Evidence of Spillover of Illness among Household Members: EQ-5D Scores from a US Sample

Center for Health Decision Science, Harvard School of Public Health, Boston, MA (EW).
Medical Decision Making (Impact Factor: 2.27). 10/2012; 33(2). DOI: 10.1177/0272989X12464434
Source: PubMed

ABSTRACT BACKGROUND: / OBJECTIVES: : The effects of illness extend beyond the individual to caregivers and family members. This study identified evidence of spillover of illness onto household members' health-related quality of life. METHODS: Medical Expenditures Panel Survey (MEPS) data from 2000-2003 were analyzed using multivariable regression to identify spillover of household members' chronic conditions onto individuals' health-related quality of life as measured by the EuroQol-5D (EQ-5D) score (N = 24,188). Spillover was assessed by disease category, timing of occurrence (preexisting or new conditions), and age of the household member (adult or child). RESULTS: : Controlling for an individual's own health conditions and other known predictors of EQ-5D scores, the authors found that the odds of an individual reporting full health (an EQ-5D score of 1.0, relative to <1.0) were lower with the presence of existing mental (odds ratio 0.71; 95% confidence interval, 0.64-0.79), respiratory (0.85; 0.75-0.97), and musculoskeletal (0.83; 0.75-0.93) conditions among adults and with mental (0.72; 0.62-0.82) and respiratory (0.80; 0.81-0.96) conditions among children in the household. The odds of an individual reporting full health were also lower for newly occurring chronic conditions in the household, including adults' mental (0.79; 0.65-0.97), nervous/sensory system (0.76; 0.61-0.96), and musculoskeletal (0.78; 0.65-0.95) conditions and children's mental conditions (0.64; 0.48-0.86). EQ-5D dimensions may be unsuited to fully capture spillover utility among household members, and MEPS lacks condition severity and caregiver status among household members. CONCLUSIONS: : Evidence from a US sample suggests that individuals who live with chronically ill household members have lower EQ-5D scores than those who live either alone or with healthy household members. Averting spillover effects may confer substantial additional benefit at the population level for interventions that prevent or alleviate conditions that incur such effects.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Given the broad scope of the spillover effects of illness, it is important to characterize the variability in these outcomes to identify relationship types in which secondary impacts of illness are particularly important to include in health economic evaluations. To examine heterogeneity in spillover effects of chronic conditions on family members by type of familial relationship with patient. Adults (aged ≥18 years) and adolescents (aged 13-17 years) who had a parent, spouse, or child in their household with a chronic condition (Alzheimer's disease/dementia, arthritis, cancer, or depression) were recruited from a US national panel to participate in an on-line survey. Respondents were asked to rate the spillover effect of their family member's illness on their own health on a 0-100 scale, with lower scores indicating greater spillover. Regression analysis was used to evaluate the association between rating scale scores and relationship with an ill family member (ill parent, child, or spouse) for each illness separately, controlling for caregiving responsibility and the health status of the ill family member. 1,267 adults and 102 adolescents met inclusion criteria. In adjusted analyses, having a sick child was significantly (p < 0.05) associated with lower rating scale scores compared with having a spouse with the same condition (cancer: -24.2; depression -9.7). Having a non-elderly or elderly adult parent with a condition, compared with a spouse, was significantly associated with lower rating scale scores for arthritis (-3.8) and depression (-5.3), but not for Alzheimer's disease/dementia or cancer. The impact of illness on family members, measured with a rating scale, varies by relationship type for certain illnesses. Having a child with cancer, a parent with arthritis, or either with depression, is significantly associated with greater spillover, compared with having a spouse with one of these conditions.
    Applied Health Economics and Health Policy 03/2014; DOI:10.1007/s40258-014-0079-8
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Several behavioral interventions, based on social enrichment and observational learning are applied in treatment of neuropsychiatric disorders. However, the mechanism of such modulatory effect and the safety of applied methods on individuals involved in social support need further investigation. We took advantage of known differences between inbred mouse strains to reveal the effect of social enrichment on behavior and neurobiology of animals with different behavioral phenotypes. C57BL/6 and DBA/2 female mice displaying multiple differences in cognitive, social, and emotional behavior were group-housed either in same-strain or in mixed-strain conditions. Comprehensive behavioral phenotyping and analysis of expression of several plasticity- and stress-related genes were done to measure the reciprocal effects of social interaction between the strains. Contrary to our expectation, mixed housing did not change the behavior of DBA/2 mice. Nevertheless, the level of serum corticosterone and the expression of glucocorticoid receptor Nr3c1 in the brain were increased in mixed housed DBA/2 as compared with those of separately housed DBA/2 mice. In contrast, socially active C57BL/6 animals were more sensitive to the mixed housing, displaying several signs of stress: alterations in learning, social, and anxiety-like behavior and anhedonia. These behavioral impairments were accompanied by the elevated serum corticosterone and the reduced expression of Nr3c1, as well as the elevated Bdnf levels in the cortex and hippocampus. Our results demonstrate the importance of social factors in modulation of both behavior and the underlying neurobiological mechanisms in stress response, and draw attention to the potential negative impact of social interventions for individuals involved in social support.
    Frontiers in Behavioral Neuroscience 08/2014; 8:257. DOI:10.3389/fnbeh.2014.00257 · 4.16 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Applications of cost-effectiveness analysis do not typically incorporate effects on caregiver quality of life despite increasing evidence that these effects are measurable.
    Medical Decision Making 07/2014; DOI:10.1177/0272989X14541328 · 2.27 Impact Factor