Are health-related quality of life and self-rated health associated with mortality? Insights from Translating Research Into Action for Diabetes (TRIAD)

Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Primary Care Diabetes (Impact Factor: 1.33). 02/2009; 3(1):37-42. DOI: 10.1016/j.pcd.2009.01.001
Source: PubMed


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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    • "A variety of studies have been implemented to explain the correlations between dietary patterns and cardiovascular diseases and hypertension [9-11]. High intakes of fruits, vegetables, cereals, fishes, nuts, low-fat dairy products and poultry in addition to relatively low intakes of fat and sugars appeared to be effective in lowering blood pressures and hypertensions [12,13]. "
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    ABSTRACT: The objective of this study is to identify the dietary patterns associated with the risk of hypertensions among Korean adults using data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2008-2010). This study analyzes data from 11,883 subjects who participated in the health and nutrition survey, aging from 20 to 64 years. We performed factor analysis based on the weekly mean intake frequencies of 36 food groups to identify major dietary patterns. We identified three major dietary patterns in both sexes, namely "traditional", "western" and "dairy and carbohydrate" patterns. Participants in the highest quartile of western pattern scores had significantly higher blood pressure, serum total cholesterol, and triglyceride levels than those in the lowest quartile. Although not statistically significant, a trend (P for trend = 0.0732) toward a positive association between the western dietary pattern and hypertension risk was observed after adjustments for age, sex, education, income, body mass index (BMI), smoking, physical activity, and energy intake. The dairy and carbohydrate pattern was inversely related with BMI and blood pressures and positively associated with serum high-density lipoprotein (HDL)-cholesterol. After adjusting the age, sex, education, income, BMI, smoking, physical activity and energy intake, the dairy and carbohydrate pattern showed inverse associations with hypertension prevalence (OR = 0.64, 95% CI = 0.55-0.75; P for trend < 0.0001). Intakes of fiber, sodium, and antioxidant vitamins were significantly higher in the top quartile for the traditional pattern than in the lowest quartile for the traditional pattern (P for trend < 0.0001). Intakes of fiber (P for trend < 0.0001), calcium (P for trend < 0.0001), retinol (P for trend = 0.0164), vitamin B1 (P for trend = 0.001), vitamin B2 (P for trend < 0.0001), niacin (P for trend = 0.0025), and vitamin C (P for trend < 0.0001) were significantly increased across quartiles for the dairy and carbohydrate pattern whereas sodium (P for trend < 0.0001) intake was decreased for this pattern. In conclusion, the dairy and carbohydrate pattern may be associated with a reduced risk of hypertension whereas the western pattern may be associated with an increased risk of hypertension among Korean adults.
    Full-text · Article · Jun 2013 · Nutrition research and practice
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    • "Subjective assessment of health related quality of life (HRQOL) is an important health outcome not only because it captures a person’s perception of their overall health status, but also because it can inform resource allocation decisions. Recent research demonstrates that HRQOL is an independent predictor of mortality in people with diabetes [1-4]. Our previous research has also found that a self-perceived negative profile on the physical health domains of HRQOL in people with diabetes can predict those who are at higher risk for hospital admission even after taking into account known risk factors [5]. "
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    ABSTRACT: Background Reduced health related quality of life (HRQOL) has been associated with increased mortality in individuals with diabetes. In contrast, increased leisure time physical activity (LTPA) has been associated with reduced mortality. The aim of this study was to investigate the combined relationship of HRQOL and LTPA on mortality and whether high levels of LTPA are associated with reduced risk of mortality in adults with diabetes and inferior HRQOL. Methods We analyzed data from a national sample of adults (18 years or older) with self-reported physician-diagnosed diabetes, who participated in the 2001 National Health Interview Survey in Taiwan (N = 797). A total of 701 participants had complete Short Form 36 (SF-36) and LTPA data and were followed from 2002 to 2008. Participants were divided into 3 groups based on their LTPA: (1) a regularly active group who reported 150 or more min/week of moderate-intensity activity; (2) an intermediately active group who reported engaging in LTPA but did not meet the criterion for the “regular” category; and (3) an inactive group who reported no LTPA. The physical component summary (PCS) and mental component summary (MCS) scores were dichotomised at the median (high vs. low) (PCS = 45.11; MCS = 47.91). Cox proportional-hazards models were used to investigate associations between baseline characteristics and mortality. Results After 4,570 person-years of follow-up, 121 deaths were recorded and the crude mortality rate was 26.5 per 1,000 person-years. Both PCS scores and LTPA were significant predictors of mortality, whereas no significant relationship was observed between MCS and mortality. After adjustment for other factors, participants with low PCS who reported no LTPA had a hazard ratio (HR) for mortality of 4.49 (95% CI = [2.15-9.36]). However, participants with low PCS who were active (including intermediate and regular LTPA) had a HR for mortality of 1.36 (95% CI = [0.64-2.92]). Conclusions Our results show a significantly increased mortality risk of diabetes associated with reduced HRQOL in individuals who report no LTPA. Engaging in LTPA may be associated with improved survival in participants with diabetes with poor self-rated physical health status.
    Full-text · Article · Jan 2013 · BMC Public Health
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    • "Advanced age is a risk factor for poor general health [17,18] and diabetes [19]. The sexual lives of individuals are influenced by several health and socio-demographic factors. "
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    ABSTRACT: Background Few studies have investigated sexual dysfunction in immigrant patients with type 2 diabetes in Sweden. The aim of this study was to examine the association between ethnicity and sexual dysfunction and to analyze if this association remains after adjusting for explanatory variables including age, marital status, HbA1c, triglycerides, and hypertension. This cross-sectional study was conducted at four primary health care centers in the Swedish town of Södertälje. A total of 354 persons with type 2 diabetes (173 Assyrians/Syrians and 181 Swedish-born patients) participated in the survey. The main outcome measure was the self-reported presence of sexual dysfunction based on two questions, one regarding loss of ability to have sexual intercourse and the other loss of sexual desire. Response rates were 78% and 86%, respectively. Findings The total prevalence of loss of ability to have intercourse was 29.5%. In the multivariate models, the odds of loss of ability to have intercourse was significantly higher in the oldest age group (OR = 5.80; 95% CI, 2.33–14.40), in men (OR = 3.33; 95% CI, 1.33–8.30), and in unmarried individuals (OR = 2.40; 95% CI, 1.02–5.70). The odds of reporting loss of sexual desire was higher in Assyrians/Syrians than in Swedish-born patients and increased from 2.00 in the age- and gender-adjusted model to 2.70 in the fully adjusted model when all confounders were taken into account. Conclusions Sexual dysfunction appears to be more common in Assyrians/Syrians than in Swedish-born patients. Health care workers should actively ask about sexual function in their patients with type 2 diabetes.
    Full-text · Article · Sep 2012 · BMC Research Notes
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