Adverse lifestyle and health-related quality of life: gender differences in patients with and without chronic conditions

Healthcare Costs and Health-Related Quality of Life in Older Multimorbid Patients After Hospitalization

Objectives

We identified factors associated with healthcare costs and health-related quality of life (HRQoL) of multimorbid older adults with polypharmacy.

Methods

Using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid older people) trial, we described the magnitude and composition of healthcare costs, and time trends of HRQoL, during 1-year after an acute-care hospitalization. We performed a cluster analysis to identify groups with different cost and HRQoL trends. Using multilevel models, we also identified factors associated with costs and HRQoL.

Results

Two months after hospitalization monthly mean costs peaked (CHF 7'124) and HRQoL was highest (0.67). They both decreased thereafter. Age, falls, and comorbidities were associated with higher 1-year costs. Being female and housebound were negatively associated with HRQoL, while moderate alcohol consumption had a positive association. Being independent in daily activities was associated with lower costs and higher HRQoL.

Conclusion

Although only some identified potential influences on costs and HRQoL are modifiable, our observations support the importance of prevention before health deterioration in older people with multimorbid illness and associated polypharmacy.

The Association between Alcohol Drinking Patterns and Health-Related Quality of Life in the Korean Adult Population: Effects of Misclassification Error on Estimation of Association

The purpose of this study was to investigate the association between drinking patterns and health-related quality of life (HRQoL) in the Korean general population and to validate the estimation of the association of alcohol use on HRQoL when former drinkers are separated from never drinkers and low-risk drinkers depending on gender. Data were collected from 23,055 adults (over 19 years old) who completed the Korean National Health and Nutritional Examination Survey (2010-2013). Multivariate logistic and linear regression analyses were performed to investigate the association between drinking patterns and HRQoL. When former drinkers were separated from never drinkers and low-risk drinkers to control for misclassification bias, there were gender differences in the associations between alcohol use and HRQoL. Although the estimation of the association of alcohol use was not valid in men, the estimation of association was valid in women, as low-risk women drinkers showed better HRQoL than nondrinkers. Therefore, when conducting research related to alcohol and health, analyses should correct for the various confounding variables and minimize the misclassification bias of drinking patterns. It is also necessary to consider gender characteristics when intervening to improve HRQoL related to drinking.

Women do not fare worse than men after lumbar fusion surgery: Two-year follow-up results from 4,780 prospectively collected patients in the Swedish National Spine Register with lumbar degenerative disc disease and chronic low back pain

BACKGROUND CONTEXT

Proper patient selection is of utmost importance in the surgical treatment of degenerative disc disease (DDD) with chronic low back pain (CLBP). Among other factors, gender was previously found to influence lumbar fusion surgery outcome.

PURPOSE

This study investigates whether gender affects clinical outcome after lumbar fusion.

STUDY DESIGN

This is a national registry cohort study.

PATIENT SAMPLE

Between 2001 and 2011, 2,251 men and 2,521 women were followed prospectively within the Swedish National Spine Register (SWESPINE) after lumbar fusion surgery for DDD and CLBP.

OUTCOME MEASURES

Patient-reported outcome measures (PROMs), visual analog scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), quality of life (QoL) parameter EQ5D, and labor status and pain medication were collected preoperatively, 1 and 2 years after surgery.

METHODS

Gender differences of baseline data and PROM improvement from baseline were analyzed. The effect of gender on clinically important improvement of PROM was determined in a multivariate logistic regression model. Furthermore, gender-related differences in return-to-work were investigated.

RESULTS

Preoperatively, women had worse leg pain (p<.001), back pain (p=.002), lower QoL (p<.001), and greater disability than men (p=.001). Postoperatively, women presented greater improvement 2 years from baseline for pain, function, and QoL (all p<.01). Women had better chances of a clinically important improvement than men for leg pain (odds ratio [OR]=1.39, 95% confidence interval [CI]: 1.19-1.61, p<.01) and back pain (OR=1.20,95% CI:1.03-1.40, p=.02) as well as ODI (OR=1.24, 95% CI:1.05-1.47, p=.01), but improved at a slower pace in leg pain (p<.001), back pain (p=.009), and disability (p=.008). No gender differences were found in QoL and return to work at 2 years postoperatively.

CONCLUSIONS

Swedish women do not have worse results than men after spinal fusion surgery. Female patients present with worse pain and function preoperatively, but improve more than men do after surgery.