment of Cancer Quality of Questionnaire-Core 30. Results: During first 3 months of therapy, both treatment groups exhibited a reduction in health-related QOL (HRQOL) with no clinically significant difference between them. The effect on HRQOL was less evident 3 weeks after completing chemotherapy with HRQOL of both groups returning to near baseline scores. Conclusions: Both treatment regimens (FAC and AC → PTX [AC followed by PTX]) were equally tolerated in patients.

Cognitive function and quality of life in mild thyroid hormone deficiency.

Subclinical hypothyroidism (sHT) is very common in general population, especially in women and older people. sHT individuals may experience symptoms that resemble those observed in overt hypothyroidism, resulting in impaired quality of life (QOL). Asymptomatic patients may suffer a reduction in perceived health status due to the awareness of disease. Cognitive function represents one of the most important domains of the QOL questionnaires. Given the intrinsic relationship between cognitive status and QOL it is worth to address these topics together, in a systematic review of the literature. Thus, we reviewed the English scientific literature available on National Library of Medicine (www.pubmed.com) sine 1980 regarding hypothyroidism, sHT, elderly, L-thyroxine (LT4) therapy, QOL, cognition, brain. We supplemented the search with records from personal files, textbooks, and relevant articles. The possible link, at molecular level, between cognition and thyroid failure was also assessed. Conflicting results on the association between sHT and cognitive and health related QOL impairment are still present, although the most recent, naturalistic studies did not find any significant relationship. Interestingly, a reduction in health related QOL is frequently reported in patients with thyroid autoimmune diseases regardless of thyroid dysfunction. We also report most significant patents on the topic.

Health-related quality of life and voice following radiotherapy for laryngeal cancer – a comparison between glottic and supraglottic tumours

Background. To provide further information about short-term effects on voice quality and health-related quality of life (HRQL) following radiotherapy for laryngeal cancer, comparing glottic and supraglottic tumours.Material and methods. Sixty-seven male patients who received radiotherapy for glottic and supraglottic tumours were included. Voice recordings were performed and patient reported outcome questionnaires filled in before radiotherapy and one-month post-completion. Acoustic and temporal measures were produced from the recordings and compared to an age-matched, vocally healthy control group (n = 23).Results. Deterioration of HRQL post-radiotherapy was noted for both the glottic and supraglottic cohort. Pre- radiotherapy the glottic cohort demonstrated acoustic and temporal measures that were statistically different from healthy controls, with improvements post-radiotherapy where several measures showed no statistically significant differences compared to healthy controls. The supraglottic cohort revealed voice measures comparable to the healthy controls but demonstrated statistically significant impairments in HRQL compared to the glottic cohort following radiotherapy.Conclusion. Patients with supraglottic tumours may experience more eating and swallowing related problems prior to radiotherapy compared to glottic tumours and demonstrate a more significant reduction in HRQL following treatment. However, in terms of voice measurements, subjective measures correlate poorly with objective acoustic parameters, thereby emphasising the importance of patient-reported outcomes as part of treatment evaluation.

Health‐related quality of life in genotype 1 treatment‐naïve chronic hepatitis C patients receiving telaprevir combination treatment in the ADVANCE study

Chronic hepatitis C virus (HCV) infection and its treatment impact patients' health-related quality of life (HRQL). To report on treatment impact and predictors of HRQL among treatment-naïve patients with genotype 1 chronic HCV infection who received 12-week telaprevir (T) with 24 (T12PR24) or 48 weeks (T12PR48) peginterferon alpha-2a/ribavirin (PR), or 48 weeks of PR in the ADVANCE study. The EQ-5D-3L (EQ-5D) questionnaire (index range: 0-1) was completed at baseline and weeks 4, 12, 24, 36, 48 and 72. Patients indicated their health state on five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Descriptive statistics for the EQ-5D index and descriptive system and area under the curve from baseline to week 12 were calculated. Predictors of EQ-5D index were identified using multivariate analyses. Data from 722 patients were included. The mean EQ-5D index decreased during the first 12 weeks and returned to baseline by week 72 (T12PR24 by week 36) across treatments. In multivariate analysis, sustained virological response (SVR) at week 72 was associated (P < 0.0001) with improved EQ-5D index [mean; SVR+ (0.90), SVR- (0.86)], a 4% difference, within the published range of minimal clinically important difference. Post hoc analyses of data from ADVANCE suggested that HRQL worsened during the first 12 weeks of therapy and returned to baseline by week 72 across treatments. Improvements were observed early following completion of a 24-week treatment (T12PR24). Telaprevir combination therapy was associated with slightly higher reductions in HRQL during the first 12 weeks (vs. PR). SVR was a statistically significant and meaningful predictor of HRQL at week 72.

Health-related quality of life and healthcare utilization in multimorbidity: results of a cross-sectional survey

We assessed the associations between multimorbidity and health-related quality of life (HRQL), and healthcare utilization, based on 16 common self-reported chronic conditions. A cross-sectional questionnaire survey including the EQ-5D was conducted in a sample of the general population of adults (≥18 years) living in Alberta, Canada. Multiple linear and logistic regressions were used to assess the association between multiple chronic conditions and HRQL, hospitalization and emergency department (ED) use. A total of 4,946 respondents reported their HRQL, noting problems mostly with pain or discomfort (48.0%). All chronic conditions were associated with a clinically important reduction in HRQL, the highest burden with anxiety or depression (-0.19, 95% CI -0.21, -0.16) and chronic pain (-0.19, 95% CI -0.21, -0.17). Multimorbidity was associated with a clinically important reduction in the EQ-5D index score (-0.12, 95% CI -0.14, -0.11) and twice the likelihood of being hospitalized (OR = 2.2, 95% CI 1.7, 2.9) or having an ED visit (OR = 1.8, 95% CI 1.4, 2.2). Pain or discomfort is a common problem in people living with chronic conditions, and the existence of multimorbidity in these individuals is associated with a reduction in the HRQL as well as frequent hospitalization and emergency department visits.

Population health status of South Asian and African-Caribbean communities in the United Kingdom

BackgroundPopulation health status scores are routinely used to inform economic evaluation and evaluate the impact of disease and/or treatment on health. It is unclear whether the health status in black and minority ethnic groups are comparable to these population health status data. The aim of this study was to evaluate health-status in South Asian and African-Caribbean populations.MethodsCross-sectional study recruiting participants aged ≥ 45 years (September 2006 to July 2009) from 20 primary care centres in Birmingham, United Kingdom.10,902 eligible subjects were invited, 5,408 participated (49.6%). 5,354 participants had complete data (49.1%) (3442 South Asian and 1912 African-Caribbean). Health status was assessed by interview using the EuroQoL EQ-5D.ResultsThe mean EQ-5D score in South Asian participants was 0.91 (standard deviation (SD) 0.18), median score 1 (interquartile range (IQR) 0.848 to 1) and in African-Caribbean participants the mean score was 0.92 (SD 0.18), median 1 (IQR 1 to 1). Compared with normative data from the UK general population, substantially fewer African-Caribbean and South Asian participants reported problems with mobility, usual activities, pain and anxiety when stratified by age resulting in higher average health status estimates than those from the UK population. Multivariable modelling showed that decreased health-related quality of life (HRQL) was associated with increased age, female gender and increased body mass index. A medical history of depression, stroke/transient ischemic attack, heart failure and arthritis were associated with substantial reductions in HRQL.ConclusionsThe reported HRQL of these minority ethnic groups was substantially higher than anticipated compared to UK normative data. Participants with chronic disease experienced significant reductions in HRQL and should be a target for health intervention.

Estimation of the impact of diabetes-related complications on health utilities for patients with type 2 diabetes in Ontario, Canada

The goal of this study was to analyze health-related quality of life (HRQL) data from a Canadian population with type 2 diabetes in order to estimate the disutility associated with experiencing a diabetes-related complication. The EQ-5D, a standardized instrument for use as a measure of health outcome, was administered to 1,147 patients in Hamilton, Ontario, with type 2 diabetes. After controlling for age, gender, and duration of diabetes, changes in utility values were estimated by regressing the EQ-5D scores onto binary indicators for the presence of an event. The primary method of analysis was Ordinary Least Squares (OLS) and due to concerns over non-Normality, bootstrap standard errors (SE) were calculated. The analysis included 1,143 participants. Based on the OLS model, reductions in HRQL were associated with duration of diabetes (-0.0015, SE=0.0006), experiencing a myocardial infarction (MI) (-0.059, SE=0.017), amputation (-0.063, SE=0.059), stroke (-0.046, SE=0.023), and kidney failure (-0.102, SE=0.047). This study estimated the reductions in HRQL associated with several important complications commonly experienced in patients with diabetes. The greatest impacts on HRQL were associated with kidney failure and MI. The utility values calculated here can be used to assess the outcome of interventions that reduce these diabetes-related complications and will have a useful impact on future economic evaluations of diabetes management strategies in Canada.

Impact of Prevalent Fractures on Quality of Life: Baseline Results From the Global Longitudinal Study of Osteoporosis in Women

To examine several dimensions of health-related quality of life (HRQL) in postmenopausal women who report previous fractures, and to provide perspective by comparing these findings with those in other chronic conditions (diabetes, arthritis, lung disease). Fractures are a major cause of morbidity among older women. Few studies have examined HRQL in women who have had prior fractures and the effect of prior fracture location on HRQL. In this observational study of 57,141 postmenopausal women aged 55 years and older (enrollment from December 2007 to March 2009) from 17 study sites in 10 countries, HRQL was measured using the European Quality of Life 5 Dimensions Index (EQ-5D) and the health status, physical function, and vitality questions of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Reductions in EQ-5D health-utility scores and SF-36-measured health status, physical function, and vitality were seen in association with 9 of 10 fracture locations. Spine, hip, and upper leg fractures resulted in the greatest reductions in quality of life (EQ-5D scores, 0.62, 0.64, and 0.61, respectively, vs 0.79 without prior fracture). Women with fractures at any of these 3 locations, as well as women with a history of multiple fractures (EQ-5D scores, 0.74 for 1 prior fracture, 0.68 for 2, and 0.58 for >/=3), had reductions in HRQL that were similar to or worse than those in women with other chronic diseases (0.67 for diabetes, 0.69 for arthritis, and 0.71 for lung disease). Previous fractures at a variety of bone locations, particularly spine, hip, and upper leg, or involving more than 1 location are associated with significant reductions in quality of life.

Long-Term Outcomes in Patients Surviving Acute Respiratory Distress Syndrome

Recent studies have begun to describe the long-term outcomes of acute respiratory distress syndrome (ARDS) survivors. These patients experience several physical, mental, and psychological morbidities that significantly impair their health-related quality of life (HRQL). Persistent for years after hospital discharge, decrements in functional and neuropsychological outcomes result in lost savings, employment reduction, and a reduction in HRQL among survivors and their caregivers. Future research should focus on the early identification of patients and their family members at risk for long-term sequelae, the mechanisms of injury leading to long-term ARDS consequences, and therapeutic modalities designed to prevent or decrease these morbidities. Clinicians, caregivers, and patients should be made aware of the deleterious long-term effects of the intensive care unit stay because they are currently poorly recognized and potentially modifiable.