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Health-related quality of life and comorbidity among older women veterans in the United States

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Abstract

Purpose

This paper examines the predictors of quality of life among older women (≥65 years of age) veterans in the United States focusing on the effect of comorbidity on health-related quality of life (HRQOL).

Methods

Data from the National Survey of Women Veterans, a cross-sectional nationally representative population-based, stratified random sample of women veterans, were used with an analytic sample size of 1,379 older women veterans. The SF12 physical and mental composite scores (PCS and MCS) were used as outcome measures, and a weighted comorbidity index was used as a covariate.

Results

Older women veterans who are married, employed, with higher income, and higher education have better physical health (PCS). For mental health, education is positively correlated, whereas depression and posttraumatic stress disorder are negatively correlated with MCS. After adjusting for socio-demographic, mental health, and chronic health indicators, the results showed that SF12 PCS varied by VA use status for each level of Seattle Index of Comorbidity. The same pattern was not found for MCS.

Conclusion

For each level of comorbidity, VA users have worse HRQOL which might suggest that case mix adjustments comparing VA users and non-VA users must take into account more than comorbidity alone.

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References

  1. Skinner, K., Kressin, N., Frayne, S., et al. (2000). The prevalence of military sexual assault among female Veterans Administration outpatients. Journal of Interpersonal Violence, 15, 289–309.

    Article  Google Scholar 

  2. Wolfe, J., Schnurr, P. P., Brown, P. J., et al. (1994). Comparing the health status of male and female veterans who use VA health care: Results from the VA Women’s Health Project. Women and Health, 29, 17–33.

    Google Scholar 

  3. Schnurr, P. P., & Lunney, C. A. (2008). Exploration of gender differences in how quality of life relates to posttraumatic stress disorder in male and female veterans. Journal of Rehabilitation Research and Development, 45, 383–394.

    Article  PubMed  Google Scholar 

  4. Davis, T. M., Bush, K. R., Kivlahan, D. R., Dobie, D. J., & Bradley, K. A. (2003). Screening for substance abuse and psychiatric disorders among women patients in a VA Health Care System. Psychiatric Services, 54, 214–218.

    Article  PubMed  Google Scholar 

  5. Washington, D. L., Davis, T. D., Der-Martirosian, C., & Yano, E. M. (2013). PTSD risk and mental health care engagement in a multi-war era community sample of women veterans. Journal of General Internal Medicine (in press).

  6. Murdoch, M., & Nichol, K. L. (1995). Women veterans’ experiences with domestic violence and with sexual harassment while in the military. Archives of Family Medicine, 4, 411–418.

    Article  PubMed  CAS  Google Scholar 

  7. Turner, C., & Frayne, S. (Eds.). (2004). Veterans health initiative: Military sexual trauma. http://www.va.gov/VHI/. Washington, DC: Department of Veterans Affairs Employee Education System and the Center for Women’s Health.

  8. Frayne, S. M., Skinner, K. M., Sullivan, L. M., et al. (1999). Medical profile of women Veterans Administration outpatients who report a history of sexual assault occurring while in the military. Journal of Women’s Health and Gender-Based Medicine, 8, 835–845.

    Article  PubMed  CAS  Google Scholar 

  9. Hankin, C. S., Skinner, K. M., Sullivan, L. M., et al. (1999). Prevalence of depressive and alcohol abuse symptoms among women VA outpatients who report experiencing sexual assault while in the military. Journal of Traumatic Stress, 12, 601–612.

    Article  PubMed  CAS  Google Scholar 

  10. Kimerling, R., Clum, G. A., & Wolfe, J. (2000). Relationships among trauma exposure chronic posttraumatic stress disorder symptoms, and self-reported health in women: Replication and extension. Journal of Traumatic Stress, 13, 115–128.

    Article  PubMed  CAS  Google Scholar 

  11. Bader, G., Ragsdale, K. G., & Franchina, J. J. (2001). Screening for mental health illness in a Veterans Affairs women’s health clinic. Psychiatric Services, 52, 1521–1522.

    Article  PubMed  CAS  Google Scholar 

  12. Escalona, R., Achilles, G., Waitzkin, H., & Yager, J. (2004). PTSD and somatization in women treated at a VA primary care clinic. Psychosomatics, 45, 291–296.

    Article  PubMed  Google Scholar 

  13. Grubaugh, A. L., Monnier, J., Magruder, K. M., Knapp, R. G., & Frueh, B. C. (2006). Female veterans seeking medical care at Veterans Affairs primary care clinics: Psychiatric and medical illness burden and service use. Women and Health, 43, 41–62.

    Article  PubMed  Google Scholar 

  14. Candilis, P. J., McLean, R. Y., Otto, M. W., Manfro, G. G., Washington, J. J, I. I. I., Penava, S. J., et al. (1999). Quality of life in patients with panic disorder. The Journal of Nervous and Mental Disease, 187(7), 429–434.

    Article  PubMed  CAS  Google Scholar 

  15. Ouimette, P., Cronkite, R., Henson, B. R., Prins, A., Gima, K., & Moos, R. H. (2004). Posttraumatic stress disorder and health status among female and male medical patients. Journal of Traumatic Stress, 17, 1–9.

    Article  PubMed  Google Scholar 

  16. Linzer, M., Spitzer, R., Kroenke, K., Williams, J. B., Hahn, S., Body, D., et al. (1996). Gender, quality of life, and mental disorders in primary care: Results from the PRIME-MD 1000 study. American Journal of Medicine, 101(5), 526–533.

    Article  PubMed  CAS  Google Scholar 

  17. Pyne, J. M., Patternson, T. L., Kaplan, R. M., Gillin, J. C., Koch, W. L., & Grant, I. (1997). Assessment of the quality of life of patients with major depression. Psychiatric Services (Washington, DC), 48(2), 224–230.

    CAS  Google Scholar 

  18. Barrett, D. H., Doebbeling, C. C., Schwartz, D. A., Voelker, M. D., Falter, K. H., Woolson, R. F., et al. (2002). Posttraumatic stress disorder and self-reported physical health status among U.S. Military personnel serving during the Gulf War period: A population-based study. Psychosomatics, 43(3), 195–205.

    Article  PubMed  Google Scholar 

  19. Forman-Hoffman, V. L., Carney, C. P., Sampson, T. R., Peloso, P. M., Woolson, R. F., Black, D. W., et al. (2005). Mental health comorbidity patterns and impact on quality of life among veterans serving during the first Gulf War. Quality of Life Research, 14, 2303–2314.

    Article  PubMed  Google Scholar 

  20. Kazis, L. E., Miller, D. R., Clark, J., Skinner, K., Lee, A., Rogers, W., et al. (1998). Health- related quality of life in patients served by the Department of Veterans Affairs results from the Veterans Health Study. Archives of Internal Medicine, 158(6), 626–632.

    Article  PubMed  CAS  Google Scholar 

  21. Wallace, A. E., Weeks, W. B., Wang, S., Lee, A. F., & Kazis, L. E. (2006). Rural and urban disparities in health-related quality of life among veterans with psychiatric disorders. Psychiatric Services, 57, 851–856.

    Article  PubMed  Google Scholar 

  22. Weeks, W. B., Wallace, A. E., Wang, S., Lee, A., & Kazis, L. E. (2006). Rural-urban disparities in health-related quality of life within disease categories of veterans. Health Status, 22(3), 204–211.

    Google Scholar 

  23. Adler, N., Boyce, W., Chesney, M., Folkman, S., & Syme, S. (1993). Socioeconomic inequalities in health: No easy solution. Journal of the American Medical Association, 269, 3140–3145.

    Article  PubMed  CAS  Google Scholar 

  24. Frayne, S. M., Parker, V. A., Christiansen, C. L., Loveland, S., Seaver, M. R., Kazis, L. E., et al. (2006). Health status among 28,000 women veterans. Journal of General Internal Medicine, 21, S40–S46.

    Article  PubMed  Google Scholar 

  25. Alonso, J. F., Ferrer, M., Gandek, B., Ware, J., Aaronson, N., Mosconi, P., et al. (2004). Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project. Quality of Life Research, 13, 283–298.

    Article  PubMed  Google Scholar 

  26. Fortin, M., Bravo, G., Hudon, C., Lapointe, L., Almirall, J., Dubois, M., et al. (2006). Relationship between multimorbidity and health-related quality of life of patients in primary care. Quality of Life Research, 15, 83–91.

    Article  PubMed  Google Scholar 

  27. Tooth, L., Hockey, R., Byles, J., & Dobson, A. (2008). Weighted multimorbidity indexes predicted mortality, health service use, and health-related quality of life in older women. Journal of Clinical Epidemiology, 61, 151–159.

    Article  PubMed  Google Scholar 

  28. Gijsen, R., Hoeymans, N., Schellevis, F., Ruwaaard, D., Satariono, W., & Van den Bos, G. (2001). Causes and consequences of comorbidity: A review. Journal of Clinical Epidemiology, 54, 661–674.

    Article  PubMed  CAS  Google Scholar 

  29. Mrus, J. M., Leonard, A. C., Yi, M. S., Sherman, S. N., Fultz, S. L., Justice, A. C., et al. (2006). Health-related quality of life in veterans and nonveterans with HIV/AIDS. Journal of General Internal Medicine, 21(Suppl. 5), S39–S47.

    Article  PubMed  Google Scholar 

  30. Ford, E. S., Mannini, D. M., Redd, S. C., Moriarty, D. G., & Mokdad, A. H. (2004). Determinants of quality of life among people with asthma: Findings from the behavioral risk factor surveillance system. Journal of Asthma, 41(3), 327–336.

    Article  PubMed  Google Scholar 

  31. Washington, D. L., Sun, S., & Canning, M. (2010). Creating a sampling frame for population-based veteran research: Coverage and overlap of VA and non-VA databases. Journal of Rehabilitation Research and Development, 47, 763–771.

    Article  PubMed  Google Scholar 

  32. Hurst, N. P., Ruta, D. A., & Kind, P. (1998). Comparison of the MOS Short Form-12 (SF12) health status questionnaire with the SF36 in patients with rheumatoid arthritis. British Journal of Rheumatology, 37, 862–869.

    Article  PubMed  CAS  Google Scholar 

  33. McHorney, C. A., Ware, J. E, Jr, Lu, J. F., & Sherbourne, C. D. (1994). The MOS 36-items Short Form Health Survey (SF-36): III: Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32(1), 40–66.

    Article  PubMed  CAS  Google Scholar 

  34. Cote, I., Gregoire, J. P., Moisan, J., et al. (2004). Quality of life in hypertension: The SF-12 compared to the SF-36. Canadian Journal of Clinical Pharmacology, 11(2), e232–e238.

    PubMed  Google Scholar 

  35. Muller-Nordhorn, J., Roll, S., & Willich, S. N. (2004). Comparison of the short-form (SF)-12 health status instrument with the SF-36 in patients with coronary heart disease. Heart, 90, 523–527.

    Article  PubMed  CAS  Google Scholar 

  36. Ware, J., Kosinski, M., & Keller, S. D. (1994). SF-36 physical and mental health summary scales: A user’s Manual. Boston, MA: The Health Institute, New England Medical Center.

    Google Scholar 

  37. Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey, construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.

    Article  PubMed  Google Scholar 

  38. U.S. Population Norms (SF36). (1998). http://www.sf-36.org/research/sf98norms.pdf.

  39. Fan, V. S., Au, D., Heagerty, P., et al. (2002). Validation of case-mix measures derived from self-reports of diagnoses and health. Journal of Clinical Epidemiology, 55, 371–380.

    Article  PubMed  Google Scholar 

  40. Davis, R., Iezzoni, L., Phullups, R., et al. (1995). Predicting in-hospital mortality, the importance of functional status information. Medical Care, 33(9), 906–921.

    Article  PubMed  CAS  Google Scholar 

  41. Washington, D. L., Bean-Mayberry, B., Riopelle, D., & Yano, E. M. (2011). Access to care for women veterans: Delayed healthcare and unmet need. Journal of General Internal Medicine, 26(Suppl 2), S655–S661.

    Article  Google Scholar 

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Acknowledgments

This study was funded by the Department of Veterans Affairs (VA) Women’s Health Services in the Office of Patient Care Services and the VA Health Services Research and Development (HSR&D) Service (#SDR-08-270). The authors gratefully acknowledge Su Sun Mor, MPH and Michael Mitchell, PhD, for assistance with database construction, and Mark Canning for project management. The views expressed within are solely those of the authors, and do not necessarily represent the views of the Department of Veterans Affairs or of the United States government.

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Authors and Affiliations

  1. Veterans Emergency Management Evaluation Center (VEMEC), Department of Veterans Affairs, 16111 Plummer St., MS-152, North Hills, CA, 91343, USA

    Claudia Der-Martirosian

  2. VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, CA, USA

    Kristina M. Cordasco & Donna L. Washington

  3. Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA

    Kristina M. Cordasco & Donna L. Washington

  4. The RAND Corporation, Santa Monica, CA, USA

    Kristina M. Cordasco

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  1. Claudia Der-Martirosian
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Correspondence to Claudia Der-Martirosian.

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Der-Martirosian, C., Cordasco, K.M. & Washington, D.L. Health-related quality of life and comorbidity among older women veterans in the United States. Qual Life Res 22, 2749–2756 (2013). https://doi.org/10.1007/s11136-013-0424-7

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