Prospectively measured 10-year changes in health-related quality of life and comparison with cross-sectional estimates in a population-based cohort of adult women and men

Health-related quality of life and psychological indicators of thriving 15-19 years after heart or lung transplantation

BACKGROUND

Survival into the second decade after cardiothoracic transplantation (CTX) is no longer uncommon. Few data exist on any health-related quality of life (HRQOL) impairments survivors face, or whether they may even experience positive psychological outcomes indicative of "thriving" (e.g., personal growth). We provide such data in a long-term survivor cohort.

METHODS

Among 304 patients prospectively studied across the first 2 years post-CTX, we re-interviewed patients ≥15 years post-CTX. We (a) examined levels of HRQOL and positive psychological outcomes (posttraumatic growth related to CTX, purpose in life, life satisfaction) at follow-up, (b) evaluated change since transplant with mixed-effects models, and (c) identified psychosocial and clinical correlates of study outcomes with multivariable regression.

RESULTS

Of 77 survivors, 64 (83%) were assessed (35 heart, 29 lung recipients; 15-19 years post-CTX). Physical HRQOL was poorer than the general population norm and earlier post-transplant levels (P's < .001). Mental HRQOL exceeded the norm (P < .001), with little temporal change (P = .070). Mean positive psychological outcome scores exceeded scales' midpoints at follow-up. Life satisfaction, assessed longitudinally, declined over time (P < .001) but remained similar to the norm at follow-up. Recent hospitalization and dyspnea increased patients' likelihood of poor physical HRQOL at follow-up (P's ≤ .022). Lower sense of mastery and poorer caregiver support lessened patients' likelihood of positive psychological outcomes (P's ≤ .049). Medical comorbidities and type of CTX were not associated with study outcomes at follow-up.

CONCLUSIONS

Despite physical HRQOL impairment, long-term CTX survivors otherwise showed favorable outcomes. Clinical attention to correlates of HRQOL and positive psychological outcomes may help maximize survivors' well-being.

Health-related quality of life of younger and older lower-income households in Malaysia

Background

Globally, a lower income is associated with poorer health status and reduced quality of life (QOL). However, more research is needed on how being older may influence QOL in lower-income households, particularly as older age is associated with an increased risk of chronic diseases and care needs. To this end, the current study attempts to determine the health-related QOL (HRQOL) among individuals from lower-income households aged 60 years and over compared to lower-income adults aged less than 60 years.

Methods

Participants were identified from the Department of Statistics Malaysia sampling frame. Surveys were carried out with individual households aged 18 years and older through self-administered questionnaires. Information was collected on demographics, household income, employment status, number of diseases, and HRQOL assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) tool.

Results

Out of a total of 1899 participants, 620 (32.6%) were female and 328 (17.3%) were aged 60 years and above. The mean (SD) age was 45.2 (14.1) and mean (SD) household income was RM2124 (1356). Compared with younger individuals, older respondents were more likely to experience difficulties in mobility (32.1% vs 9.7%, p<0.001), self-care (11.6% vs 3.8%, p<0.001), usual activities (24.5% vs 9.1%, p<0.001), pain/discomfort (38.8% vs 16.5%, p<0.001) and anxiety/depression (21.4% vs 13.5%, p<0.001). The mean (SD) EQ-5D index scores were lower among older respondents, 0.89 (0.16) vs 0.95 (0.13), p = 0.001. After adjusting for covariates, age was a significant influencing factor (p = 0.001) for mobility (OR = 2.038, 95% CI:1.439–2.885), usual activities (OR = 1.957, 95% CI:1.353–2.832) and pain or discomfort (OR = 2.241, 95% CI:1.690–2.972).

Conclusion

Lower-income older adults had poorer HRQOL compared to their younger counterparts. This has important implications concerning intervention strategies that incorporate active ageing concepts on an individual and policy-making level to enhance the QOL and wellbeing, particularly among the older lower-income population.

The impact of demographic and clinical characteristics on the trajectories of health-related quality of life among patients with Fabry disease

Background

Fabry disease (FD) is an X-linked lysosomal storage disorder characterized by multiorgan dysfunction. Since individuals with FD usually experience progressive clinical disease manifestations, their health-related quality of life (HRQOL) is expected to change over time. However, there is limited longitudinal research examining HRQOL outcomes in individuals with FD. We aimed to: assess longitudinal outcomes in HRQOL in adults with FD; examine the physical- and mental HRQOL trajectories at the initial registration (baseline), 3–5 year, and 7–13 year follow-ups; and evaluate the possible associations of age, sex and medical complications with the physical- and mental HRQOL trajectories.

Methods

Forty-three individuals with FD (53% female) who were aged 18 to 81 years at baseline attended clinical follow-up visits between 2006 and 2020. Medical records were extracted retrospectively. Demographics and the 36-item Short-Form Health Survey (SF-36) were recorded at scheduled visits, except for the last data collection which was prospectively obtained in 2020. The physical (PCS) and mental (MCS) composite scores (SF-36) were chosen as outcome measures.

Results

The eight SF-36 domain scores were stable over a span of 13 years, and only physical- and social functioning domains worsened clinically over this follow-up period. Mean baseline SF-36 domain scores were all significantly lower (decreased HRQOL) in the FD sample compared with Norwegian population norms. Two hierarchical linear models were run to examine whether demographics and medical complications (measured at the last clinical visit) predicted physical and mental HRQOL trajectories. Age above 47 years (p < 0.001), male sex (p = 0.027), small fibre neuropathy (p < 0.001), renal dysfunction (p < 0.001), and cerebrovascular events (p = 0.003) were associated with lower HRQOL over time. No significant interactions were found between the time of follow up and the abovementioned predictors of HRQOL.

Conclusions

Overall HRQOL trajectories remained stable between baseline, 3–5 year, and 7–13 year follow-ups, with the majority of individuals reporting decreased physical and mental HRQOL. Medical complications in combination with older age and male sex are important predictors of lower HRQOL in FD. Awareness of this relationship is valuable both for health care providers and for patients. The findings provide indicators that can guide treatment decisions to improve physical and mental HRQOL outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13023-021-02066-y.

Associations between health-related quality of life, body mass index, health status and sociodemographic variables in geriatric patients and non-hospitalized older people: A comparative cross-sectional study

BACKGROUND

Data on health-related quality of life (HRQoL) in geriatric patients and non-hospitalized older people are lacking, and the associations among HRQoL, body mass index (BMI) and health status are not sufficiently investigated in these groups.

AIM

This study aims to describe and compare HRQoL in a sample of geriatric patients and non-hospitalized people >70 years. It further aims to investigate the associations between HRQoL, BMI, health status and sociodemographic variables in geriatric patients and non-hospitalized people >70 years.

METHODS

This cross-sectional study included 107 geriatric patients and 328 non-hospitalized older people. HRQoL was measured with the 36-Item Short Form Survey (SF-36) and BMI was divided into three classes: underweight (<22 kg/m²), normal weight (22-27 kg/m²) and overweight (>27 kg/m²).

RESULTS

All SF-36 scores were lower for the geriatric patients than for the non-hospitalized people (p < .001). Underweight (BMI <22 kg/m²) was registered for 43.9% of the geriatric patients and for 13.7% of the non-hospitalized people. No significant associations were found between the SF-36 subscale scores and underweight, but overweight was associated with lower scores on physical functioning (B: -8.7) and vitality (B: -6.8) compared to those with normal BMI (p < .05). The participants with rheumatic diseases, pulmonary diseases, hypertension and digestive diseases had significantly lower scores on most SF-36 scales reflecting physical health.

CONCLUSION

HRQoL is substantially lower in geriatric patients than in non-hospitalized older people. The negative effects of both overweight and morbidity on HRQoL indicate that it is important to monitor weight and disease symptoms to promote HRQoL in older people, whether hospitalized or non-hospitalized.

Longitudinal assessment of health-related quality of life in osteoporosis: data from the population-based Canadian Multicentre Osteoporosis Study

Little is known about the association between health-related quality of life (HRQOL) and osteoporosis in the absence of fracture, and how HRQOL may change over time. This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture.

INTRODUCTION

Fragility fractures have a detrimental effect on the health-related quality of life (HRQOL) of those with osteoporosis. Less is known about the association between HRQOL and osteoporosis in the absence of fracture.

METHODS

Canadian Multicentre Osteoporosis Study participants completed the SF-36, a detailed health questionnaire and measures of bone mineral density (BMD) at baseline and follow-up. We report the results of participants ≥ 50 years with 10-year follow-up. Self-reported osteoporosis at baseline and BMD-based osteoporosis at follow-up were ascertained. Multivariable linear regression models were developed for baseline SF-36 domains, component summaries, and change over time, adjusting for relevant baseline information.

RESULTS

Baseline data were available for 5266 women and 2112 men. Women in the osteoporosis group had substantially lower SF-36 baseline scores, particularly in the physically oriented domains, than those without osteoporosis. A similar but attenuated pattern was evident for the men. After 10-year follow-up (2797 women and 1023 men), most domain scores dropped for women and men regardless of osteoporosis status, with the exception of mentally-oriented ones. In general, a fragility fracture was associated with lower SF-36 scores and larger declines over time.

CONCLUSIONS

This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. HRQOL should be thoroughly investigated even prior to fracture, to develop appropriate interventions for all stages of the disease.

Irritable bowel syndrome and quality of life in a community-dwelling population in Japan

Objective Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders and is characterized by recurrent abdominal pain or abnormal defecation. This investigation evaluated the relationship between IBS and self-reported quality of life in a community-dwelling population in Japan. Methods For this cross-sectional survey, we enrolled 1002 volunteers who participated in the Iwaki Health Promotion Project in 2013. IBS symptoms were evaluated using the criteria from the Japanese version of the Rome III Questionnaire. The assessments included an interview to obtain sociodemographic data, the second version of the Short-Form Health Survey (SF-36), and the Center for Epidemiologic Studies Depression Scale. Multiple regression analysis was used to assess the relationship between IBS symptoms and scores on the SF-36. Results A total of 59 subjects (5.9%) were classified as having IBS. Scores for all eight domains of the SF-36, the physical component summary, and the mental component summary were significantly and negatively associated with the Center for Epidemiologic Studies Depression scores. Physical functioning, role physical, vitality, mental health, and physical component summary scores were significantly and negatively associated with IBS. Conclusions The burden of IBS symptoms affects both physical and mental wellbeing, even after adjusting for confounders. Our findings suggest that screening for IBS symptoms and evaluating the need for medical care is important for community health workers.

Norwegian reference values for the Short-Form Health Survey 36: development over time

Purpose

Reference values for patient-reported outcome measures are useful for interpretation of results from clinical trials. The study aims were to collect Norwegian SF-36 reference values and compare with data from 1996 to 2002.

Methods

In 2015, SF-36 was sent by mail to a representative sample of the population (N = 6165). Time trends and associations between background variables and SF-36 scale scores were compared by linear regression models.

Results

The 2015 response rate was 36% (N = 2118) versus 67% (N = 2323) in 1996 and 56% (N = 5241) in 2002. Only 5% of the youngest (18–29 years) and 27% of the oldest (>70 years) responded in 2015. Age and educational level were significantly higher in 2015 relative to 1996/2002 (p < .001). The oldest age group in 2015 reported better scores on five of eight scales (p < 0.01), the exceptions being bodily pain, vitality, and mental health compared to 1996/2002 (NS). Overall, the SF-36 scores were relatively stable across surveys, controlled for background variables. In general, the most pronounced changes in 2015 were better scores on the role limitations emotional scale (7.4 points, p < .001) and lower scores on the bodily pain scale (4.6 points, p < .001) than in the 1996/2002 survey.

Conclusions

The low response rate in 2015 suggests that the results, especially among the youngest, should be interpreted with caution. The high response rate among the oldest indicates good representativity for those >70 years. Despite societal changes in Norway the past two decades, HRQoL has remained relatively stable.

Long-Term Deterioration of Perceived Health and Functioning in Adults With Cerebral Palsy

OBJECTIVE

To describe longitudinal change in perceived health, presence of health issues, and functional level in adults with cerebral palsy (CP).

DESIGN

Prospective cohort study.

SETTING

Participants' daily environment.

PARTICIPANTS

Adults (N=49) with CP (age range, 35-45y; 27 [55%] men; 36 [75%] spastic) formerly known in pediatric rehabilitation care participated.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Postal questionnaires were completed by the adults or their proxies (n=9). Health outcomes included perceived health (adapted from the 36-Item Short Form Health Survey) and presence of health issues such as pain, severe fatigue (dichotomized), and functional level (Barthel Index; walking performance).

RESULTS

Over a 10-year period, the percentage of adults with CP worrying about their health increased (29%-54%; P=.008) and those indicating that health problems limit their activities increased (19%-45%; P=.002). In the same period, most adults continued to report good general health (93%-86%; P=.148). Presence of some health issues increased over time, such as pain; severe fatigue was a common health issue at follow-up (32%). Over a 14-year period, mobility and self-care deteriorated (Barthel Index, 17.1±4.8 to 16.3±5.6; P=.007). Walking performance, specifically indoors, declined (83%-71%; P=.010).

CONCLUSIONS

Adults with CP experienced deterioration in health outcomes in the long term. Most notably, perceived health and functional level decreased. Pain and severe fatigue were the most common health issues in adult CP. More research is required to explore the mechanisms at work in the process of aging in persons with CP. Systematic follow-up of adults with CP appears necessary to timely detect and intervene in health problems and functional decline.

Reduced health-related quality of life among Japanese college students with visual impairment

Background

Although previous studies have shown detrimental effects of visual impairment on health-related quality of life (HRQOL), they were primarily conducted on elderly individuals with visual impairment. The objective of this cross-sectional study was to investigate if HRQOL is impaired in young college students with visual impairment and to explore the relationships between HRQOL and other factors. It was hypothesized that visual impairment is not influential enough to lower the HRQOL of young people due to their better physical fitness and more flexible mentality.

Methods

A total of 21 college students (mean age = 25 years old) with varying degrees of visual impairment completed the short form (SF)-36 health survey and questionnaires on daily physical activities. Subjects were grouped depending on the type of visual impairment: blind (n = 11) or severely impaired (n = 10). In addition, grip strength and single-leg standing balance were assessed.

Results

No between-group differences were found in the SF-36 scores. However, compared to the general Japanese standards (50.0 ± 10.0), the Vitality scores of the blind group were lower (41.9 ± 7.2, p = 0.004) and the Physical Function scores of the severely impaired group were higher (55.3 ± 2.4, p = 0.001). In addition, a negative correlation was found between standing balance (variability of foot center of pressure) and the Physical Component Summary score of the SF-36 (r² = 0.35, p = 0.005).

Conclusions

These findings suggest that even among young people severe visual impairment leads to reductions in some components of HRQOL.