Association between chronic conditions and health-related quality of life: differences by level of urbanization in
Alvaro Taype-Rondan1, Elizabeth Sarah Abbs1,2, Maria Lazo-Porras1
1CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Armendáriz 497, Miraflores, 18, Lima, 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.
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