Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project
Cite this article as: Alonso, J., Ferrer, M., Gandek, B. et al. Qual Life Res (2004) 13: 283. doi:10.1023/B:QURE.0000018472.46236.05 Abstract Context: Few studies and no international comparisons have examined the impact of multiple chronic conditions on populations using a comprehensive health-related quality of life (HRQL) questionnaire. Objective: The impact of common chronic conditions on HRQL among the general populations of eight countries was assessed. Design: Cross-sectional mail and interview surveys were conducted. Participants and setting: Sample representatives of the adult general population of eight countries (Denmark, France, Germany, Italy, Japan, the Netherlands, Norway and the United States) were evaluated. Sample sizes ranged from 2031 to 4084. Main outcome measures: Self-reported prevalence of chronic conditions (including allergies, arthritis, congestive heart failure, chronic lung disease, hypertension, diabetes, and ischemic heart disease), sociodemographic data and the SF-36 Health Survey were obtained. The SF-36 scale and summary scores were estimated for individuals with and without selected chronic conditions and compared across countries using multivariate linear regression analyses. Adjustments were made for age, gender, marital status, education and the mode of SF-36 administration. Results: More than half (55.1%) of the pooled sample reported at least one chronic condition, and 30.2% had more than one. Hypertension, allergies and arthritis were the most frequently reported conditions. The effect of ischemic heart disease on many of the physical health scales was noteworthy, as was the impact of diabetes on general health, or arthritis on bodily pain scale scores. Arthritis, chronic lung disease and congestive heart failure were the conditions with a higher impact on SF-36 physical summary score, whereas for hypertension and allergies, HRQL impact was low (comparing with a typical person without chronic conditions, deviation scores were around −4 points for the first group and −1 for the second). Differences between chronic conditions in terms of their impact on SF-36 mental summary score were low (deviation scores ranged between −1 and −2). Conclusions: Arthritis has the highest HRQL impact in the general population of the countries studied due to the combination of a high deviation score on physical scales and a high frequency. Impact of chronic conditions on HRQL was similar roughly across countries, despite important variation in prevalence. The use of HRQL measures such as the SF-36 should be useful to better characterize the global burden of disease. Chronic disease Comorbidity Health status Health Survey Quality of life Questionnaire References
Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey Manual and Interpretation Guide. Boston, MA: The Health Institute, 1993.
Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: A World Health Organization Study in Primary Care. JAMA 1998; 280(2): 147-151.
Goldberg DP, Gater R, Sartorius N, et al. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 1997; 27(1): 191-197.
Donovan JL, Kay HE, Peters TJ, et al. Using the ICSOoL to measure the impact of lower urinary tract symptoms on quality of life: Evidence from the ICS-‘BPH’ Study. International Continence Society-Benign Prostatic Hyperplasia. Br J Urol 1997; 80(5): 712-721.
Patrick DL, Erickson P. Health Status and Health Policy. Allocating Resources to Health Care. New York: Oxford University Press, Inc., 1993.
Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA 1989; 262(7): 907-913.
Kempen GI, Ormel J, Brilman EI, Relyveld J. Adaptive responses among Dutch elderly: The impact of eight chronic medical conditions on health-related quality of life. Am J Public Health 1997; 87(1): 38-44.
Schlenk EA, Erlen JA, Dunbar-Jacob J, et al. Health-related quality of life in chronic disorders: A comparison across studies using the MOS SF-36. Qual Life Res 1998; 7(1): 57-65.
Mallon E, Newton JN, Klassen A, Stewart-Brown SL, Ryan TJ, Finlay AY. The quality of life in acne: A comparison with general medical conditions using generic questionnaires. Br J Dermatol 1999; 140(4): 672-676.
Komaroff AL, Fagioli LR, Doolittle TH, et al. Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups. Am J Med 1996; 101(3): 281-290.
Candilis PJ, McLean RY, Otto MW, et al. Quality of life in patients with panic disorder. J Nerv Ment Dis 1999; 187(7): 429-434.
Fanuele JC, Birkmeyer NJ, Abdu WA, Tosteson TD, Weinstein JN. The impact of spinal problems on the health status of patients: Have we underestimated the effect? SPINE 2000; 25(12): 1509-1514.
Singer MA, Hopman WM, MacKenzie TA. Physical functioning and mental health in patients with chronic medical conditions. Qual Life Res 1999; 8(8): 687-691.
Given CW, Given B, Azzouz F, Stommel M, Kozachik S. Comparison of changes in physical functioning of elderly patients with new diagnoses of cancer. Med Care 2000; 38(5): 482-493.
Aaronson NK, Acquadro C, Alonso J, et al. International Quality of Life Assessment (IQOLA) Project. Qual Life Res 1992; 1(5): 349-351.
Gandek B, Ware JE Jr. Methods for validating and norming translations of health status questionnaires: The IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol 1998; 51(11): 953-959.
Ware JE Jr, Keller SD, Gandek B, Brazier JE, Sullivan M. Evaluating translations of health status questionnaires. Methods from the IQOLA project. International Quality of Life Assessment. Int J Technol Assess Health Care 1995; 11(3): 525-551.
Special issue. Translating functional health and well-being: International Quality of Life Assessment (IQOLA) Project Studies of the SF-36 Health Survey. Issue dedicated to Denis Bucquet. J Clin Epidemiol 1998; 51(11): 891-1214.
Wagner AK, Gandek B, Aaronson NK, et al. Cross-cultural comparisons of the content of SF-36 translations across 10 countries: Results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51(11): 925-932.
Gandek B, Ware JE Jr, Aaronson NK, et al. Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: Results from the IQOLA project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51(11): 1149-1158.
Raczek AE, Ware JE, Bjorner JB, et al. Comparison of Rasch and summated rating scales constructed from SF-36 physical functioning items in seven countries: Results from the IQOLA project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51(11): 1203-1214.
Aaronson NK, Muller M, Cohen PD, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998; 51(11): 1055-1068.
Ware JE, Kosinski M, Keller SD. SF-36 Physical and Mental Health Summary Scales: A User's Manual. Boston, MA: 1994.
Ware JE Jr, Kosinski M, Gandek B, et al. The factor structure of the SF-36 Health Survey in 10 countries: Results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51(11): 1159-1165.
Ware JE, Jr, Gandek B, Kosinski M, et al. The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: Results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51(11): 1167-1170.
Fukuhara S, Ware JE Jr, Kosinski M, Wada S, Gandek B. Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey. J Clin Epidemiol 1998; 51(11): 1045-1053.
Kjøller M, Rasmussen NK, Keiding L, Petersen HC, Nielsen GA. Sundhed og sygelighed I Danmark og udviklingen siden. rapport fra DIKEs repræsentative undersøgelse blandt voksne danskere, editor. 1987. København: DIKE, 1995.
Ware JE, Bayliss MS, Rogers WH, Kosinski M, Tarlow AR. Differences in 4-year health outcomes for elderly and poor, chronically III patients treated in HMO and fee-for-service systems Results from the Medical Outcomes Study. JAMA 1996; 276: 1039-1047.
McHorney CA, Kosinski M, Ware JE Jr. Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: Results from a national survey. Med Care 1994; 32(6): 551-567.
StataCorp. Stata Statistical Software: Release 5.0. College Station, TX: Stata Corporation, 1997.
Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care 1989; 27(suppl 3): S178-S189.
Lawrence K, McWhinnie D, Goodwin A, et al. Randomised controlled trial of laparoscopic versus open repair of inguinal hernia: Early results. Br Med J 1995; 311: 981-985.
Mahajan P, Okamoto LJ, Schaberg A, Kellerman D, Schoenwetter WF. Impact of fluticasone propionate powder on health-related quality of life in patients with moderate asthma. J Asthma 1997; 34(3): 227-234.
Watson RG, Tham TC, Johnston BT, McDougall NI. Double blind cross-over placebo controlled study of omeprazole in the treatment of patients with reflux symptoms and physiological levels of acid reflux — the 'sensitive oesophagus'. Gut 1997; 40(5): 587-590.
Bennett LS, Barbour C, Langford B, Stradling JR, Davies RJ. Health status in obstructive sleep apnea: Relationship with sleep fragmentation and daytime sleepiness, and effects of continuous positive airway pressure treatment. Am J Respir Crit Care Med 1999; 159(6): 1884-1890.
Devins GM, Edworthy SM, Seland TP, Klein GM, Paul LC, Mandin H. Differences in illness instrusiveness across rheumatoid arthritis, end-stage renal disease, and multiple sclerosis. J Nerv Ment Dis 1993; 181: 377-381.
Ball P, Make B. Acute exacerbations of chronic bronchitis: An international comparison. Chest 1998; 113(suppl 3): 199S-204S.
Harlow SD, Linet MS. Agreement between questionnaire data and medical records. The evidence for accuracy of recall. Am J Epidemiol 1989; 129(2): 233-248.
Mackenbach JP, Looman CW, van der Meer JB. Differences in the misreporting of chronic conditions, by level of education: The effect on inequalities in prevalence rates. Am J Public Health 1996; 86(5): 706-711.
Midthjell K, Holmen J, Bjorndal A, Lund-Larsen G. Is questionnaire information valid in the study of a chronic disease such as diabetes? The Nord-Trondelag diabetes study. J Epidemiol Community Health 1992; 46(5): 537-542.
Tretli S, Lund-Larsen PG, Foss OP. Reliability of questionnaire information on cardiovascular disease and diabetes: Cardiovascular disease study in Finnmark county. J Epidemiol Community Health 1982; 36(4): 269-273.
Payer L. Medicine and Culture. New York: Henry Holt and Company, 1988.
Alonso J, Regidor E, Barrio G, Prieto L, Rodríguez C, De La Fuente De Hoz L. Valores poblacionales de referencia de la versión española del Cuestionario de Salud SF-36. Med Clin (Barc) 1998; 111(11): 410-416.
Ferrer M, Alonso J, Morera J, et al. Chronic obstructive pulmonary disease stage and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group. Ann Intern Med 1997; 127(12): 1072-1079.
McHorney CA. Health status assessment methods for adults: Past accomplishments and future challenges. Annu Rev Public Health 1999; 20: 309-335.
Hyder AA, Rotllant G, Morrow RH. Measuring the burden of disease: Healthy life-years. Am J Public Health 1998; 88(2): 196-202.
Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349: 1436-1442.
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