Effect of health-related quality of life on women and men's Veterans Affairs (VA) health care utilization and mortality

Recent health-related quality of life, but not change, predicted mortality and healthcare utilization

OBJECTIVE

To assess whether change in HRQOL over a seven-year period was associated with subsequent mortality and hospitalization, after adjusting for important covariates, in a cohort of U.S. Veterans.

METHODS

We used data from a cohort of Veterans who completed a HRQOL survey in 1998 (Short-Form 36 for Veterans [SF-36V]) and a 2006 follow-up (SF-12V) HRQOL survey and SF12V scores were calculated at both time-points. We used logistic regression analyses to model the relationship between changes in the SF12-V physical component (PCS) and mental health component (MCS) scores and 1-year hospitalization and 1-year and 3.3-year mortality after the 2006 follow-up survey.

RESULTS

13,900 participants provided data for both the initial and follow-up surveys. We found no significant associations between changes in PCS or MCS and one-year hospitalization after adjusting for follow-up HRQOL and other covariates. We found significant but relatively weak associations between changes in MCS and our mortality outcomes.

CONCLUSION

Given the follow-up MCS and PCS, change in PCS over the previous 7 years added little information for predicting mortality and hospitalization Although the change in MCS added some information for predicting mortality. Therefore, knowledge of patient's current HRQOL generally provides meaningful information for predicting subsequent mortality and hospitalization.

Associations between health-related quality of life and financial barriers to care among women veterans and women non-veterans

The authors of this study examined the association between health-related quality of life and financial barriers to care, defined as not getting the needed care due to cost considerations. To better understand health-related quality of life among women veterans, the authors compared women veterans to women non-veterans. The authors conducted cross-sectional analyses using data from the 2009 Behavioral Risk Factor Surveillance System survey. The authors assessed four health-related quality of life measures: (1) general health; (2) physical health; (3) mental health; and (4) functional status. The authors performed multinomial logistic regressions to examine the relationship between financial barriers to receiving healthcare and health-related quality of life measures after controlling for other independent variables. The authors included women veterans not in active military duty (N = 3,747) and a matched sample of women non-veterans (N = 3,747), selected using a propensity score method so that they would have distributions of demographic and socioeconomic characteristics similar to those of the veterans. Overall, 14% of women reported financial barriers. Women who reported financial barriers to receiving healthcare were more likely to have poor health-related quality of life in all four dimensions than those who did not report such barriers. Compared to women non-veterans, women veterans did not differ in reported financial barriers but were more likely to report poor health-related quality of life. Reporting financial barriers to receiving needed healthcare was significantly associated with poor health-related quality of life among women. Veteran status was also significantly associated with poor health-related quality of life. These findings suggest the need for healthcare policy makers and practitioners to align emerging new models of healthcare delivery to improve health-related quality of life for women veterans.

Discordance Between Self-report of Physician Diagnosis and Administrative Database Diagnosis of Arthritis and Its Predictors

Objective.

To study predictors of discordance between self-reported physician diagnosis and administrative database diagnosis of arthritis.

Methods.

A cohort of all veterans who utilized Veterans Integrated Service Network (VISN)-13 medical facilities were mailed a questionnaire that included patient self-report of physician diagnosis of arthritis and questions regarding demographics, functional limitation, and SF-36V (a validated version of the Medical Outcomes Study Short-Form 36). Kappa coefficient was used to assess the extent of agreement between self-report of physician diagnosis and administrative database definitions that incorporated International Classification of Diseases (ICD) codes and use of medications for arthritis. We identified predictors of overall discordance between self-report and administrative database diagnosis using multivariable logistic regression analyses.

Results.

Among 70,334 eligible veterans surveyed, 19,749 subjects had an ICD diagnosis of arthritis in the administrative database in the year prior to the survey; 34,440 answered the arthritis question and 18,464 self-reported a physician diagnosis of arthritis. Kappa coefficient showed slight to fair agreement of 0.19–0.32 between self-report and administrative database definitions of arthritis. We found significantly higher overall discordance among veterans with more comorbidities, greater age, worse functional status, lower use of outpatient and inpatient services, lower education level, and among single medical-site users.

Conclusion.

Low level of agreement between self-report and database diagnosis of arthritis and its significant association with patient demographic, clinical, and functional characteristics highlights the limitation of use of these strategies for identification of patients with arthritis in epidemiological studies.

Effect of comorbidity on quality of life of male veterans with prevalent primary total knee arthroplasty

This is a study of the impact of specific and overall comorbidity on health-related quality of life (HRQoL) in men with primary total knee arthroplasty (TKA). In a population-based sample of male veterans who responded to a cross-sectional survey using the validated short-form 36 for veterans (SF-36 V) and had undergone primary TKA prior to survey, eight SF-36 V domain and two summary scores (physical and mental component (PCS and MCS) summary) were compared using multivariable-adjusted multiple linear regressions between patients with and without five comorbidities--chronic obstructive pulmonary disease (COPD)/asthma, diabetes, depression, hypertension, and heart disease. Analyses were adjusted for age, five comorbidities, and time since TKA. Two hundred ninety-three male patients constituted the analytic set with mean (SD) age of 70.3 (8.8) years; 97% were Caucasian and mean (SD) duration since TKA was 2.1 (0.7) years. COPD/asthma was associated with significantly lower adjusted MCS (mean +/- standard error of mean, 47.1 +/- 0.7 vs. 43.1 +/- 1.2; p <or= 0.001) and PCS (30.1 +/- 0.6 vs. 27.7 +/- 1.0; p < 0.05), depression with significantly lower MCS (48.9 +/- 0.7 vs. 37.6 +/- 1.2; p <or= 0.001) but not PCS, hypertension with significantly lower MCS (47.0 +/- 0.7 vs. 44.3 +/- 1.0; p < 0.05) but not PCS, and heart disease with significantly lower MCS (47.4 +/- 0.8 vs. 44.2 +/- 0.9; p <or= 0.001) and PCS (30.5 +/- 0.7 vs. 28.1 +/- 0.8; p < 0.05). Diabetes was not associated with lower MCS or PCS. The overall number of comorbidities was associated with lower MCS and PCS (p <or= 0.001 for both). Medical and psychiatric comorbidity impacts physical and mental/emotional HRQoL in patients with primary TKA. The impact differs by comorbidity. Higher comorbidity load negatively impacts both physical and mental/emotional HRQoL.