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The importance of considering differential item functioning in investigating the impact of chronic conditions on health-related quality of life in a multi-ethnic Asian population

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Abstract

Purpose

The present study aims to examine the impact of chronic conditions after adjusting for differential item functioning (DIF) on the various aspects of health-related quality of life (HRQoL) in a multi-ethnic Asian population in Singapore.

Method

Data on 3006 participants from a nation-wide cross-sectional survey of mental health literacy conducted in Singapore were used. Multiple Indicators Multiple Causes model was used to investigate the effects of chronic medical conditions on various HRQoL dimensions assessed with the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) after adjusting for DIF.

Results

Twenty out of 36 items were detected with DIF for chronic conditions including high blood pressure, cardiovascular disorders, diabetes, cancer, neurological disorders and ulcer as well as for a few demographic factors such age, gender and marital status. Twenty significant associations between chronic conditions and SF-36 domains were observed. After controlling for all chronic conditions, socio-demographic and DIF items, a significant association emerged between cardiovascular disorders and physical functioning, while the association between diabetes and ulcer and general health became nonsignificant. All other associations remained statistically significant.

Conclusion

Our findings provide useful information and important implications of DIF on the impact of chronic conditions on HRQoL. We found the impact of DIF with respect to the impact of chronic conditions on HRQoL to be minimal after accounting for measurement bias in this multiracial Asian population.

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References

  1. Bowling, A. (1995). Measuring disease: A review of disease-specific quality of life measurement scales. Buckingham: Open University Press.

    Google Scholar 

  2. Ware, J. E., Jr. (2000). SF-36 health survey update. Spine, 25, 3130–3139.

    Article  PubMed  Google Scholar 

  3. Alonso, J., Ferrer, M., Gandek, B., 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 

  4. Wee, H. L., Cheung, Y. B., Loke, W. C., et al. (2008). The association of body mass index with health-related quality of life: An exploratory study in a multiethnic Asian population. Value Health, 11(Suppl 1), S105–S114.

    Article  PubMed  Google Scholar 

  5. Department of Statistics, Yearbook of statistics Singapore. (2015). Department of Statistics. Ministry of Trade and Industry: Republic of Singapore.

    Google Scholar 

  6. Thumboo, J., Fong, K. Y., Machin, D., et al. (2001). A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore. Quality of Life Research, 10, 175–188.

    Article  CAS  PubMed  Google Scholar 

  7. Thumboo, J., Fong, K. Y., Chan, S. P., et al. (2002). The equivalence of English and Chinese SF-36 versions in bilingual Singapore Chinese. Quality of Life Research, 11, 495–503.

    Article  PubMed  Google Scholar 

  8. Thumboo, J., Feng, P. H., Boey, M. L., et al. (2000). Validation of the Chinese SF-36 for quality of life assessment in patients with systemic lupus erythematosus. Lupus, 9, 708–712.

    Article  CAS  PubMed  Google Scholar 

  9. Keller, S. D., Ware, J. E., Jr., Bentler, P. M., et al. (1998). Use of structural equation modeling to test the construct validity of the SF-36 Health Survey in ten countries: Results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51, 1179–1188.

    Article  CAS  PubMed  Google Scholar 

  10. Gandek, B., Sinclair, S. J., Kosinski, M., et al. (2004). Psychometric evaluation of the SF-36 health survey in Medicare managed care. Health Care Financing Review, 25, 5–25.

    PubMed  PubMed Central  Google Scholar 

  11. Gandek, B., Ware, J. E., Jr., Aaronson, N. K., et al. (1998). 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. Journal of Clinical Epidemiology, 51, 1149–1158.

    Article  CAS  PubMed  Google Scholar 

  12. Gao, F., Ng, G. Y., Cheung, Y. B., et al. (2009). The Singaporean English and Chinese versions of the EQ-5D achieved measurement equivalence in cancer patients. Journal of Clinical Epidemiology, 62, 206–213.

    Article  PubMed  Google Scholar 

  13. Thumboo, J., Wu, Y., Tai, E. S., et al. (2013). Reliability and validity of the English (Singapore) and Chinese (Singapore) versions of the Short-Form 36 version 2 in a multi-ethnic urban Asian population in Singapore. Quality of Life Research, 22, 2501–2508.

    Article  PubMed  Google Scholar 

  14. Yu, Y. F., Yu, A. P., & Ahn, J. (2007). Investigating differential item functioning by chronic diseases in the SF-36 health survey: A latent trait analysis using MIMIC models. Medical Care, 45, 851–859.

    Article  PubMed  Google Scholar 

  15. Meng, H., King-Kallimanis, B. L., Gum, A., et al. (2013). Measurement bias of the SF-36 Health Survey in older adults with chronic conditions. Quality of Life Research, 22, 2359–2369.

    Article  PubMed  Google Scholar 

  16. Bagheri, Z., Jafari, P., Faghih, M., et al. (2015). Testing measurement equivalence of the SF-36 questionnaire across patients on hemodialysis and healthy people. International Urology and Nephrology, 47, 2013–2021.

    Article  PubMed  Google Scholar 

  17. Bjorner, J. B., Kreiner, S., Ware, J. E., et al. (1998). Differential item functioning in the Danish translation of the SF-36. Journal of Clinical Epidemiology, 51, 1189–1202.

    Article  CAS  PubMed  Google Scholar 

  18. Zumbo, B. D. (1999). A handbook on the theory and methods of differential item functioning (DIF): Logistic regression modeling as a unitary framework for binary and likert type (ordinal) item scores. Ottawa: Directorate of Human Resources Research and Evaluation, Department of National Defense.

    Google Scholar 

  19. Gandhi, P. K., Ried, L. D., Kimberlin, C. L., et al. (2013). Influence of explanatory and confounding variables on HRQoL after controlling for measurement bias and response shift in measurement. Expert Review of Pharmacoeconomics Outcomes Research, 13, 841–851.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gandhi, M., Thumboo, J., Luo, N., et al. (2015). Do chronic disease patients value generic health states differently from individuals with no chronic disease? A case of a multicultural Asian population. Health Qualit of Life Outcomes, 13, 8.

    Article  Google Scholar 

  21. Chong, S. A., Abdin, E., Picco, L., et al. (2016). Recognition of mental disorders among a multiracial population in Southeast Asia. BMC Psychiatry, 16, 121.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chong, S. A., Vaingankar, J., Abdin, E., et al. (2012). The prevalence and impact of major depressive disorder among Chinese, Malays and Indians in an Asian multi-racial population. Journal of Affective Disorders, 138, 128–136.

    Article  PubMed  Google Scholar 

  23. Ware, J. E., Jr., & Gandek, B. (1998). Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of Clinical Epidemiology, 51, 903–912.

    Article  PubMed  Google Scholar 

  24. Ware, J. E., & Kosinski, M. (2001). Interpreting SF-36 summary health measures: A response. Quality of Life Research, 10, 405–413. (discussion 415-20).

    Article  CAS  PubMed  Google Scholar 

  25. Proitsi, P., Hamilton, G., Tsolaki, M., et al. (2011). A multiple indicators multiple causes (MIMIC) model of behavioural and psychological symptoms in dementia (BPSD). Neurobiology of Aging, 32, 434–442.

    Article  CAS  PubMed  Google Scholar 

  26. Ware, J. E., Jr., Kosinski, M., Gandek, B., et al. (1998). The factor structure of the SF-36 Health Survey in 10 countries: Results from the IQOLA project. International quality of life assessment. Journal of Clinical Epidemiology, 51, 1159–1165.

    Article  PubMed  Google Scholar 

  27. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.

    Article  Google Scholar 

  28. Browne, M. W., & Cudeck, R. (1992). Alternative ways of assessing model fit. Sociological Methods and Research, 21, 230–258.

    Article  Google Scholar 

  29. Grassi, M., Nucera, A., & G. European Community Respiratory Health Study Quality of Life Working. (2010). Dimensionality and summary measures of the SF-36 v1.6: Comparison of scale- and item-based approach across ECRHS II adults population. Value Health, 13, 469–478.

    PubMed  Google Scholar 

  30. Saarni, S. I., Suvisaari, J., Sintonen, H., et al. (2007). Impact of psychiatric disorders on health-related quality of life: General population survey. British Journal of Psychiatry, 190, 326–332.

    Article  PubMed  Google Scholar 

  31. Saarni, S. I., Harkanen, T., Sintonen, H., et al. (2006). The impact of 29 chronic conditions on health-related quality of life: A general population survey in Finland using 15D and EQ-5D. Quality of Life Research, 15, 1403–1414.

    Article  PubMed  Google Scholar 

  32. Fernandez, A., Saameno, J. A., Pinto-Meza, A., et al. (2010). Burden of chronic physical conditions and mental disorders in primary care. British Journal of Psychiatry, 196, 302–309.

    Article  PubMed  Google Scholar 

  33. Penner-Goeke, K., Henriksen, C. A., Chateau, D., et al. (2015). Reductions in quality of life associated with common mental disorders: Results from a nationally representative sample. Journal of Clinical Psychiatry, 76, 1506–1512.

    Article  PubMed  Google Scholar 

  34. Subramaniam, M., Abdin, E., Vaingankar, J. A., et al. (2013). Impact of psychiatric disorders and chronic physical conditions on health-related quality of life: Singapore Mental Health Study. Journal of Affective Disorders, 147, 325–330.

    Article  PubMed  Google Scholar 

  35. Saarni, S. I., Suvisaari, J., Sintonen, H., et al. (2007). The health-related quality-of-life impact of chronic conditions varied with age in general population. Journal of Clinical Epidemiology, 60, 1288–1297.

    Article  PubMed  Google Scholar 

  36. Knight, M., Stewart-Brown, S., & Fletcher, L. (2001). Estimating health needs: The impact of a check list of conditions and quality of life measurement on health information derived from community surveys. Journal of Public Health Medicine, 23, 179–186.

    Article  CAS  PubMed  Google Scholar 

  37. US Department of Health and Human Services. (1994). Evaluation of national health interview survey diagnostic reporting. Vital and Health Statistics, 2, 1–116.

    Google Scholar 

  38. Carkinm, D. M., & Tracy, P. E. (2015). Adjusting for unit non-response in surveys through weighting. Crime and delinquency, 61, 143–158.

    Article  Google Scholar 

  39. Heeringa, S. G., West, B. T., & Berglund, P. A. (2010). Applied survey data analysis. Oxfordshire: Taylor and Francis Group, LLC.

    Book  Google Scholar 

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Funding

This study was funded by Ministry of Health, Health Services Research Competitive Research Grant (HSRG/0036/2013).

Author information

Authors and Affiliations

  1. Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore

    Edimansyah Abdin, Mythily Subramaniam, Louisa Picco, Shirlene Pang, Janhavi Ajit Vaingankar, Shazana Shahwan, Vathsala Sagayadevan, Yunjue Zhang & Siow Ann Chong

Authors
  1. Edimansyah Abdin
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  2. Mythily Subramaniam
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  3. Louisa Picco
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  4. Shirlene Pang
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  5. Janhavi Ajit Vaingankar
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  6. Shazana Shahwan
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  7. Vathsala Sagayadevan
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  8. Yunjue Zhang
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  9. Siow Ann Chong
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Corresponding author

Correspondence to Edimansyah Abdin.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

TITLE:

Model 3

DATA:

FILE IS data.dat;

VARIABLE:

NAMES ARE RESID resp diabet highbp pain cancer

 

neuro cardio ulcer hyperlip female ethnic1 ethnic2 ethnic3

 

ethnic4 age1 age2 age3 marit1 marit2 marit3 edu1 edu2

 

edu3 edu4 employ1 employ2 employ3 inc1 inc2 inc3 gh01

 

ht pf01 pf02 pf03 pf04 pf05 pf06 pf07 pf08 pf09 pf10

 

rp01 rp02 rp03 rp04 re01 re02 re03 sf01 bp01 bp02

 

vt01 mh01 mh02 mh03 vt02 mh04 vt03 mh05 vt04 sf02

 

gh02 gh03 gh04 gh05 strata weight;

 

USEVARIABLES ARE resp diabet highbp pain cancer

 

neuro cardio ulcer hyperlip pf01 pf02 pf03 pf04

 

pf05 pf06 pf07 pf08 pf09 pf10 rp01 rp02 rp03 rp04

 

re01 re02 re03 sf01 bp01 bp02 vt01 mh01 mh02 mh03

 

vt02 mh04 vt03 mh05 vt04 gh01 sf02 gh02 gh03 gh04

 

gh05 female ethnic2 ethnic3 ethnic4 age2 age3 marit2 marit3

 

edu1 edu2 edu3 employ2 employ3 inc2 inc3;

MISSING = .;

 

STRATIFICATION = strata;

 

WEIGHT = weight;

 

CATEGORICAL ARE

pf01 pf02 pf03 pf04 pf05 pf06 pf07 pf08 pf09 pf10

 

rp01 rp02 rp03 rp04 re01 re02 re03 sf01 bp01 bp02

 

vt01 mh01 mh02 mh03 vt02 mh04 vt03 mh05 vt04 sf02

 

gh01 gh02 gh03 gh04 gh05;

ANALYSIS:

 

TYPE = COMPLEX;

 

ESTIMATOR = WLSMV;

 

MODEL:

pf by pf01 pf02 pf03 pf04 pf05 pf06 pf07 pf08 pf09 pf10;

 

rp by rp01 rp02 rp03 rp04;

 

gh by gh01 gh02 gh03 gh04 gh05;

 

re by re01 re02 re03;

 

sf by sf01 sf02;

 

bp by bp01 bp02;

 

vt by vt01 vt02 vt03 vt04;

 

mh by mh01 mh02 mh03 mh04 mh05;

 

pf-mh on resp diabet highbp pain cancer neuro cardio

 

ulcer hyperlip female ethnic2 ethnic3 ethnic4 age2 age3

 

marit2 marit3 edu1 edu2 edu3 employ2 employ3 inc2 inc3;

 

pf01 on age2-age3;

 

pf02 on hyperlip;

 

pf05 on ethnic4;

 

pf06 on pain cardio employ2;

 

pf08 on edu3;

 

rp02 on employ2;

 

rp04 on neuro;

 

gh01 on diabet cancer ethnic4 age2 age3 edu1 edu2;

 

gh02 on ulcer ethnic4 edu1 edu2 edu3 inc2 inc3;

 

gh03 on edu1;

 

gh04 on neuro female edu2;

 

gh05 on diabet cancer marit3;

 

re02 on neuro female marit2;

 

re03 on age2;

 

sf02 on inc2;

 

bp01 on highbp;

 

vt01 on edu1;

 

vt02 on age2 age3;

 

vt03 on resp;

 

vt04 on resp-hyperlip;

 

vt04 on female-inc3;

OUTPUT: standardized modindices;

 

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Abdin, E., Subramaniam, M., Picco, L. et al. The importance of considering differential item functioning in investigating the impact of chronic conditions on health-related quality of life in a multi-ethnic Asian population. Qual Life Res 26, 823–834 (2017). https://doi.org/10.1007/s11136-016-1418-z

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