Self-reported chronic conditions and EQ-5D index scores in the US adult population

Relative importance of selected predictors of health-related quality-of-life (HRQOL) among U.S. adults

PURPOSE

Many factors have been associated with health-related quality of life (HRQOL), and researchers often have tried to rank these contributing factors. Variable importance quantifies the net independent contribution of each individual predictor in a set of predictors to the prediction accuracy of the outcome. This study assessed relative importance (RI) of selected contributing factors to respondents' physically unhealthy days (PUD), mentally unhealthy days (MUD), activity limitation days (ALD), and EuroQol EQ-5D index derived from the Healthy Days measures (dEQ-5D).

METHODS

Using data from the 2021 Behavioral Risk Factor Surveillance Systems (BRFSS), we estimated the RI of seven socio-demographics and seventeen chronic conditions and risk behaviors. A variable's importance was measured as the average increase in the coefficient of determination after adding the variable to all possible sub-models.

RESULTS

After controlling for socio-demographics, arthritis and no physical activity were the most important variables for PUD with a RI of 10.5 and 10.4, respectively, followed by depression (RI = 8.5) and COPD (RI = 8.3). Depression was the most important variable for MUD with RI = 23.0 while all other 16 predictors had a RI < 7.0. Similar results were observed for ALD and dEQ-5D: depression was the most important predictor (RI = 16.3 and 15.2, respectively), followed by no physical activity, arthritis, and COPD (RI ranging from 7.1 to 9.2).

CONCLUSION

This study quantified and ranked selected contributing factors of HRQOL. Results of this analysis also can be used to validate HRQOL measures based on domain knowledge of HRQOL.

Five-year EuroQol 5-Dimension Outcomes After Endoscopic Sinus Surgery

OBJECTIVE

The EuroQol 5-Dimension (EQ-5D) is a general health survey that is quick to administer, widely used, and directly convertible to health utility values (HUV). We aim to describe the five-year EQ-5D outcomes among patients who undergo surgical treatment for chronic rhinosinusitis (CRS).

STUDY DESIGN

Prospective observational cohort study.

METHODS

Patients with CRS completed the EQ-5D questionnaire preoperatively and annually for five years following endoscopic sinus surgery. Paired t-tests and McNemar's tests were used to compare preoperative and postoperative scores. Mixed-effects modeling was used for multivariate analysis.

RESULTS

Among 1296 patients enrolled in our study, 812 (74.7%) completed the postoperative survey at one year and 336 (38.9%) completed it at five years. There was a significant and sustained reduction of patients reporting pain/discomfort (74.9% vs. 58.0%, p < 0.001) and anxiety/depression (49.6% vs. 38.1%, p = 0.01) out to five years. Frequency of problems reported in the usual activity domain decreased at one year and was sustained through year four (30.6% vs 19.7%, p = 0.003). After multivariable modeling, female gender (p = 0.02), prior sinus surgery (p = 0.01), tobacco use (p = 0.038), headaches (p = 0.013), allergies (p = 0.001), diabetes (p = 0.022), hypertension (p = 0.036), higher preoperative SNOT-22 score (p < 0.001), and a lower preoperative Lund-Mackay score (p < 0.001) were associated with significantly worse EQ-5D HUV over time. Similarly, a worse EQ-5D Visual Analog Scale (VAS) over time was associated with allergies (p = 0.03), diabetes (p < 0.001), hypertension (p = 0.04), higher preoperative SNOT-22 score (p < 0.001), and prior sinus surgery (p < 0.001).

CONCLUSION

Patients with chronic rhinosinusitis experience significant sustained improvements in health-related quality of life up to five years after ESS as measured by the EQ-5D instrument.

LEVEL OF EVIDENCE

Level 2 Laryngoscope, 134:2592-2601, 2024.

Individualized Treatment for Glaucoma Patients with Diabetes mellitus

Glaucoma and diabetes mellitus are two common chronic diseases in Europe and worldwide which require intensive therapy. Various pathophysiological mechanisms have been discussed which favour the development of glaucoma, especially in the presence of diabetes mellitus. Medicinal and surgical adjustment of intraocular pressure is associated with some limitations in patients with diabetes mellitus, for example, filtering interventions show lower success rates than in non-diabetic glaucoma patients. Besides pure ophthalmological endocrinological therapy, the psychological burden of two chronic diseases should also be considered and included in the individual therapy plan.

Health State Utility Mapping of Rimegepant for the Preventive Treatment of Migraine: Double-Blind Treatment Phase and Open Label Extension (BHV3000-305)

INTRODUCTION

The objectives of this study were to (1) report long-term health-related quality of life (HRQoL) outcomes among patients using rimegepant preventatively in BHV3000-305 (NCT03732638) open-label extension (OLE) and (2) map Migraine-Specific Quality of Life questionnaire version 2.1 (MSQv2) to EQ-5D-3L utility values over the double-blind treatment (DBT; 0-12 weeks) and the OLE (13-64 weeks) to assess the influence of treatment on these values.

METHODS

This was a post hoc analysis using data from a rimegepant study for the prevention of migraine (BHV3000-305). Adult patients with migraine took either rimegepant 75 mg or placebo every other day (EOD) during the DBT phase. All patients received rimegepant during the OLE. MSQv2 was measured at baseline, weeks 12, 24, and 64. A validated algorithm was used to map MSQv2 scores to EQ-5D utilities.

RESULTS

Baseline data were available for 347 patients treated with placebo and 348 treated with rimegepant in the DBT period, who continued to the OLE. Baseline EQ-5D utilities were similar between trial arms: 0.598 for placebo and 0.614 for rimegepant. EQ-5D improved from baseline to week 12 and utilities increased by + 0.09 for placebo and + 0.10 for rimegepant (p value = 0.011). By 24 weeks, at which point patients who were originally randomized to placebo had received rimegepant 75 mg EOD for 12 weeks, HRQoL measures (MSQv2 and EQ-5D) were similar across groups, demonstrating rapid onset of treatment effect. This HRQoL improvement was durable out to 64 weeks.

CONCLUSION

Compared to placebo, treatment with rimegepant 75 mg was associated with greater improvement in EQ-5D utilities during the 12-week DBT phase. Patients originally randomized to placebo experienced a similar improvement in EQ-5D utilities after switching to rimegepant during the OLE, demonstrating that benefits are realized within 12 weeks of active treatment. This preventive effect was durable out to 64 weeks and was associated with an additional increase in HRQoL over time.

TRIAL REGISTRATION

NCT03732638.

Psychometric properties of the PROMIS Preference score (PROPr) in patients with rheumatological and psychosomatic conditions

Background

The PROMIS Preference score (PROPr) is a new generic preference-based health-related quality of life (HRQoL) score that can be used as a health state utility (HSU) score for quality-adjusted life years (QALYs) in cost-utility analyses (CUAs). It is the first HSU score based on item response theory (IRT) and has demonstrated favorable psychometric properties in first analyses. The PROPr combines the seven PROMIS domains: cognition, depression, fatigue, pain, physical function, sleep disturbance, and ability to participate in social roles and activities. It was developed based on preferences of the US general population. The aim of this study was to validate the PROPr in a German inpatient sample and to compare it to the EQ-5D.

Methods

We collected PROPr and EQ-5D-5L data from 141 patients undergoing inpatient treatment in the rheumatology and psychosomatic departments. We evaluated the criterion and convergent validity, and ceiling and floor effects of the PROPr and compared those characteristics to those of the EQ-5D.

Results

The mean PROPr (0.26, 95% CI: 0.23; 0.29) and the mean EQ-5D (0.44, 95% CI: 0.38; 0.51) scores differed significantly (d = 0.18, p < 0.001). Compared to the EQ-5D, the PROPr scores were less scattered across the measurement range which has resulted in smaller confidence intervals of the mean scores. The Pearson correlation coefficient between the two scores was r = 0.72 (p < 0.001). Both scores showed fair agreement with an Intraclass Correlation Coefficient (ICC) of 0.48 (p < 0.05). The PROPr and EQ-5D demonstrated similar discrimination power across sex, age, and conditions. While the PROPr showed a floor effect, the EQ-5D showed a ceiling effect.

Conclusion

The PROPr measures HSU considerably lower than the EQ-5D as a result of different construction, anchors and measurement ranges. Because QALYs derived with the EQ-5D are widely considered state-of-the-art, application of the PROPr for QALY measurements would be problematic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41927-022-00245-3.

Health Inequality Analysis in Europe: Exploring the Potential of the EQ-5D as Outcome

Objective: This study explored the additive value of the multi-item EuroQol 5-Dimension 5-Level (EQ-5D-5L) as an outcome measure in health inequality analyses, relative to the single-item EuroQol visual analog scale (EQ VAS). Methods: A sample comprising the general population from Italy, the Netherlands, and United Kingdom (UK) completed the EQ-5D-5L and the EQ VAS. The level of education was selected as a proxy for socio-economic status (SES). EQ-5D-5L level sum scores (LSS) were compared against EQ VAS scores. Stratified and multivariable analyses were used to study the associations between SES and the LSS/EQ VAS relative to the presence of chronic health conditions. Results: A total of 10,172 people participated in this study. In the UK and Netherlands, the LSS was worst for respondents with a low educational level and better for respondents with middle and high educational levels. For Italy, the LSS was best for respondents with a middle educational level compared to respondents with low and high educational levels. The same patterns were observed for the EQ VAS, but differences were slightly smaller. Multivariable analyses showed generally stronger predictive relations in the UK, and with the LSS. The presence of chronic health conditions and being unable to work were independent strong predictors, canceling out the effects of education. Conclusions: In three different European countries, the EQ-5D measures show the presence of education-dependent health inequalities, which are universally explained in regression analysis by independently the presence of chronic health conditions and the inability to work. In stratified analysis, the EQ-5D-5L LSS discriminates slightly better between participants with different levels of SES compared to the EQ VAS.

Health-related quality of life in hospitalized older patients with versus without prolonged use of opioid analgesics, benzodiazepines, and z-hypnotics: a cross-sectional study

BACKGROUND

Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients' self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates.

METHODS

The study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients' self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models.

RESULTS

Patients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82). In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient - 0.19 (95% CI, - 0.31 to - 0.06).

CONCLUSIONS

Older patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.

A comprehensive catalogue of EQ-5D scores in chronic disease: results of a systematic review

PURPOSE

Chronic diseases are associated with impaired health-related quality of life (HRQoL) outcomes. Comparison of HRQoL outcomes between different diseases and with the general population is of major importance to health economists, epidemiologists, clinicians, and policy makers. The aim of this systematic literature review was to develop a catalogue with EQ-5D scores in chronic non-communicable diseases, and to compare these scores with reference values from the general population.

METHODS

MEDLINE, Embase, and Web of Science were systematically searched independently by two reviewers. Studies were included if they reported mean EQ-5D index values for the adult population and if these scores were compared with the general population. The QualSyst tool for quantitative research was used for quality appraisal.

RESULTS

Two hundred and seven articles met the inclusion criteria. An extensive catalogue summarizes the EQ-5D scores in a wide variety of chronic diseases. Mean EQ-5D index values ranged between - 0.20 and 1. Lower EQ-5D scores are reported in chronic diseases compared to the general population, specifically in neurological disorders. Most of the diseases demonstrate a substantial disutility, although a minority of diseases have equal or even higher index scores than the general population.

CONCLUSION

A comprehensive, international catalogue has been developed to provide EQ-5D index scores for diverse chronic diseases compared with reference values based on the available literature. The catalogue gives a clear overview of the existing EQ-5D scores and can be rapidly accessed by researchers worldwide for different applications such as health economic evaluations, decision making, resource allocation, and other policy objectives. Future studies should focus on unexamined diseases and specific patient groups to expand the evidence base on HRQoL in chronic diseases.

Allergic rhinitis and rhinosinusitis synergistically compromise the mental health and health-related quality of life of Korean adults: A nationwide population-based survey

Background

Allergic rhinitis (AR) and rhinosinusitis (RS) negatively impact psychological well-being and health-related quality of life (HRQoL). However, few population-based studies have investigated the effects of these conditions on mental health and HRQoL.

Purpose

To explore independent associations of AR and/or RS with mental health and HRQoL using data from the 2013–2015 Korea National Health and Nutrition Examination Survey (KNHANES).

Methods

The KNHANES is a nationwide cross-sectional survey of the non-institutionalized population of Korea. A total of 15,441 adults completed the clinical examination and the health questionnaire. We divided all participants into four groups: AR-/RS-, AR-/RS+, AR+/RS-, and AR+/RS+. Logistic regression analyses were performed after adjustment for sociodemographic characteristics, general health behaviors, and other comorbidities.

Results

The AR+/RS+ group contained the highest proportion of subjects with perceived stress and depressed mood. Subjects with AR+/RS+ also had more frequent problems in terms of pain/discomfort and anxiety/depression. After adjusting for all confounders, the odds ratios (ORs) were 2.96 (p = 0.009) for depressed mood and 3.17 (p = 0.013) for suicidal ideation in the AR+/RS+ group compared with in the AR-/RS- group. The AR+/RS- group reported more perceived stress (OR, 1.56, p = 0.003) and depression (OR, 1.72, p = 0.024) compared with the AR-/RS- group. In terms of the ORs for HRQoL, the AR+/RS+ group reported more problems in terms of self-care (OR, 3.73, p = 0.038) and more pain/discomfort (OR 2.19, p = 0.006) compared with the AR-/RS- group.

Conclusions

In the Korean population, AR and RS exerted a synergistic negative impact on mental health and HRQoL, especially suicidal ideation. Most patients seek help from clinicians for impaired HRQoL. Therefore, clinicians should consider the underlying mental health and HRQoL of patients with AR and/or RS, as these may be impaired by their conditions.

Health-related quality of life variations by sociodemographic factors and chronic conditions in three metropolitan cities of South Asia: the CARRS study

OBJECTIVES

Health-related quality of life (HRQOL) is a key indicator of health. However, HRQOL data from representative populations in South Asia are lacking. This study aims to describe HRQOL overall, by age, gender and socioeconomic status, and examine the associations between selected chronic conditions and HRQOL in adults from three urban cities in South Asia.

METHODS

We used data from 16 287 adults aged ≥20 years from the baseline survey of the Centre for Cardiometabolic Risk Reduction in South Asia cohort (2010-2011). HRQOL was measured using the European Quality of Life Five Dimension-Visual Analogue Scale (EQ5D-VAS), which measures health status on a scale of 0 (worst health status) to 100 (best possible health status).

RESULTS

16 284 participants completed the EQ5D-VAS. Mean age was 42.4 (±13.3) years and 52.4% were women. 14% of the respondents reported problems in mobility and pain/discomfort domains. Mean VAS score was 74 (95% CI 73.7 to 74.2). Significantly lower health status was found in elderly (64.1), women (71.6), unemployed (68.4), less educated (71.2) and low-income group (73.4). Individuals with chronic conditions reported worse health status than those without (67.4 vs 76.2): prevalence ratio, 1.8 (95% CI 1.61 to 2.04).

CONCLUSIONS

Our data demonstrate significantly lower HRQOL in key demographic groups and those with chronic conditions, which is consistent with previous studies. These data provide insights on inequalities in population health status, and potentially reveal unmet needs in the community to guide health policies.

Association between chronic conditions and health-related quality of life: differences by level of urbanization in Peru

Purpose

To evaluate the role of urbanization as an effect modifier for the association between specific chronic conditions and number of conditions with health-related quality of life (QOL).

Methods

We analyzed cross-sectional data from the CRONICAS Cohort Study conducted in Lima (highly urbanized), Tumbes (semi-urban), as well as rural and urban sites in Puno. Exposures of interest were chronic bronchitis, depressive mood, hypertension, type 2 diabetes, and a composite variable aggregating the number of chronic conditions (the four exposures plus heart disease and stroke). QOL outcomes were assessed with EuroQol’s EQ-5D visual analogue scale (EQ-VAS). We fitted linear regressions with robust variance to evaluate the associations of interest. Study site was assessed as a potential effect modifier using the likelihood-ratio (LR) test.

Results

We evaluated data on 2433 subjects: 51.3% were female, mean age was 57.2 years. Study site was found to be an effect modifier only for the association between depressive mood and EQ-VAS score (LR test p < 0.001). Compared to those without depressive mood, participants with depressive mood scored −13.7 points on the EQ-VAS in Lima, −7.9 in urban Puno, −11.0 in semi-urban Tumbes, and −2.7 in rural Puno. Study site was not found to be an effect modifier for the association between the number of chronic conditions and EQ-VAS (LR test p = 0.64).

Conclusion

The impact of depressive mood on EQ-VAS was larger in urban than in rural sites, while site was not an effect modifier for the remaining associations.

Electronic supplementary material

The online version of this article (doi:10.1007/s11136-017-1649-7) contains supplementary material, which is available to authorized users.

Association between Symptoms of Allergic Rhinitis with Decreased General Health–Related Quality of Life

Background

The impact of specific allergic rhinitis symptoms on patient quality of life (QOL) is currently unknown.

Objective

In this study, we sought to determine the association between nasal and extranasal symptoms of allergic rhinitis with general health–related QOL.

Methods

A total of 150 participants with ages > 18 years and persistent allergic rhinitis were prospectively recruited for this cross-sectional study. General health–related QOL was measured by using the visual analog scale (VAS) from the five-dimension EuroQol QOL survey (EQ-5D). The severity of nasal and extranasal symptoms was measured by using the 22-item Sino-Nasal Outcome Test (SNOT-22). The severity of nasal obstruction was measured by using the Nasal Obstruction Severity Evaluation (NOSE) scale. Each participant also completed a Rhinitis Control Assessment Test (RCAT).

Results

The total SNOT-22 score was significantly correlated with RCAT (r = -0.68 [95% confidence interval {CI}, -0.75 to -0.58]; p < 0.001) and EQ-5D VAS (r = -0.44 [95% CI, -0.56 to -0.30]; p < 0.001). Of the 22 symptoms assessed on the SNOT-22, sleep-related symptoms, and otologic symptoms were associated with the greatest decrease in general health–related QOL. Nasal symptoms were least associated with general health–related QOL. The symptom of nasal obstruction was not at all associated with general health–related QOL (p = 0.267). We confirmed this finding by showing no significant correlation between the NOSE score and EQ-5D VAS (r = -0.05 [95% CI, -0.21 to 0.12]; p = 0.582).

Conclusion

Sleep and otologic symptoms were associated with the greatest negative impact on QOL in adults with persistent allergic rhinitis and should be routinely assessed in their clinical evaluation.

Associations between illness duration and health-related quality of life in specified mental and physical chronic health conditions: results from a population-based survey

PURPOSE

We compared health-related quality of life (HRQOL) in incident (≤1 year since diagnosis), mid-term (>1-5 years since diagnosis), and long-term (>5 years since diagnosis) cases of mental and physical chronic illness with the general population and assessed the modifying effects of age and gender on the association between HRQOL and illness duration.

METHODS

Data from the 2007 Australian National Health and Mental Wellbeing Survey were used. HRQOL was captured by the Assessment of Quality of Life Scale 4D. Multivariable linear regression analyses compared HRQOL of individuals with different duration of illnesses with those who did not have the condition of interest.

RESULTS

The 8841 survey respondents were aged 16-85 years (median 43 years, 50.3% female). For the overall sample, worse HRQOL was associated with incident (P = 0.049) and mid-term (P = 0.036) stroke and long-term depression (P < 0.001) and anxiety (P = 0.001). Age had moderating effect on the associations between HRQOL and duration of asthma (P < 0.001), arthritis (P = 0.001), diabetes (P = 0.004), stroke (P = 0.009), depression (P < 0.001), bipolar disorder (P < 0.001), and anxiety (P < 0.001), but not heart disease (P = 0.102). In older ages, the greatest loss in HRQOL was associated with incident asthma, depression, and bipolar disorder. In younger ages, the greatest loss in HRQOL was associated with arthritis (any duration) and incident diabetes and anxiety. Additionally, gender moderated the association between HRQOL and arthritis, with worse HRQOL among men with incident arthritis (P = 0.047).

CONCLUSIONS

Loss of HRQOL associated with longer duration of chronic illness is most apparent in stroke and mental illness and differs between age groups.

Association between perceived discrimination and healthcare-seeking behavior in people with a disability

BACKGROUND

Experiences of discrimination lead people from vulnerable groups to avoid medical healthcare. It is yet to be known if such experiences affect people with disabilities (PWD) in the same manner.

OBJECTIVES

To determine the association between perceived discrimination and healthcare-seeking behavior in people with disabilities and to explore differences of this association across disability types.

METHODS

We performed a cross-sectional study with data from a national survey of people with disabilities. Perceived discrimination and care-seeking behavior were measured as self-reports from the survey. Dependence for daily life activities, possession of health insurance, and other disability-related variables were included and considered as confounders. We used Poisson regression models and techniques for multistage sampling in the analyses. A stratified analysis was used to explore effects of discrimination across types of disability.

RESULTS

Most of PWD were 65 years or older (67.1%). Prevalence of healthcare seeking was 78.8% in those who perceived discrimination, and 86.1% in those who did not. After adjusting for potential confounders, the probability of not seeking care was higher in people who reported perceived discrimination (adjusted PR = 1.15; 95%CI: 1.04-1.28). In a stratified analysis, significant effects of discrimination were found in people with communication disability (adjusted PR = 1.34, 95%CI: 1.07-1.67) and with physical disability (adjusted PR = 1.17, 95%CI: 1.03-1.34).

CONCLUSIONS

People with disabilities who perceive discrimination are less likely to seek healthcare. This association was higher for people with communication and physical disabilities. These results provide evidence to institutions who attempt to tackle discrimination.

Risk of depression in patients with chronic rhinosinusitis: A nationwide population-based retrospective cohort study

BACKGROUND

Depression is prevalent in patients with chronic rhinosinusitis (CRS). However, no population-based study has ever investigated this relationship. We used nationwide population insurance data to conduct a retrospective cohort study to evaluate the subsequent risk of depression among patients with CRS.

METHODS

We used the National Health Insurance Research Database (NHIRD) of Taiwan identified 15,371 CRS patients diagnosed during 2000-2010. The non-CRS group consisted of 61,484 individuals without CRS frequency matched by sex, age, and the year of diagnosis. The occurrence of depression was monitored until the end of 2011. The hazard ratios (HRs) of depression were estimated using the Cox proportional hazards model after adjusting for demographic characteristics and comorbidities.

RESULTS

The overall incidence of depression was 77% higher in the CRS group than in the non-CRS group (8.25 vs. 4.66/1000 person-years, p<0.001), with an adjusted HR of 1.56 (95% confidence interval=1.43-1.70). Further data analyses revealed that the adjusted HRs of depression in the CRS group compared with the non-CRS group by sex, age, urbanization level, monthly income, occupation category, and comorbidity were all significant. However, there was no difference in incidences of depression between CRS patients with and without surgical treatment (8.31 vs. 8.24/1000 person-years).

CONCLUSION

The present study suggests that patients with CRS are at an increased risk of depression, compared with those without CRS. Therefore, we should pay attention to the psychiatric status of these patients and provide adequate support for them.

Chronic care model in primary care: can it improve health-related quality of life?

Purpose

Chronic diseases such as hypertension, diabetes mellitus, and hyperlipidemia are public health concerns. However, little is known about how these affect patient-level health measures. The aim of the study was to examine the impact of a chronic care model (CCM) on the participant's health-related quality of life (QoL).

Patients and methods

Participants received either usual care or CCM by a team of health care professionals including pharmacists, nurses, dietitians, and general practitioners. The participants in the intervention group received medication counseling, adherence, and dietary advice from the health care team. The QoL was measured using the EQ-5D (EuroQoL-five dimension, health-related quality of life questionnaire) and comparison was made between usual care and intervention groups at the beginning and end of the study at 6 months.

Results

Mean (standard deviation) EQ-5D index scores improved significantly in the intervention group (0.92±0.10 vs 0.95±0.08; P≤0.01), but not in the usual care group (0.94±0.09 vs 0.95±0.09; P=0.084). Similarly, more participants in the intervention group reported improvements in their QoL compared with the usual care group, especially in the pain/discomfort and anxiety/depression dimensions.

Conclusion

The implementation of the CCM resulted in significant improvement in QoL. An interdisciplinary team CCM approach should be encouraged, to ultimately result in behavior changes and improve the QoL of the patients.

Legg-Calvé-perthes disease: quality of life, physical activity, and behavior pattern

BACKGROUND

Legg-Calvé-Perthes disease (LCPD) is a disease in children leading to deformation of the femoral head and can be a promoter for early dysfunction of the hip and early osteoarthritis of the hip. The study of health-related quality of life, physical activity, and behavior patterns in patients with LCPD can reveal its consequences later in life and also contribute to a better understanding of the etiology of the disease.

PATIENTS AND METHODS

We identified 145 patients with LCPD diagnosed and treated at Uppsala University Hospital between 1978 and 1995. A total of 116 patients answered questionnaires regarding health-related quality of life (EQ-5D-3L), physical activity [International Physical Activity Questionnaire (IPAQ)], and hyperactive/inattentive behavior pattern [ADHD self-reporting symptom checklist (ASRS v1.1)] by interview. Patients were asked to report on fractures or soft-tissue injuries that required medical care. Medical charts were reviewed to determine age at onset of LCPD and treatment received.

RESULTS

Patients with LCPD had significantly lower EQ-5D-3L and EQ VAS scores than the Swedish general population in all age groups. A total of 28% of our patient group had ASRS scores indicating they are likely or highly likely to have an ADHD diagnosis. A lower EQ-5D-3L score was significantly correlated with a higher total ASRS v1.1 score (ρ=-0.309**). Over 90% of our patient group was physically active on a moderate or high level, despite 52% reporting either some or severe problems with pain according to the EQ-5D-3L questionnaire. Patients with high ASRS v1.1 scores (>16) had a significantly higher incidence of soft-tissue injuries than those with lower ASRS v1.1 scores.

CONCLUSION

The consequence of LCPD in adulthood was expressed in a lower quality of life compared with the Swedish general population. Despite this, the patients in our study reported a higher level of physical activity than the general population. A tendency toward hyperactive behavior pattern and high physical activity level may be present even in childhood and could contribute to the etiology of LCPD.

LEVEL OF EVIDENCE

A retrospective study, level II.

EQ-5D-derived health utility values in patients undergoing surgery for chronic rhinosinusitis

OBJECTIVES/HYPOTHESIS

Health utility value (HUV) is an index used to measure health-related quality of life for the valuation and comparison of treatments. The Euroqol 5-Dimension (EQ-5D) questionnaire is a widely used method for determining HUV, but it has not been applied for this purpose in patients with chronic rhinosinusitis (CRS) who undergo sinus surgery.

STUDY DESIGN

Prospective cohort study.

METHODS

Patients with CRS, who were recruited from 11 different otolaryngologic practices, completed the EQ-5D questionnaire at baseline, as well as 3, 12, and 24 months after surgery. HUVs calculated from the results of this questionnaire were compared to those reported in the general U.S. population and to patients suffering from other chronic diseases.

RESULTS

Baseline EQ-5D surveys were completed by 242 patients. Mean baseline HUV (standard deviation) was 0.81 (0.13). Female gender, revision surgery, and the use of intraoperative image guidance were associated was significantly lower baseline values. HUV rose at 3 months to 0.89 (0.12) and remained improved at 12 months 0.88 (0.10) and 24 months 0.89 (0.10) (P < 0.001). Baseline HUV in CRS (0.81[0.13]) is lower than the general U.S. population (0.85 [0.18]) and appears appropriately positioned among other common chronic conditions including asthma (0.82-0.92), migraine (0.81-0.91), and seasonal allergies (0.94).

CONCLUSIONS

Sinus surgery provides improvement in HUV in patients with CRS. These values may be paired with costs of care to perform cost-utility analysis on this group of patients.

LEVEL OF EVIDENCE

2c.

A reference case for economic evaluations in osteoarthritis: an expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

BACKGROUND

General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach.

OBJECTIVES

To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions.

METHODS

Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards.

RESULTS

Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumb-based disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the "standard optimal care" in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided.

CONCLUSIONS

The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate therapeutic strategies of OA in terms of costs and effectiveness.

Long-Term Outcomes in Sinus Surgery

Objective

The 6-question EuroQol 5-Dimension Health Assessment (EQ-5D) is a widely used, simple instrument that monitors general health-related quality of life (HRQoL) in chronic disease. It has not previously been applied to US patients undergoing endoscopic sinus surgery (ESS).

Study Design

Prospective cohort study.

Setting

Academic Medical Center.

Subjects and Methods

The study population consisted of 267 patients with chronic rhinosinusitis (CRS) who completed 2 disease-specific instruments—the Chronic Sinusitis Survey (CSS) and the Sinonasal Outcomes Test-22 (SNOT-22)—and 1 general health-related quality-of-life instrument—the EQ-5D—before and after ESS for CRS. Baseline scores were compared to those collected 3 and 12 months after surgery and to the general US population.

Results

Surveys were completed at all time points by 186 patients, for a response rate of 69.7%. Patients with CRS, when compared to the US population, reported more problems in the domains of pain/discomfort (73.1% vs 40.8%, P < .01), anxiety/depression (50.5% vs 26.4%, P < .01), and usual activities (30.6% vs 15.0%, P < .01). One year following ESS, there was a significant decrease in patients who reported problems with pain/discomfort (54.3%, P < .001), anxiety/depression (30.6%, P < .001), and usual activities (21.5%, P < .01). After surgery, CRS anxiety/depression scores were no different from those of the US general population. Chronic Sinusitis Survey and SNOT-22 scores demonstrated similar postoperative improvements.

Conclusion

The EQ-5D assessment provides meaningful general health outcomes data with low patient burden. Application of this instrument demonstrated long-term improvement in the quality of life of patients who undergo sinus surgery.

Impact of lower urinary tract symptoms and depression on health-related quality of life in older adults

Purpose

We aimed primarily to investigate the level of health-related quality of life (HRQoL), lower urinary tract symptoms (LUTS), and depression in older adults and secondly to identify the impact of LUTS and depression on HRQoL.

Methods

A community-based cross-sectional study was conducted from April to November 2010. Participants were recruited from five community senior centers serving community dwelling older adults in Jeju city. Data analysis was based on 171 respondents. A structured questionnaire was used to guide interviews; the data were collected including demographic characteristics, body mass index, adherence to regular exercise, comorbidities (hypertension, diabetes mellitus, and osteoarthritis), depression, urinary incontinence, LUTS (measured via the International Prostate Symptom Score [IPSS]), and HRQoL as assessed by use of the EQ-5D Index. Stepwise multiple regression analysis was used to test predictors of HRQoL.

Results

Eighteen percent (18.6%) of the respondents reported depressive symptoms. The mean LUTS score was 8.9 (IPSS range, 0 to 35). The severity of LUTS, was reported to be mild (score, 0 to 7) by 53% of the respondents, moderate (score, 8 to 19) by 34.5%, and severe (score, 20 to 35) by 12.5%. HRQoL was significantly predicted by depression (Partial R²=0.193, P<0.01) and LUTS (Partial R²=0.048, P=0.0047), and 24% of the variance in HRQoL was explained.

Conclusions

LUTS and depression were the principal predictors of HRQoL in older adults.

Socio-economic differences in the health-related quality of life impact of cardiovascular conditions

BACKGROUND

Those responsible for planning and commissioning health services require a method of assessing the benefits and costs of interventions. Quality-adjusted life years, based on health-related quality of life (HRQoL) estimates, can be used as part of this commissioning process. The purpose of this study was to generate nationally representative HRQoL estimates for cardiovascular disease (heart attack, angina and stroke) and predisposing conditions (diabetes, hypertension and obesity) and assess differential impacts by socio-economic position using data from the Health Survey for England.

METHODS

Regression modelling was used to estimate the relationship of EQ-5D index scores with each condition independently and differentially by socio-economic position.

RESULTS

Of the cardiovascular conditions/risk factors considered, having doctor-diagnosed stroke, heart attack or angina were each associated with the greatest decreases in EQ-5D. With the exception of heart attack, the reduction in EQ-5D associated with the condition/risk factor was greater for those occupying lower socio-economic positions, statistically significantly so for obesity, hypertension and diabetes.

CONCLUSION

The estimates calculated provide nationally representative baseline data for England, which can be used for modelling the impact of interventions on HRQoL. They illustrate the importance of socio-economic circumstances for the association between a given condition/risk factor and HRQoL.

The impact of co-morbidity burden on preference-based health-related quality of life in the United States

BACKGROUND

Many statistical analyses, clinical trials and cost-utility analyses designed to measure the impact of a particular disease on utility scores often overlook the important influence of co-morbidity burden.

OBJECTIVES

This study aims to examine the impact of co-morbidity burden on EQ-5D index scores in a nationally representative sample of the US.

METHODS

The pooled 2001 and 2003 Medical Expenditure Panel Survey was used. The total number of chronic conditions for each individual was calculated based on Clinical Classification Categories codes. Spline regression was used to identify nonlinear age effects: individuals were separated into four quartiles based on age. Censored least absolute deviation was used to regress EQ-5D index scores on age and chronic co-morbidity, controlling for income, gender, race, ethnicity, education, physical activity and smoking status. Interactions between age and chronic conditions were also explored.

RESULTS

The coefficients for chronic co-morbidities were highly statistically significant with large magnitudes for those with two or more chronic conditions (coefficient two chronic conditions=-0.16; coefficient nine chronic conditions=-0.28). After controlling for chronic co-morbidities and other confounders, age was not statistically significant except for those aged>58 years and the magnitude of this coefficient was very small (coefficient aged>58 years=-0.0006). The interactions between age and chronic co-morbidity were significant, but the deleterious impact of their interaction was largely dominated by the existence and number of chronic conditions.

CONCLUSIONS

Chronic conditions have a significant deleterious impact on EQ-5D index scores that is much more pronounced than age and other sociodemographic and behavioural characteristics. Future analyses and cost-utility models should incorporate the impact of multiple morbidity.

Health-related quality of life in adults reporting arthritis: analysis from the National Health Measurement Study

Background

Arthritis is the leading cause of disability in the United States. We assess the generic health-related quality-of-life (HRQOL) among a nationally representative sample of US adults with and without self-reported arthritis.

Methods

The NHMS, a cross-sectional survey of 3,844 adults (35–89 years) administered EuroQol-5D (EQ-5D), Health Utilities Index Mark 2 (HUI2) and 3 (HUI3), SF-36v2™, Quality of Well-being Scale self-administered form (QWB-SA), and the Health and Activities Limitations index (HALex) to each respondent via a telephone interview. Weighted multiple linear regression was used to generate age-gender-arthritis-stratified unadjusted HRQOL means and means adjusted for sociodemographic, socioeconomic covariates and comorbidities by arthritis–age category.

Results

The estimated population prevalence of self-reported arthritis was 31%. People with arthritis were more likely to be woman, older, of lower socioeconomic status, and had more self-reported comorbidities than were those not reporting arthritis. Adults with arthritis had lower HRQOL on six different indexes compared with adults without arthritis, with overall differences ranging from 0.03 (QWB-SA, age-group 65–74) to 0.17 (HUI3, age-group 35–44; all P-value < .05).

Conclusion

Arthritis in adults is associated with poorer HRQOL. We provide age-related reference values for six generic HRQOL measures in people with arthritis.

Evaluation of health-related quality of life using EQ-5D in Takamatsu, Japan

OBJECTIVES

Healthy Japan 21 (Japanese National Health Promotion in the 21st Century) was started in 2000 to promote extension of healthy life expectancy and improve health-related quality of life (HRQOL). The present study aims to describe HRQOL of Japanese subjects using the EuroQol questionnaire (EQ-5D) and investigate the influence of social background, health-related behaviors, and chronic conditions on HRQOL using representatives in Takamatsu, Japan.

METHODS

Data were obtained from a 2005 Takamatsu City health survey mailed to 2,500 randomly selected Japanese individuals in Takamatsu, a medium-sized city. We examined data from 915 Japanese adults. The questionnaire addressed social background, health-related behaviors, chronic conditions, EQ-5D items, and self-rated health. The impact of social background, health-related behaviors, and chronic conditions on Japanese HRQOL was examined through multivariate regression, adjusting for age and sex.

RESULTS

EQ-5D scores decreased with age, particularly for respondents who were unemployed or retired. Adjusting for sex and age, the results showed that age, unemployment/retirement, feeling severe stress, and musculoskeletal and gastrointestinal diseases were significantly associated with decreased HRQOL. Conversely, sufficient sleep (7-8 h/day) and having a hobby were significantly associated with increased HRQOL.

CONCLUSIONS

Information is lacking regarding HRQOL in Japanese populations. This study furthers our understanding of some important determinants influencing Japanese HRQOL, using the EQ-5D in Takamatsu, Japan. Our results also resembled some findings from similar studies in other countries. We hope to use the EQ-5D with other health survey questionnaires to gather more data about HRQOL of Japanese people.

Temporal change in health-related quality of life: a longitudinal study in general practice 1999-2004

BACKGROUND

In order to assess and plan for changing healthcare needs, the lack of available information regarding temporal changes in the health-related quality of life of a population must be addressed.

AIM

This paper aims to describe such changes over 5 years in a general population.

DESIGN OF STUDY

Longitudinal postal questionnaire study.

SETTING

UK general practice.

METHOD

This was a longitudinal postal questionnaire study in two general practice populations, using the generic instrument EQ-5D to measure health-related quality of life. Individuals were included if they responded to three postal surveys in 1999, 2001, and 2004 and there were three consecutive values of EQ-5D(index) available between 1999 and 2004.

RESULTS

A total of 2498 subjects were included in the study. After adjustment for potential confounders (including ageing), health-related quality of life declined significantly over the observation period. The change in EQ-5D(index) was from 0.79 to 0.74 and for EQ-5D(vas) 76.8 to 73.3 (P for both trends <0.001).

CONCLUSION

Health-related quality of life deteriorated in these populations over 5 years. In an era of improvements in mortality, this has important implications for the use of health-related quality of life data in healthcare planning and resource allocation.

A review of health utilities across conditions common in paediatric and adult populations

Background

Cost-utility analyses are commonly used in economic evaluations of interventions or conditions that have an impact on health-related quality of life. However, evaluating utilities in children presents several challenges since young children may not have the cognitive ability to complete measurement tasks and thus utility values must be estimated by proxy assessors. Another solution is to use utilities derived from an adult population. To better inform the future conduct of cost-utility analyses in paediatric populations, we reviewed the published literature reporting utilities among children and adults across selected conditions common to paediatric and adult populations.

Methods

An electronic search of Ovid MEDLINE, EMBASE, and the Cochrane Library up to November 2008 was conducted to identify studies presenting utility values derived from the Health Utilities Index (HUI) or EuroQoL-5Dimensions (EQ-5D) questionnaires or using time trade off (TTO) or standard gamble (SG) techniques in children and/or adult populations from randomized controlled trials, comparative or non-comparative observational studies, or cross-sectional studies. The search was targeted to four chronic diseases/conditions common to both children and adults and known to have a negative impact on health-related quality of life (HRQoL).

Results

After screening 951 citations identified from the literature search, 77 unique studies included in our review evaluated utilities in patients with asthma (n = 25), cancer (n = 23), diabetes mellitus (n = 11), skin diseases (n = 19) or chronic diseases (n = 2), with some studies evaluating multiple conditions. Utility values were estimated using HUI (n = 33), EQ-5D (n = 26), TTO (n = 12), and SG (n = 14), with some studies applying more than one technique to estimate utility values. 21% of studies evaluated utilities in children, of those the majority being in the area of oncology. No utility values for children were reported in skin diseases. Although few studies provided comparative information on utility values between children and adults, results seem to indicate that utilities may be similar in adolescents and young adults with asthma and acne. Differences in results were observed depending on methods and proxies.

Conclusions

This review highlights the need to conduct future research regarding measurement of utilities in children.

Quality of life in glaucoma and three other chronic diseases: a systematic literature review

Chronic diseases have a long-term negative impact on quality of life (QOL). Decreased QOL is associated with increased financial burden on healthcare systems and society. However, few publications have investigated the impact of glaucoma on patients' QOL in comparison with other chronic diseases observed in patients with similar demographic characteristics. To this end, a systematic literature search to assess QOL in glaucoma and three other chronic diseases (osteoporosis, type 2 diabetes mellitus and dementia) was performed. A total of 146 publications were identified that reported QOL using six commonly used generic QOL instruments: 36-, 12- and 20-item Short-Form Health Surveys (SF-36, -12 and -20), EuroQoL (EQ-5D), Sickness Impact Profile (SIP) and the Health Utilities Index-Mark III (HUI-III). The publication breakdown was as follows: glaucoma (10%), osteoporosis (26%), diabetes (52%) and dementia (12%); one publication assessed QOL in glaucoma, diabetes and dementia. QOL was affected to a similar or slightly lesser degree by glaucoma than by osteoporosis, diabetes or dementia. Among the publications reporting SF-36, -12 and -20 evaluations, physical component scores were generally lower than mental component scores across all diseases. QOL was affected more in patients with glaucoma than in demographically matched non-glaucomatous controls according to SF-20 assessment. EQ-5D and SIP results showed that QOL decreased as the severity of glaucoma increased. Patients with glaucoma had the lowest scores on the SIP instrument, indicating better QOL than patients with osteoporosis or diabetes (no data were available on dementia). The HUI-III instrument identified poorer QOL in patients with dementia than other diseases, probably due to cognitive deficits. However, for some of the instruments, data were scarce, and interpretation of the results should be conservative. Although there are limited published QOL studies in glaucoma, its impact on QOL appears to be broadly similar to that of other serious chronic diseases. Development of a QOL instrument that measures vision-specific and general health aspects would better document the impact of glaucoma on QOL and would facilitate comparisons with other chronic disease states.

Three methods tested to model SF-6D health utilities for health states involving comorbidity/co-occurring conditions

OBJECTIVES

Compare three commonly used methods to combine the impacts of multiple health conditions on SF-6D health utility scores.

STUDY DESIGN AND SETTING

We used data from the 1998-2004 Medicare Health Outcomes Survey to compare three commonly suggested models of multiple health conditions' impacts on health-related quality of life: additive, minimum, and multiplicative. We modeled SF-6D scores using information about 15 health conditions, both unadjusted and adjusted for age, sex, education, and income. Model performance was assessed using mean squared error, mean predictive error by number of health conditions, and mean predictive error for groups with specific combinations of health conditions.

RESULTS

Ninety-five thousand one hundred ninety-five observations were used for model estimation, and 94,794 observations were used for model testing. The adjusted models always had better performance than the unadjusted models. The multiplicative model showed smaller mean predictive error than the other models in both those younger than 65 years and those 65 years and older. Mean predictive error for the multiplicative model was generally within the minimally important difference of the SF-6D.

CONCLUSION

All tested models are imperfect in these Medicare data, but the multiplicative model performed best.

Trends in medical care expenditures of US adults with arthritis and other rheumatic conditions 1997 to 2005

OBJECTIVE

To examine trends in annual medical expenditures from 1997 to 2005 among adults with arthritis and other rheumatic conditions (denoted Arthritis group).

METHODS

We analyzed annual medical expenditures (2005 US dollars) among adults with Arthritis using the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the US civilian, noninstitutionalized population. Expenditures were stratified by Arthritis and comorbidity status.

RESULTS

The Arthritis population increased by 22% (36.8 to 44.9 million) during this period, attributable entirely to the subpopulation with at least one comorbid condition (31.8 to 40.3 million). The overall, inflation-adjusted annual mean medical expenditures for adults with Arthritis increased from $6,848 in 1997 to $7,854 in 2005. In 1997, inpatient care was the most expensive component of overall expenditures (mean $2,702), but beginning in 2001, mean inpatient and ambulatory expenditures were almost identical. Mean prescription expenditures increased nearly every year, almost doubling from $970 in 1997 to $1,811 in 2005. Aggregate total expenditures for the Arthritis population increased markedly during this period, from $252.0 to $353.0 billion (+40%). Most of this increase was attributable to the population increase in the Arthritis and comorbid condition subgroup.

CONCLUSION

Mean annual ambulatory and prescription expenditures for adults with Arthritis increased far above the rate of medical inflation, offsetting a relative decline in inpatient expenditures. Increases in overall mean and aggregate total expenditures are attributable to the increasing number of adults with Arthritis and at least one comorbid chronic condition. Projected increases in this population suggest that these expenditures will continue to rise.

The national burden of musculoskeletal pain in Japan: Projections to the year 2055

OBJECTIVES

To project the national burdens of low back, hip, and knee pains in Japan from 2005 to 2055 in terms of quality adjusted life years (QALYs).

METHODS

The age- and sex-specific prevalence rates of low back, hip, and knee pains in the questionnaire survey (3048 men and 1885 women) were multiplied by the corresponding age- and sex-specific Japanese population projections. The losses of QALYs associated with low back, hip, and knee pains were calculated as the projected numbers of men and women with pain at each site multiplied by the corresponding sex-specific mean differences of EQ-5D scores between those who reported pain at each site and those who reported no musculoskeletal pain in the questionnaire survey.

RESULTS

Among a total of 87.9 million Japanese people aged 30 years or older in 2005, 21.4 million (24.3%), 3.2 million (3.7%), and 9.1 million (10.4%) were estimated to have low back, hip, and knee pains, respectively. The prevalence rates of low back, hip, and knee pains will gradually increase in subsequent years, reaching 26.5%, 4.4%, and 12.9%, respectively by 2055. Consequently, the losses of QALYs associated with low back, hip, and knee pains per 1000 population will increase from 17.2, 3.8, and 8.9, respectively in 2005 to 18.8, 4.5, and 11.2, respectively by 2055.

DISCUSSION

Due to population aging, the national burden of musculoskeletal pain in Japan is projected to increase in the next 50 years. Musculoskeletal pain has not been counted among national healthcare priorities. However, the control of musculoskeletal pain should not be bypassed to improve QOL and extend healthy life expectancy.

[The decline of health-related quality of life associated with some diseases in Korean adults]

OBJECTIVES

This study was conducted to measure the decline in the health-related quality of life (HRQoL) associated with some diseases in South Korean adults.

METHODS

The EQ-5D health states in the 2005 National Health and Nutrition Examination Survey (NHNES) and the Korean EQ-5D valuation set were used to obtain the EQ-5D indexes of the study subjects. Each disease group was defined when the subjects reported to the NHNES that they were diagnosed with the corresponding disease during the previous 1 year by physicians. Since the distributions of the EQ-5D indexes in each subgroup were negatively skewed, median regression analysis was used to estimate the effects of specific diseases on the HRQoL. Median regression analysis produced estimates that approximated the median of the EQ-5D indexes and there are more robust for analyzing data with many outliers.

RESULTS

A total of 16,692 subjects (6,667 patients and 10,025 people without any disease) were included in the analysis. As a result of the median regression analysis, stroke had the strongest impact on the HRQoL for both males and females, followed by osteoporosis, osteoarthritis, rheumatic arthritis, and herniation of an intervertebral disc. While asthma had a significant impact on the HRQoL only in men, cataract, temporo-mandibular dysfunction, and peptic ulcer significantly affected the HRQoL only in women.

CONCLUSIONS

Stroke and musculoskeletal diseases were associated with the largest losses of the HRQoL in Korean adults.

Association of extraesophageal reflux disease and sinonasal symptoms: prevalence and impact on quality of life

OBJECTIVES

The purpose of this study was to investigate the prevalence of extraesophageal reflux disease symptoms and their association with sinonasal disorders within a general sample of adults in our community and to determine how these conditions affect perception of general health, sinus-related quality of life (QOL), and perception of reflux and digestive function.

STUDY DESIGN/METHODS

A community-dwelling sample of 1,878 adults completed symptom and QOL surveys in a two-stage prospective design: an initial screening questionnaire (n = 1,878) and disease-specific (sinus and reflux/digestion) and general health-related QOL instruments (n = 1,073). Demographic and response data were summarized and analyzed for prevalence and correlations among data sets.

RESULTS

Sinonasal symptoms were reported in 71% of subjects who completed the initial screening questionnaire, and reflux-related symptoms were reported by 59% of respondents. The co-occurrence of sinonasal and reflux symptoms was reported by 45% of respondents. Subjects with both sinonasal and reflux symptoms scored significantly worse on the disease-specific and general physical and mental QOL scales than subjects with only reflux or sinonasal symptoms or no symptoms.

CONCLUSIONS

Symptoms associated with inflammatory sinonasal disorders and gastroesophageal reflux disease are common in the general U.S. adult population and co-occur in the same individuals to a greater degree than can be attributed to chance alone. Co-occurrence was found to be associated with significant declines in both disease-specific and general physical and mental QOL. This finding has implications with regard to pathogenesis and treatment of these disorders.

Low back pain deprives the Japanese adult population of their quality of life: a questionnaire survey at five healthcare facilities in Japan

OBJECTIVES

To estimate the degree to which low back pain (LBP) deprives the Japanese adult population of their quality of life (QOL) in terms of quality-adjusted life-years (QALYs).

METHODS

A questionnaire survey was conducted among participants of health examinations at five healthcare facilities in Japan. Age- and sex-specific mean values of the EQ-5D score were calculated for (1) those who reported LBP and interference with daily activities (IDA) due to the pain (n = 251), (2) those who reported LBP but no IDA (n = 955), and (3) those who reported no musculoskeletal pain (n = 2887). To estimate the loss of QALYs due to LBP in the Japanese adult population, we multiplied the age- and sex-specific mean differences of the EQ-5D scores between the LBP with (or without) IDA group and the no pain group by the corresponding age- and sex-specific numbers of people with LBP with (or without) IDA in Japan.

RESULTS

Among the entire Japanese adult population of 103 million people, 11,800,000 (4,910,000 men and 6,890,000 women) were estimated to suffer from LBP, and 2,403,000 (976,000 men and 1,427,000 women) people were estimated to encounter IDA due to the pain. The loss of QALYs due to LBP in the Japanese adult population was estimated at 947,000 (9.18 per 1000 population). The loss of QALYs due to IDA in the LBP people was estimated at 139,000 (1.35 per 1000 population).

CONCLUSIONS

The estimated loss of QALYs due to LBP suggests that LBP substantially deprives the Japanese adult population of their QOL.

Prevalence, severity, and impact of symptoms on female family caregivers of patients at the initiation of radiation therapy for prostate cancer

PURPOSE

In a sample of family caregivers (FCs) of patients with prostate cancer who were to begin radiation therapy (RT), the purposes were to determine the prevalence and severity of depression, anxiety, pain, sleep disturbance, and fatigue; determine the relationships among these symptoms and between these symptoms and functional status and quality of life (QOL); evaluate for differences in functional status and QOL between FCs with low and high levels of these symptoms; and determine which factors predicted FCs' functional status and QOL.

PATIENTS AND METHODS

FCs were recruited before patients initiated RT and completed self-report questionnaires that evaluated demographic characteristics, symptoms, functional status, and QOL.

RESULTS

Sixty female FCs participated in the study. On the basis of established cut point scores for each symptom questionnaire, 12.2% of the FCs had clinically meaningful levels of depression, 40.7% anxiety, 15.0% pain, 36.7% sleep disturbance, 33.3% morning fatigue, and 30.0% evening fatigue. FCs who were older and who had lower levels of state anxiety and higher levels of depression, morning fatigue, and pain reported significantly poorer functional status (R(2) = 38.7%). FCs who were younger, had more years of education, were working, and who had higher levels of depression, morning fatigue, sleep disturbance, and lower levels of evening fatigue reported significantly lower QOL scores (R(2) = 70.1%).

CONCLUSION

A high percentage of FCs experienced clinically meaningful levels of a variety of symptoms. These symptoms have a negative impact on the FCs' functional status and QOL.