Gender bias in economic evaluation methods: quality of life and family role effects

Quality of life and return to work and sports after spinal ependymoma resection

Adult spinal ependymoma presents a rare low-grade tumor entity. Due to its incidence peak in the fourth decade of life, it mostly affects patients during a professionally and physically active time of life. We performed a retrospective monocentric study, including all patients operated upon for spinal ependymoma between 2009 and 2020. We prospectively collected data on professional reintegration, physical activities and quality-of-life parameters using EQ-5D and SF-36. Issues encountered were assessed using existing spinal-cord-specific questionnaires and free-text questions. In total, 65 of 114 patients agreed to participate. Most patients suffered from only mild pre- and postoperative impairment on the modified McCormick scale, but 67% confirmed difficulties performing physical activities in which they previously engaged due to pain, coordination problems and fear of injuries after a median follow-up of 5.4 years. We observed a shift from full- to part-time employment and patients unable to work, independently from tumor dignity, age and neurological function. Despite its benign nature and occurrence of formal only mild neurological deficits, patients described severe difficulties returning to their preoperative physical activity and profession. Clinical scores such as the McCormick grade and muscle strength may not reflect the entire self-perceived impairment appropriately.

Making pharmaceutical research and regulation work for women

The legacy of male bias within pharmaceutical research, regulation, and commercialisation needs to be rectified, argue Sundari Ravindran and colleagues

Alcohol use disorder and health-related quality of life in Korean night-shift workers: A cross-sectional study using the KNHANES 2007-2015 data

This study aimed to evaluate the prevalence of night-shift work, and the association of night-shift work with alcohol use disorders(AUDs), as well as with health-related quality of life(HRQL), in Korean adult workers. A total of 26,895 adult workers aged 20–59 years were included in the analysis. AUDs were assessed using the Alcohol Use Disorders Identification Test(AUDIT), and HRQL was measured by the EuroQol-5D questionnaire with five main dimensions. We found an interaction effect between gender and working status on AUDs (p = 0.0065), suggesting that women are more fragile than men in terms of the effects of night work but not regarding HRQL (p = 0.1729). Female night workers had higher risk of AUDs than female day workers (odds ratio(OR): 2.23, 95% confidence interval (CI): 1.48–3.38) but this effect was not noted in male night workers (OR: 0.97, 95% CI: 0.69–1.37). Lower HRQL was found in depression dimension for night workers compared to day workers (OR: 1.37, 95% CI: 1.00–1.89), whereas day-night regular shift workers were protected from depression. Risk of AUDs and lower HRQL were identified in female night workers but not in male night workers. This association suggests that women are more fragile than men in terms of the effects of night work.

Factors associated with health-related quality of life in Koreans aged over 50 Years: the fourth and fifth Korea National Health and Nutrition Examination Survey

BACKGROUND

To evaluate and analyse the factors associated with health-related quality of life (HR-QoL) in the Korean population aged 50 years and older.

METHODS

We used data obtained from the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V) 2007-2012, a national, cross-sectional health examination and survey, for which representative data on the health, nutritional status, and physical activities of the Korean general population are collected by the Korea Centres for Disease Control and Prevention (KCDC). The sampling protocol for the KNHANES was designed to involve a complex, stratified, multistage probability cluster survey of a representative sample of the noninstitutionalized civilian population in South Korea using a cross-sectional design. The association between HR-QoL and socio-economic factors and medical comorbidities in adults aged 50 years and older was investigated using data from the KNHANES IV-V from 2007 to 2012 (n = 17,937). The EuroQol 5-Dimension Questionnaire (EQ-5D) was used to evaluate HR-QoL, and the factors associated with HR-QoL were analysed after adjusting for socio-economic and demographic factors, anthropometric measurements and clinical comorbidities.

RESULTS

Health status declined with ageing, and low socio-economic status had negative associations with health status. Gender had no association with health status. Among chronic medical conditions, arthritis and depression had significant associations with health status in older people when stratified by age and gender (P < 0.05).

CONCLUSIONS

These findings suggest that older people may value the ability to perform daily activities, which may mean that it is necessary to pay more attention to the factors associated with musculoskeletal pain and emotional distress, as well as socio-economic status or chronic diseases.

TRIAL REGISTRATION

The Korea National Health and Nutrition Examination Survey (KNHNES) is not a clinical trial registry, but the national health survey conducted by the Government of the Republic of Korea, to gather information on health and nutritional status of Korean population, to plan public health services and health education programs, and to do statistical studies of the efficiency of public health services required for setting up welfare and healthcare policies.

Determinants of Health-Related Quality of Life Among Elderly: Evidence From Chi Linh Town, Vietnam

As Vietnam confronts with the challenge of an aging population, the importance of quality of life for elderly people becomes apparent. This article aims to assess health-related quality of life (HRQoL) and its correlates for the elderly, using a cross-sectional study design. A total of 1599 adults, aged 60 years and older, were drawn from the 2016 baseline survey of Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS), which incorporated the EQ-5D, to measure HRQoL. Data were analyzed using multivariate linear regression analyses. The EQ-5D index of the elderly was found to be 0.871 (95% confidence interval = 0.862-0.880). After controlling for covariates, there were statistically significant associations between lower HRQoL and older age (≥80 years), lower education, no pension, chronic disease(s), and health insurance schemes targeting poor/near poor/priority groups. Current and future policies for improving HRQoL in old age should be extended to cover the most vulnerable groups.

Quality of Life in Brazil's Family Health Strategy: Common Mental Disorders, Use of Psychotropic Drugs and Sociodemographic Factors

The aim of the study was to evaluate the patients' quality of life in Brazil's Family Health Strategy and its association with sociodemographic factors, presence of common mental disorders, and use of psychotropic drugs. Were interviewed 442 patients. Tools were: World Health Organization Quality of Life Assessment-Bref and Self Reporting Questionnaire. Male and low education were strongly associated with higher quality of life. Use of psychotropic drugs and the presence of CMD were strongly associated with poor quality of life. There is a pressing need for primary health care professionals to invest in tracking, and in holistic interventions that are able to cover the healthcare needs of these vulnerable groups.

Gender and ethnic health disparities among the elderly in rural Guangxi, China: estimating quality-adjusted life expectancy

BACKGROUND

Ethnic health inequalities for males and females among the elderly have not yet been verified in multicultural societies in developing countries. The aim of this study was to assess the extent of disparities in health expectancy among the elderly from different ethnic groups using quality-adjusted life expectancy.

DESIGN

A cross-sectional community-based survey was conducted. A total of 6,511 rural elderly individuals aged ≥60 years were selected from eight different ethnic groups in the Guangxi Zhuang Autonomous Region of China and assessed for health-related quality of life (HRQoL). The HRQoL utility value was combined with life expectancy at age 60 years (LE60) data by using Sullivan's method to estimate quality-adjusted life expectancy at age 60 years (QALE60) and loss in quality-adjusted life years (QALYs) for each group.

RESULTS

Overall, LE60 and QALE60 for all ethnic groups were 20.9 and 18.0 years in men, respectively, and 24.2 and 20.3 years in women. The maximum gap in QALE60 between ethnic groups was 3.3 years in males and 4.6 years in females. The average loss in QALY was 2.9 years for men and 3.8 years for women. The correlation coefficient between LE60 and QALY lost was -0.53 in males and 0.12 in females.

CONCLUSION

Women live longer than men, but they suffer more; men have a shorter life expectancy, but those who live longer are healthier. Attempts should be made to reduce suffering in the female elderly and improve longevity for men. Certain ethnic groups had low levels of QALE, needing special attention to improve their lifestyle and access to health care.

Common Mental Disorders in Primary Health Care Units: Associated Factors and Impact on Quality of Life

BACKGROUND

Considering the high worldwide prevalence of common mental disorders (CMDs), characterizing the association between CMD and quality of life (QoL) constitute a valuable measure to gauge patient's functional impairment due to CMD symptoms.

OBJECTIVE

To investigate factors associated with the incidence of CMD and its impact on the QoL in primary health care (PHC) patients.

DESIGN

Cross-sectional study completed in a municipality in Brazil. Standardized tools included the Self-Reporting Questionnaire-20 to detect CMDs and the WHOQOL-brief to assess QoL, in addition to a sociodemographic and treatment-related questionnaire.

RESULTS

A total of 41.4% of the patients met cutoff scores for a CMD, and the presence of a CMD was associated with female gender and marital status. Patients with CMDs had lower QoL scores than patients who were negative for a CMD.

CONCLUSIONS

CMDs are highly prevalent in PHC settings and affect patients' QoL. The high frequency of CMD in those that seek care through PHC necessitate incorporating mental health services into the range of available services.

Influence of culture, residential segregation and socioeconomic development on rural elderly health-related quality of life in Guangxi, China

Background

This study aimed to assess ethnic differences in health-related quality of life (HRQoL) among the rural elderly, and to examine the influence of ethnic culture, residential segregation and socioeconomic development on HRQoL.

Methods

A total of 6,511 rural elderly aged 60 years and older from 5,541 households in 116 villages across eight ethnic groups in Guangxi Zhuang Autonomous region were selected and assessed for HRQoL. The EQ-5D index values were calculated based on the Chinese Time Trade-Off values set. The EQ-5D descriptive system scores, visual analogue scale scores, and index values were described by ethnic group. The EQ-5D index was modeled against ethnic culture, residential segregation and socioeconomic development using villages as random effects.

Results

The median (IQR) of HRQoL among all the ethnic groups was 0.88 (0.80, 0.96). Pain/discomfort was the most prevalent problem, followed by anxiety/depression. After controlling for sociodemographic characteristics, a significant difference in HRQoL among ethnic groups persisted, but this was not true for residential segregation.

Conclusion

Social welfare and health policies designed to improve the health of the rural elderly should focus more on older, female, less-educated, Yao minority individuals as well as lower-income households.

Health-related quality of life, and its determinants, among older people in rural Vietnam

Background

The proportion of people in Vietnam aged 60 and above has increased rapidly in recent decades. However, there is a lack of evidence, particularly in rural settings, on their health-related quality of life (HRQoL) within the context of socioeconomic changes and health-sector reform in the country. This study assesses the level and determinants of HRQoL in a rural district in order to provide evidence for designing and implementing appropriate health policies.

Methods

In 2007, 2,873 people aged 60+ living in 2,240 households randomly selected from the FilaBavi demographic surveillance site (DSS) were interviewed using a generic EQ-5D questionnaire to assess their HRQoL. Socioeconomic characteristics of the people and their households were extracted from the DSS's re-census that year, and the EQ-5D index was calculated based on the time trade-off tariff. Multilevel-multivariate linear regression analysis was performed to measure the affect of socioeconomic factors on HRQoL.

Results

The EQ-5D index at old age was found to be 0.876 (95%CI: 0.870-0.882). Age between 60-69 or 70-79 years, position as household head, working until old age, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on the deterioration of HRQoL at older ages, mainly due to reduction in physical rather than mental functions. Educational disparity in HRQoL is low, and exists mostly between basic and higher levels of education. Being a household head and working at old age are advantageous for attaining better quality of life in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical utilities. Long-term living conditions more likely affect HRQoL than short-term economic conditions.

Conclusions

HRQoL at old age is at a high level, and varies substantially according to socioeconomic factors. Its determinants should be addressed in social and health policies designed to improve health of older people, especially among the most vulnerable groups.