Are health-related quality-of-life and self-rated health associated with mortality? Insights from Translating Research Into Action for Diabetes (TRIAD).
ABSTRACT To determine if health-related quality-of-life and self-rated health are associated with mortality in persons with diabetes.
Survey and medical record data were obtained from 7892 patients with diabetes in Translating Research Into Action for Diabetes (TRIAD), a multicenter prospective observational study of diabetes care in managed care. Vital status at follow-up was determined from the National Death Index. Multivariable proportional hazard models were used to determine if a generic measure of health-related quality-of-life (EQ-5D) and self-rated health measured at baseline were associated with 4-year all-cause, cardiovascular, and noncardiovascular mortality.
At baseline, the mean EQ-5D score for decedents was 0.73 (S.D.=0.20) and for survivors was 0.81 (S.D.=0.18) (p<0.0001). Fifty-five percent of decedents and 36% of survivors (p<0.0001) rated their health as fair or poor. Lower EQ-5D scores and fair or poor self-rated health were associated with higher rates of mortality after adjusting for the demographic, socioeconomic, and clinical risk factors for mortality.
Health-related quality-of-life and self-rated health predict mortality in persons with diabetes. Health-related quality-of-life and self-rated health may provide additional information on patient risk independent of demographic, socioeconomic, and clinical risk factors for mortality.
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ABSTRACT: Aim: To evaluate the effect of diabetes onset on health-related quality of life (HRQoL) in men. Methods: A prospective cohort study with a 34-year follow-up (The Helsinki Businessmen Study, Finland). A socio-economically homogenous group of 1815 men (born 1919-1934), free of diabetes and clinically healthy in 1974, when cardiovascular risk factors were measured and self-related health (SRH) evaluated with a five-step scale. In 2000 and 2007, HRQoL was assessed with a questionnaire, including the RAND-36 (SF-36) instrument. Incidence of diabetes up to 2007 was retrieved using the National Reimbursement Register for diabetes medication, or from questionnaire surveys between 2000 and 2007. Onset of diabetes was divided as follows: 1991 or earlier, 1992-1995, 1996-2000, 2001-2003, 2004-2007. Results: Altogether 216 men (11.9%) developed diabetes during the 34-year follow-up, and they had more cardiovascular risk factors at baseline than those without diabetes. According to the evaluation in 2000, and compared to men free of diabetes during follow-up, three RAND-36 scales (physical function, general health, social functioning) were significantly worsened already after 0-4 years from diabetes onset and did not deteriorate thereafter. Instead, HRQoL was not worsened up to 7 years before diabetes onset (between 2000 and 2007). No consistent impact of diabetes was observed on mental health-related scales. Conclusion: Diabetes does not affect physical health-related quality of life until after diabetes onset. Lack of an association between the prediabetic state and HRQoL may offer an important window for the prevention and argument for early detection also from the HRQoL viewpoint.European geriatric medicine 09/2013; 4(4):217-220. DOI:10.1016/j.eurger.2013.04.009 · 0.55 Impact Factor
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ABSTRACT: Health-related quality of life (HRQoL) is considered a representative outcome in the evaluation of chronic disease management initiatives emphasizing patient-centered care. We evaluated the association between receipt of processes-of-care (PoC) for diabetes and HRQoL. This cross-sectional study used self-reported data from non-institutionalized adults with diabetes in a Swiss canton. Outcomes were the physical/mental composites of the short form health survey 12 (SF-12) physical composite score, mental composite score (PCS, MCS) and the Audit of Diabetes-Dependent Quality of Life (ADDQoL). Main exposure variables were receipt of six PoC for diabetes in the past 12 months, and the Patient Assessment of Chronic Illness Care (PACIC) score. We performed linear regressions to examine the association between PoC, PACIC and the three composites of HRQoL. Mean age of the 519 patients was 64.5 years (SD 11.3); 60% were male, 87% reported type 2 or undetermined diabetes and 48% had diabetes for over 10 years. Mean HRQoL scores were SF-12 PCS: 43.4 (SD 10.5), SF-12 MCS: 47.0 (SD 11.2) and ADDQoL: -1.6 (SD 1.6). In adjusted models including all six PoC simultaneously, receipt of influenza vaccine was associated with lower ADDQoL (β=-0.4, p≤0.01) and foot examination was negatively associated with SF-12 PCS (β=-1.8, p≤0.05). There was no association or trend towards a negative association when these PoC were reported as combined measures. PACIC score was associated only with the SF-12 MCS (β=1.6, p≤0.05). PoC for diabetes did not show a consistent association with HRQoL in a cross-sectional analysis. This may represent an effect lag time between time of process received and health-related quality of life. Further research is needed to study this complex phenomenon.01/2015; 3(1):e000042. DOI:10.1136/bmjdrc-2014-000042