Relative impact of multimorbid chronic conditions on health-related quality of life--results from the MultiCare Cohort Study.
Relative impact of multimorbid chronic conditions on health-related quality of life--results from the MultiCare Cohort Study.
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DOI：
10.1371/journal.pone.0066742
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发表时间：
2013-01-01
期刊：
影响因子：
3.7
通讯作者：
Konig, Hans-Helmut
中科院分区：
文献类型：
--
作者：
Brettschneider, Christian;Leicht, Hanna;Konig, Hans-Helmut
背景：多发病对健康相关的生活质量(HRQL)有负面影响。以前的研究只包括有限数量的条件。在这项研究中，我们分析了在没有预先选择特定疾病的情况下，大量条件对多病患者HRQL的影响。我们还探讨了这些条件对HRQL的特定维度的影响。材料和方法：这项分析基于对3189名年龄在65岁至85岁的多病初级保健患者的多中心前瞻性队列研究。分析了45种条件对HRQL的影响。对病情的严重性进行了评级。采用EQ-5D，包括5个维度和一个视觉模拟量表(EQ-VAS)。数据分析采用多重普通最小二乘法和多元Logistic回归。以加权计数分数衡量的多病与较低的总体HRQL(EQ-VAS)显著相关，b = -1.02(SE：0.06)。帕金森病对总体高分辨生活质量(EQ-VAS)的负面影响最显著，b = -12.29(SE：2.18)，其次是风湿、抑郁和肥胖。在EQ-5D的各个维度上，除焦虑/抑郁维度外，抑郁(OR = 1.39~3.33)和肥胖(OR = 1.44~1.95)对EQ-5D的所有五个维度都有负向影响。肥胖对这一维度有正向影响，OR = 为0.78(SE：0.07)。“自理”维度OR = 4.52(SE：1.37)和“日常活动”OR = 3.59(SE：1.0)对帕金森氏症的影响最大。作为一个限制，我们的样本可能只代表最多中等疾病严重程度的患者。结论：多病患者的总体HRQL随着病情的增加和严重程度的增加而降低。帕金森氏症、抑郁和肥胖对HRQL的影响最大。进一步的研究应该解决疾病组合的影响，这些疾病组合需要非常大的样本量和先进的统计方法。
BACKGROUND: Multimorbidity has a negative impact on health-related quality of life (HRQL). Previous studies included only a limited number of conditions. In this study, we analyse the impact of a large number of conditions on HRQL in multimorbid patients without preselecting particular diseases. We also explore the effects of these conditions on the specific dimensions of HRQL.MATERIALS AND METHODS: This analysis is based on a multicenter, prospective cohort study of 3189 multimorbid primary care patients aged 65 to 85. The impact of 45 conditions on HRQL was analysed. The severity of the conditions was rated. The EQ-5D, consisting of 5 dimensions and a visual-analogue-scale (EQ VAS), was employed. Data were analysed using multiple ordinary least squares and multiple logistic regressions. Multimorbidity measured by a weighted count score was significantly associated with lower overall HRQL (EQ VAS), b = -1.02 (SE: 0.06). Parkinson's disease had the most pronounced negative effect on overall HRQL (EQ VAS), b = -12.29 (SE: 2.18), followed by rheumatism, depression, and obesity. With regard to the individual EQ-5D dimensions, depression (OR = 1.39 to 3.3) and obesity (OR = 1.44 to 1.95) affected all five dimensions of the EQ-5D negatively except for the dimension anxiety/depression. Obesity had a positive effect on this dimension, OR = 0.78 (SE: 0.07). The dimensions "self-care", OR = 4.52 (SE: 1.37) and "usual activities", OR = 3.59 (SE: 1.0), were most strongly affected by Parkinson's disease. As a limitation our sample may only represent patients with at most moderate disease severity.CONCLUSIONS: The overall HRQL of multimorbid patients decreases with an increasing count and severity of conditions. Parkinson's disease, depression and obesity have the strongest impact on HRQL. Further studies should address the impact of disease combinations which require very large sample sizes as well as advanced statistical methods.