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How do common chronic conditions affect health-related quality of life?
Isobel T M Heyworth1, Michelle L Hazell, Mary F Linehan
1Faculty of Medical and Human Sciences University of Manchester, Manchester.
Insights
Having multiple chronic conditions significantly lowers health-related quality of life (HRQoL). This study quantifies the negative impact of comorbidities on patient well-being, highlighting a key area for clinical guidelines.
Area of Science:
- Public Health
- Health Services Research
- Quality of Life Research
Background:
- Comorbidity is prevalent, yet its impact on health-related quality of life (HRQoL) is under-researched.
- Existing National Institute for Health and Clinical Excellence (NICE) guidelines do not account for comorbidity.
- Previous studies faced limitations including patient-defined conditions, unquantified confounders, and small sample sizes.
Purpose of the Study:
- To investigate the impact of combinations of chronic conditions on HRQoL.
- To address limitations in previous research on comorbidity and HRQoL.
Main Methods:
- Survey data on general health, respiratory status, and EQ-5D HRQoL measure collected from 5169 patients (>16 years).
- Questionnaires were linked to General Practitioner (GP) records to determine the status of six common chronic diseases.
- Analysis of mailed questionnaire data from two general practices in Manchester, UK.
Main Results:
- A significant negative correlation was found between increasing numbers of chronic conditions and lower HRQoL (P<0.001).
- Factors such as increasing age, obstructive airway disease, lower education, and smoking also correlated with reduced HRQoL.
- The number of chronic conditions was a strong predictor of the EQ-5D index score (coefficient = -0.079, P<0.001) after regression analysis.
Conclusions:
- Increasing numbers of chronic conditions exert a substantial negative influence on health-related quality of life.
- The findings underscore the importance of considering comorbidity in healthcare resource allocation and patient care strategies.
Background:
Comorbidity is common. National Institute for Health and Clinical Excellence (NICE) guidelines have been created to make best use of resources to improve patients' quality of life but do not currently take account of comorbidity. The effect of multiple chronic conditions with regard to health-related quality of life (HRQoL) is poorly researched. Criticisms of previous research have been due to patient-defined chronic conditions, lack of quantification of the effects of confounding factors, selection of affected patients only, small sample sizes, and upper age limits.
Aim:
This study aims to address these issues, looking into the impact of combinations of chronic conditions on HRQoL.
Design Of The Study:
Participants filled in a questionnaire containing general health information, specific respiratory questions, and the EQ-5D measure of HRQoL. The questionnaires were then matched up to their GP records to obtain their disease status for six common chronic diseases (asthma, chronic obstructive pulmonary disease, ischaemic heart disease, hypertension, diabetes, and cerebrovascular disease).
Method:
Data from a mailed questionnaire were analysed from 5169 patients aged >16 years from two general practices in Wythenshawe, Manchester in 2004. Completion of the questionnaire was taken to indicate consent to participate.
Results:
Significant correlations were found between a lower HRQoL and increasing numbers of chronic conditions (P<0.001), increasing age, possible obstructive airway disease, lack of higher education, smoking, and female sex. These all remained significant following regression, except for sex, with number of chronic conditions being a strong predictor of the weighted health state index score, EQ-5D(index) (coefficient = -0.079, P<0.001).
Conclusion:
Increasing numbers of chronic conditions have a strong negative effect on HRQoL.
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