Prevalent falls, fall frequencies and health-related quality of life among community-dwelling older Chinese adults

PURPOSE

Fall is a serious health hazard to older adults. The aim of our study was to investigate the relationship between falls and health-related quality of life (HRQOL) in mainland China.

METHODS

Data from 4579 Chinese community-dwelling older adults was analyzed. Data of falls was self-reported by participants, the HRQOL of older adults was measured by the 3-Level EQ-5D (EQ-5D-3L, 3L). Regression models were built to explore the associations of falls (experience and frequency) with the 3L data (index score, EQ-VAS score and health problems). The potential interaction effects between falls and gender on HRQOL were assessed using a likelihood ratio test, sex-stratified analysis was also performed to separately investigate the associations in men and women.

RESULTS

A total of 368 (8.0%) participants had the experience of fall during the last year. Falls (experience and frequency) were significantly related to EQ-5D-3L index and EQ-VAS scores, fall experience contributed to pain/discomfort and anxiety/depression problems, while fall frequency was associated with physical-related problems and pain/discomfort. Significant interactions between falls and sex in several EQ-5D measures were also observed, and men had lager magnitude of associations than women.

CONCLUSION

Falls were negative associated with overall HRQOL as well as separate HRQOL dimensions among older adults. It also appears that the HRQOL influence on older men is more evident than older women.

Impact of major age-related eye disorders on health-related quality of life assessed by EQ-5D: a systematic review and meta-analysis

PURPOSE

This study is to quantitatively estimate the health-related quality of life (HRQOL) impact of major age-related eye diseases (AREDs) including cataract, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR) assessed by the EuroQoL Five-Dimensional Questionnaire (EQ-5D).

METHODS

PubMed, Embase, Cochrane Library, and CINAHL were searched until October 20, 2022. Studies were included if they reported the EQ-5D health utility score (HUS) or visual analogue scale (VAS) score of both AREDs patients and healthy controls. The mean difference (MD) in HUS or VAS score between cases and controls and its 95% confidence interval (95%CI) were pooled using the random-effects model. We also performed sensitivity analysis using the leaving-one-out method and subgroup analyses by sample size and race. The prevalence in reporting any problems in the five EQ-5D dimensions was summarized and compared between cases and controls using the Chi-square test.

RESULTS

Fifteen articles involving 30,491 participants were included in this review. Pooled estimates indicated reduced HUS in AMD patients (MD = - 0.04, 95%CI - 0.07, - 0.01; P = 0.009), DR patients (MD = - 0.03, 95%CI - 0.05, - 0.01; P = 0.01), and glaucoma patients (MD = - 0.06, 95%CI - 0.10, - 0.01; P = 0.01), compared with the controls. Significantly lower EQ-5D VAS score was also observed in cataract patients (MD = - 11.33, 95%CI - 13.47, - 9.18; P < 0.001) and DR patients (MD = - 6.41, 95%CI - 10.64, - 2.18; P = 0.003). AREDs patients reported usual activities and anxiety/depression problems more frequently than the control group.

CONCLUSIONS

Our findings confirmed the HRQOL impairment caused by major AREDs including AMD, cataract, DR, and glaucoma. High-quality studies with large sample sizes are warranted to further verify our results.

A hearing bolt-on item increased the measurement properties of the EQ-5D-5L in a community-based hearing loss screening program

OBJECTIVE

To investigate the measurement properties of a hearing item ('bolt-on') added to the EQ-5D-5L descriptive system.

METHODS

Cross-sectional data on the EQ-5D-5L descriptive system with the addition of a hearing bolt-on item, namely, 'I have no/slight/moderate/severe/extreme problems hearing', was collected through face-to-face interviews with 418 participants of a community-based hearing loss screening program in Singapore. The distribution of responses to the EQ-5D and the hearing items were compared in terms of the proportion of 'no problems' and the Shannon index (H'). The measurement properties of the hearing item were assessed by testing its correlation with the hearing thresholds in dBHL; and with the standard EQ-5D items. The properties were also evaluated by comparing the proportion of 'full health' in participants with different hearing severities between standard and hearing bolt-on EQ-5D-5L; and the ability in identifying the participants between the standard EQ-5D-5L index score and the level sum score (LSS) of the hearing bolt-on system.

RESULTS

Compared to the standard EQ-5D items, the hearing item has a lower proportion of 'no problems' (80.1% vs. 80.9-97.9%); more evenly-distributed responses (H' value: 0.92 vs. 0.18-0.87); and much stronger correlation with the hearing thresholds (|r|: 0.322 and 0.325 vs. 0.008-0.139). It generally has a weak correlation with EQ-5D items (|r|: 0.055-0.160); and reduces the proportion of 'full health' for the participants with different hearing functions with the percentage reduction varying from 6.6 to 22.7%. The LSS is more discriminative than the standard EQ-5D-5L index score as well (F-statistic: 12.71 and 13.93 vs.4.06 and 4.70).

CONCLUSIONS

A hearing bolt-on to EQ-5D-5L can validly measure hearing severities and is likely to increase the sensitivity of the resultant preference-based EQ-5D index to hearing loss.

A cross-sectional study evaluating health-related quality of life of Chinese pediatric patients with hematological malignancies using EQ-5D-Y

Background

The study aimed to assess health-related quality of life (HRQoL) and to estimate the health utility of pediatric patients with hematological malignancies (HMs) in China.

Method

A cross-sectional study recruited a series of pediatric inpatients diagnosed with HM from November 2018 to May 2019 in the Shanghai Children's Medical Center. Subjects were interviewed to collect sociodemographic information about themselves and their guardians. The EQ-5D-Y was completed by each patient to rate their own HRQoL, which later derived the health utility. The health status was also assessed by clinicians following the Eastern Cooperative Oncology Group (ECOG) system. Upon the descriptive analysis and univariate analysis, multivariate generalized linear models were built to explore the associations of risk factors with HRQoL measures of utility, Visual Analog Scale (VAS) score, and the five EQ-5D-Y domains.

Results

The 96 subjects had a mean age of 10.5 years and included 62 (64.4%) boys. There were 46 (47.9%) and 25 (26.0%) children diagnosed with acute lymphoblastic leukemia and non-Hodgkin's lymphoma, respectively. The means (SD) of utility and EQ-VAS scores were 0.88 (0.10) and 85.8 (15.1), respectively. Twenty-six (27.1%) patients were graded poor health by the ECOG standard (score 2/3). Both univariate and multivariate analyses found strong correlations between ECOG and HRQoL. After adjusting for covariates, poor ECOG score was significantly associated with an impaired utility and VAS of -0.103 and -8.65, respectively. With regard to individual HRQoL domains, worse ECOG was more likely to report health problems with an increased risk of 2.94 to 12.50; residence, income, guardians' education, and disease duration were also found to be significantly related to either the utility or certain health domains.

Conclusion

The HRQoL of Chinese pediatric patients with HM is considered relatively poor and of great concern to healthcare. With the strong correlations between EQ-5D-Y-related HRQoL measures and the traditional clinical index ECOG, the EQ-5D-Y is able to provide valuable evidence for clinical decision-making at the individual level. At the same time, its health utility can inform resource allocation at a macro level.

Comparison of EQ-5D-5L and EORTC QLU-C10D utilities in gastric cancer patients

BACKGROUND

To compare measurement properties of the utility scores derived from various country-specific value sets of EQ-5D-5L (5L) and EORTC QLU-C10D (10D) in gastric cancer patient.

METHODS

The study used cross-sectional data of 243 Chinese gastric cancer patients who completed both 5L and EORTC QLQ-C30. Utility score of QLU-C10D is generated from all the available QLU-C10D value sets currently; the score of 5L is derived from the corresponding 5L value sets for the countries with both the 5L and QLU-C10D value sets and the Chinese 5L value set. Convergent validity was evaluated by testing their correlations with the VAS score. Known-group validity was assessed by comparing the utility scores the patients with different severities. Their relative efficiency (RE) was also compared.

RESULTS

Correlation coefficient of 5L and QLU-C10D utility scores with VAS ranged from 0.54 to 0.59, and 0.55 to 0.63, respectively. Both the utility scores were in general able to discriminate the patients with different severities; and 5L utility score had higher RE in the majority of known-groups.

CONCLUSION

EQ-5D-5L and QLU-C10D utility scores were different and, thus, non-swappable. They possess similar convergent validity and known-group validity; while EQ-5D-5L scores may have better discriminative power.

A head-to-head comparison of the EQ-5D-3L index scores derived from the two EQ-5D-3L value sets for China

Objective

Two EQ-5D-3L (3L) value sets (developed in 2014 and 2018) co-exist in China. The study examined the level of agreement between index scores for all the 243 health states derived from them at both absolute and relative levels and compared the responsiveness of the two indices.

Methods

Intraclass correlations coefficient (ICC) and Bland–Altman plot were adopted to assess the degree of agreement between the two indices at the absolute level. Health gains for 29,403 possible transitions between pairs of 3L health states were calculated to assess the agreement at the relative level. Their responsiveness for the transitions was assessed using Cohen effect size.

Results

The mean (SD) value was 0.427 (0.206) and 0.649 (0.189) for the 3L₂₀₁₄ and 3L₂₀₁₈ index scores, respectively. Although the ICC value showed good agreement (i.e., 0.896), 88.9% (216/243) of the points were beyond the minimum important difference limit according to the Bland–Altman plot. The mean health gains for the 29,403 health transitions was 0.234 (3L₂₀₁₄ index score) and 0.216 (3L₂₀₁₈ index score). The two indices predicted consistent transitions in 23,720 (80.7%) of 29,403 pairs. For the consistent pairs, Cohen effective size value was 1.05 (3L₂₀₁₄ index score) or 1.06 (3L₂₀₁₈ index score); and the 3L₂₀₁₄ index score only yielded 0.007 more utility gains. However, the results based on the two measures varied substantially according to the direction and magnitude of health change.

Conclusion

The 3L₂₀₁₄ and 3L₂₀₁₈ index scores are not interchangeable. The choice between them is likely to influence QALYs estimations.

Testing measurement properties of two EQ-5D youth versions and KIDSCREEN-10 in China

OBJECTIVE

To assess measurement properties of the two youth versions of EQ-5D (i.e., 5-level EQ-5D-Y [Y-5L] and 3-level EQ-5D-Y [Y-3L]) and KIDSCREEN-10 in China.

METHODS

Children and adolescents attending schools in Shanghai, China were recruited to self-complete the Y-5L, KIDSCREEN-10, and Y-3L questionnaires. Their feasibility was assessed according to missing responses. Convergent validity of the EQ-5D-Y dimensions, a summated dimension score [SDS], and Visual Analogue Scale (VAS) were assessed by examining their correlations with the KIDSCREEN-10 index score and dimensions. Known-groups validity of SDS, VAS, and KIDSCREEN-10 index score were tested by comparing the scores of pupils with and without two conditions (i.e., overweight and shortsightedness), and the relative efficiency (RE) between them was also evaluated.

RESULTS

A total of 262 pupils (girl: 58.4%; mean age: 12.7 years) were enrolled. Missing responses were low for both the Y-5L (0.3%) and Y-3L (2.4%), and KIDSCREEN-10 (0.3%). The overall ceiling effects were 40.3% for the Y-5L, 44.1% for the Y-3L and 1.1% for the KIDSCREEN-10. The SDS_Y-5L, SDS_Y-3L and VAS were moderately correlated with the KIDSCREEN-10 index score (|r|= 0.425 for SDS_Y-5L, 0.323 for SDS_Y-3L, and 0.435 for VAS; p < 0.01 for all). Similar EQ-5D-Y and KIDSCREEN-10 dimensions showed moderate to strong correlations (|r|> 0.3). Both the SDS_Y-5L and SDS_Y-3L had lower values, and VAS and KIDSCREEN-10 index score had higher values for pupils without shortsightedness compared with those for their counterparts. The difference was statistical significance for the SDS_Y-5L and VAS (P < 0.05 for both), which also had higher RE in the condition.

CONCLUSIONS

The Y-5L, Y-3L, and KIDSCREEN-10 questionnaires are feasible and valid for measuring HRQoL among children/adolescents in China. It also appears that the advantages of Y-5L over Y-3L were modest.

Could the EQ-5D-3L predict all-cause mortality in older Chinese? Evidence from a 5-year longitudinal study in eastern China

PURPOSE

To assess the ability of the 3-level EQ-5D (i.e., EQ-5D-3L) in predicting all-cause mortality in older Chinese adults.

METHODS

The data were from a 5-year longitudinal study, Weitang Geriatric Diseases Study, including 4579 community-dwelling older people in eastern China, with the mean age of 72.5 years at baseline and female being 52.0%. Three multivariable logistic regression models were adopted to assess the associations of the baseline EQ-5D data [i.e., the EQ-5D problems, EQ-5D-3L index score, and EQ-5D visual analog scale (VAS) score] with the 5-year all-cause mortality, adjusting for socio-demographic characteristics, and subsequently, health conditions and lifestyle habits.

RESULTS

A total of 183 participants died over the 5-year study period. A larger proportion of the dead reported problems in physical dimensions (i.e., including three dimensions: mobility, self-care, and usual activities, p < 0.05 for all). The mean EQ-5D index score (0.928) and EQ-VAS score (79.7) of the living were higher than those of the dead (0.915 and 73.2, p < 0.05 for both). In multivariable logistic analyses, the EQ-5D health problems in the physical-related dimensions [odds ratio (OR) 2.16, p < 0.05] and the EQ-VAS score (OR: 0.97, p < 0.001) were associated with the 5-year all-cause mortality when adjusting for socio-demographic characteristics, health conditions, and lifestyle habits.

CONCLUSIONS

It appears that the EQ-5D-3L could predict mortality in general older Chinese, which could be used to detect high-risk older individuals in China.

Health utility of type 2 diabetes patients using basal insulin in China: results from the BEYOND II study

OBJECTIVE

To derive the health utility scores of type 2 diabetes (T2D) patients using basal insulin (BI) with diverse characteristics in China.

METHODS

The study used the data of insulin-using T2D patients on BI treatment enrolled in the BEYOND II study, which is a multi-center, observational study from 78 hospitals nationwide. The 3-level EQ-5D (EQ-5D-3L) questionnaire was administered to each patient to derive their health utility scores using the EQ-5D-3L value set for China. Patients' clinical and sociodemographic information were retrieved from their electronic case report form (eCRF). Ordinary least-square models with different specifications were explored to identify the best-fitting model to predict the utility scores.

RESULTS

The sample (n = 12,583) achieved a mean (standard deviation) EQ-5D-3L utility score of 0.936 (0.120). According to the model, a Chinese male who was younger than 59 years, not underweight, diagnosed with T2D shorter than 10 years, with controlled plasma glucose and free of diabetes complications/comorbidities, would have a mean utility of 0.993. Being female, older age, underweight, and higher plasma glucose, longer diabetes duration was negatively related to EQ-5D-3L scores. Comorbidities and seven of eleven complications were associated with utility decrement. Interactions between some complications were also discovered.

CONCLUSIONS

The derived health utility scores for diabetes complications could facilitate the assessment of the cost-effectiveness of health interventions for Chinese insulin-using T2D patients.

Leukocyte related parameters in older adults with metabolically healthy and unhealthy overweight or obesity

It remains unclear whether leukocyte-related parameters could be used as biomarkers to differentiate metabolically unhealthy overweight/obesity (MUO) from metabolically healthy overweight/obesity (MHO). We aimed to examine the differences in the distribution of leukocyte-related parameters between older adults with MHO and MUO and the correlations of leukocyte-related parameters with individual components of metabolic abnormality. In the Weitang Geriatric Diseases Study on older Chinese adults aged 60 years or above, 404 individuals with MHO and 480 with MUO contributed to the analysis. Overweight/obesity was defined as body mass index (BMI) of 25 kg/m² or more. MHO and MUO were discriminated based on the Adult Treatment Panel III (ATP III) criteria. Leukocyte-related parameters were assessed using an automated hematology analyzer. All leukocyte-related parameters except monocytes were elevated in MUO group compared with MHO group (all P < 0.05). The prevalence of MUO increased by 24% with each 10⁹/L increase of leukocytes after adjusting for confounders in the multiple-adjusted model (P < 0.01) and each unit elevation of other parameters except lymphocytes and monocytes were significantly associated with the presence of MUO (all P < 0.01). Trend tests revealed a linear trend for the association between MUO and all the leukocyte-related parameters (all P for trend < 0.05). Significant interactions between leukocyte-related parameters and sex on the presence of MUO were observed (all P value for interaction < 0.05). Higher leukocyte-related parameters were found in patients with MUO than those with MHO and were associated with higher prevalence of MUO which seems to be sex-dependent. Further studies are needed to see whether these parameters could be used as biomarkers for the screening or diagnosis for MUO in clinical or public health practice.

How the EQ-5D utilities are derived matters in Chinese diabetes patients: a comparison based on different EQ-5D scoring functions for China

OBJECTIVES

In China, multiple approaches to calculating EQ-5D utilities are available, including the two EQ-5D-3L (3L₂₀₁₄ and 3L₂₀₁₈) scoring functions, the EQ-5D-5L (5L) scoring function, and the crosswalk function linking the 3L utilities and 5L health states. The study compared utilities derived from them in terms of agreement and discriminative power; and assessed whether the use of different approaches may affect QALY estimation in Chinese type 2 diabetes (T2D) patients.

METHODS

Cross-sectional data of 289 T2D patients who self-completed both the 5L and 3L questions were used. Agreement were examined using intraclass correlation coefficient (ICC) and Bland-Altman plots. The ability of the EQ-5D utilities in differentiating the patients with and without clinical conditions was evaluated using F-statistics. Their influence on QALY estimation was assessed adopting mean absolute difference (MAD) in utility values between the patients.

RESULTS

The ICC values were 0.881 (3L₂₀₁₄-3L₂₀₁₈), 0.958 (5L-c5L₂₀₁₄), and 0.806 (5L-c5L₂₀₁₈). The two 3L utilities and the three 5L utilities had poor agreement at the lower end of utility scale according to Bland-Altman plots. The 3L₂₀₁₈ utilities had lower F-statistics compared to the 3L₂₀₁₄ utilities; the two c5L utilities had larger or similar F-statistics compared to the 5L utilities. The mean MADs were 0.138 (5L), 0.116 (3L₂₀₁₄), 0.115 (c5L₂₀₁₄), 0.055 (c5L₂₀₁₈), and 0.055 (3L₂₀₁₈).

CONCLUSION

The 3L₂₀₁₄ utilities is more discriminative than the 3L₂₀₁₈ utilities; and the two c5L utilities have no worse discriminative power compared with the 5L utilities. The choice of the approach to calculating the EQ-5D utilities is likely to affect QALY estimates.

Measuring health-related quality of life in elementary and secondary school students using the Chinese version of the EQ-5D-Y in rural China

Background

To measure health-related quality of life (HRQOL) of elementary and secondary school students in rural China using the simplified Chinese version of the EQ-5D-Y.

Method

Both the samples of students were from a school-based cohort study in a county located in southwestern China. The students self-completed the EQ-5D-Y. Feasibility was evaluated according to the percentages of missing values. Known group validity was assessed by comparing the frequency of reporting EQ-5D-Y problems between groups known to differ in health status.

Results

A total of 1728 elementary students and 2116 secondary students were included in the analysis. Their respective mean age was 8.7 (range: 7–15) years and 14.8 (range: 11–18) years, with girls being 45.1 and 50.1%, respectively. The missing values in both samples were quite low. Elementary students were less likely to have problems on‘having pain or discomfort’ and ‘feeling worried, sad or unhappy’ dimensions, but more likely to report problems on the dimensions related to physical functioning. Gender difference in HRQOL was only detected for secondary students in terms of ‘doing usual activities’, ‘having pain or discomfort,’ and ‘feeling worried, sad or unhappy’ (P < 0.05 for all). The significant differences in HRQOL were not observed for the other characteristics.

Conclusions

It appears that the EQ-5D-Y is feasible and valid instrument in school-aged children and adolescents in rural China; but it suffers from similar disadvantages to those found in other general populations. The HRQOL distributions measured by the EQ-5D-Y were also provided.

Health status and associated factors of HIV-infected patients in Kunming, China

OBJECTIVE

To assess health status of HIV-positive patients and to examine its predictors in Kunming, China.

METHODS

HIV-positive patients were recruited from a general hospital and an infection hospital in 2015. Health status of the patients was evaluated using standardized questions on eight health domains (mobility, self-care, pain and discomfort, cognition, interpersonal activities, vision, sleep and energy, and emotional distress) of the WHO World Health Survey. A multivariate linear regression model was employed to explore the predictors of health status.

RESULTS

A total of 1,363 HIV patients were recruited. The mean (SD) health status score was 73.4 (18.2), with the prevalence of reporting problems ranging from 17.6% (self-care problems) to 86.3% (vision problems). CD₄ count, occupation, household income, accessibility to healthcare services, and healthcare expenditures were found to be significant predictors of health status.

CONCLUSIONS

Healthcare services for HIV patients may assist improvement of interpersonal activities and relieve emotional distress, and efforts are needed to continually increase accessibility to the services. Special attention should be given to those at low socioeconomic level and those suffering from low CD₄ count.

Diabetic retinopathy and health-related quality of life among Chinese with known type 2 diabetes mellitus

PURPOSE

We aim to describe the impact of diabetic retinopathy (DR) on health-related quality of life (HRQOL) among community-dwelling Chinese adults who had been previously diagnosed with type 2 diabetes mellitus (T2DM).

METHODS

A community-based survey including 913 patients with T2DM was conducted in Suzhou, China. Retinopathy lesions were graded according to the Airlie House classification system of the Early Treatment Diabetic Retinopathy Study. The HRQOL was measured by the Chinese version of the EuroQol Group's five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). A Gamma distribution with log link was incorporated into linear regression models to assess the associations between DR and EQ-5D-5L health utility score.

RESULTS

The mean EQ-5D-5L index scores were 0.971 ± 0.082 among individuals with unilateral DR and 0.970 ± 0.145 among those with bilateral DR, which were lower compared with those without DR (0.986 ± 0.045, P = 0.02). In multivariate analysis adjusting for confounders, people with bilateral DR reported lower the EQ-5D index scores compared with those without DR. The presence of DR was significantly associated with problems in usual activities (odds ratio [OR] = 0.16, P = 0.02, comparing participants with unilateral vs. no DR; OR = 0.11; P = 0.01, comparing participants with bilateral vs. no DR). No significant variations in EQ-5D-5L index scores as well as different domains of health problems between individuals with unilateral and bilateral DR were observed (P > 0.05).

CONCLUSION

Chinese T2DM patients with bilateral DR tend to report lower HRQOL scores compared with those without DR, especially in health problems associated with usual activities.

Health-Related Quality of Life and Its Factors of Hemodialysis Patients in Suzhou, China

<b><i>Background:</i></b> To identify factors of health-related quality of life (HRQOL) of Chinese end-stage renal disease patients undergoing hemodialysis (HD). <b><i>Methods:</i></b> In all, 315 HD patients were recruited from a tertiary hospital in Suzhou, ­China. Each patient completed the Kidney Disease Quality of Life Short Form. It generated 4 types of HRQOL scores: PCS score, MCS score, kidney disease component summary (KDCS) score, and SF-6D index score. Multiple linear regressions were conducted to identify the factors associated with each of the scores. <b><i>Results:</i></b> Factors associated with poorer HRQOL were determined including: middle age and above (≥45 years), without partner, presence of complication, long dialysis vintage (≥4.5 years) with physical component summary; low education level, presence of comorbidity, long dialysis vintage, low hemoglobin level with mental component summary; without partner, presence of comorbidity, long dialysis vintage with KDCS; middle age and above, without partner, low education level; long dialysis vintage, more frequent dialysis (≥2 times/week) with SF-6D. <b><i>Conclusion:</i></b> The study evaluated the HRQOL of HD patients in mainland China.

Self-Reported Sleep Quality, Duration, and Health-Related Quality of Life in Older Chinese: Evidence From a Rural Town in Suzhou, China

STUDY OBJECTIVES

To determine the associations of self-reported sleep quality and duration with health-related quality of life (HRQOL) in older Chinese.

METHODS

We analyzed community-based cross-sectional data of 5,539 individuals aged 60 years and older in the Weitang Geriatric Disease Study. Information of sleep quality and duration were self-reported through participants' responses to predefined questions; HRQOL data were collected by using the European Quality of Life-5 Dimensions (EQ-5D). We estimated the associations of sleep quality and duration with the EQ-5D index and visual analog scale (VAS) scores using linear regression models. The associations between sleep quality and duration and EQ-5D-detected health problems were modeled using logistic regression.

RESULTS

In multiple linear models adjusting sociodemographic factors, health conditions, and lifestyle habits, both EQ-5D index and VAS scores declined with deterioration of sleep quality. The coefficients for poor and intermediate sleep quality were -0.053 (95% confidence interval [CI]:-0.065, -0.042) and -0.022 (95% CI: -0.030, -0.013), respectively, in relation to EQ-5D index score. They were -5.2 (95% CI: -6.7, -2.4) and - 3.8 (95% CI: -4.9, -2.7) in modeling the EQ-5D VAS score. HRQOL declined as sleep duration decreased below 7.01 hours or exceeded 8.01 hours, though most of the associations did not reach statistical significance. In multiple logistic models, poor sleep quality was associated with problems of mobility, pain/discomfort, and anxiety/ depression; short sleep duration was associated with mobility problems.

CONCLUSIONS

Poor sleep quality and extreme sleep durations appeared to be negatively associated with HRQOL in older Chinese adults.