Double trouble: the impact of multimorbidity and deprivation on preference-weighted health related quality of life a cross sectional analysis of the Scottish Health Survey

International Journal for Equity in Health

Research

Graham CM Watt¹  Stewart W Mercer¹  Eleanor Grieve²  Kenny D Lawson²  Elisabeth AE Fenwick²  Sally Wyke³  Bruce Guthrie⁴ 

[1] General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK;Health Economics and HTA, Institute of Health & Wellbeing, University of Glasgow, G12 8RZ, 1 Lilybank Gardens, Glasgow, UK;Institute of Health & Wellbeing, University of Glasgow, 25-28 Bute Gardens, Glasgow G12 8RS, UK;Quality Safety and Informatics Research Group, Population Health Sciences Division, Medical Research Institute, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK;

关键词: Multimorbidity;    Preference_Weighted Health Related Quality of Life (PW_HRQoL);    Deprivation;    Inequality;   

DOI  :  10.1186/1475-9276-12-67

 received in 2013-01-16, accepted in 2013-06-11,  发布年份 2013

来源: Springer

【 摘 要 】

ObjectiveTo investigate the association between multimorbidity and Preference_Weighted Health Related Quality of Life (PW_HRQoL), a score that combines physical and mental functioning, and how this varies by socioeconomic deprivation and age.DesignThe Scottish Health Survey (SHeS) is a cross-sectional representative survey of the general population which included the SF-12, a survey of HRQoL, for individuals 20 years and over.MethodsFor 7,054 participants we generated PW_HRQoL scores by running SF-12 responses through the SF-6D algorithm. The resulting scores ranged from 0.29 (worst health) to 1 (perfect health). Using ordinary least squares, we first investigated associations between scores and increasing counts of longstanding conditions, and then repeated for multimorbidity (2+ conditions). Estimates were made for the general population and quintiles of socioeconomic deprivation. For multimorbidity, the analyses were repeated stratifying the population by age group (20–44, 45–64, 65+).Results45% of participants reported a longstanding condition and 18% reported multimorbidity. The presence of 1, 2, or 3+ longstanding conditions were associated with average reductions in PW_HRQoL scores of 0.081, 0.151 and 0.212 respectively. Reduction in scores associated with multimorbidity was 33% greater in the most deprived quintile compared to the least deprived quintile, with the biggest difference (80%) in the 20–44 age groups. There were no significant gender differences.ConclusionsPW_HRQoL decreases markedly with multimorbidity, and is exacerbated by higher deprivation and younger age. There is a need to prioritise interventions to improve the HRQoL for (especially younger) adults with multimorbidity in deprived areas.Box 1What Is Known?Prevalence and premature onset of multimorbidity increases as socioeconomic position worsens. Previous studies have investigated the effect of multimorbidity on Health Related Quality of Life (HRQoL) on separate physical and mental health states. There is limited data on how HRQoL falls as the number of conditions increase, and how estimates vary across the general population.Leaving physical and mental health as separate categories can inhibit assessment of overall HRQoL. The use of a Preference_Weighted Health Related Quality of Life (PW_HRQoL) score provides a single summary measure of overall health, by weighting mental and physical states by their perceived importance as part of overall HRQoL. The use of a single score enables a simple and consistent assessment of the impact of conditions and how this varies across the population. Economists term PW_HRQoL scores health utilities.What this study adds?This is the first study to estimate how the impact of multimorbidity on PW_HRQoL scores varies by age group and socioeconomic deprivation. Multimorbidity has a substantial negative impact on HRQoL which is most severe in areas of deprivation, especially in younger adults.Measuring the burden of multimorbidity using PW_HRQoL provides consistency with how economists measure HRQoL; changes in which can be used in economic evaluation to assess the cost effectiveness of interventions.

【 授权许可】

CC BY   
© Lawson et al.; licensee BioMed Central Ltd. 2013