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The effect of polypharmacy on quality of life in adult patients with nonalcoholic fatty liver disease in the United States

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Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) is a significant epidemiological problem with rising prevalence. Due to limited literature, the objective of this study is to examine the association between polypharmacy and health-related quality of life (QoL) in NAFLD adult patients.

Methods

A retrospective observational study design was conducted to analyze health data collected by Steatohepatitis Clinical Research Network (NASH CRN). Patients were classified as receiving a polypharmacy therapy with five or more medications in their first screening visit. QoL was measured using the Short Form 36 (SF-36) instrument. Each patient self-reported the SF-36 form during the screening visit was compared between polypharmacy and non-polypharmacy groups using Wilcoxon Rank Sum test. Multivariable generalized linear models and multinomial logistic regression were performed to examine each predictor and its effect on QoL.

Results

Data included 1067 NAFLD adult patients; 834 patients used polypharmacy. The mean age was 48.64 years, and most patients were female (62%). Comparing NAFLD patients without steatohepatitis, borderline NASH, and definite NASH, the non-polypharmacy group had a significantly higher QoL than the polypharmacy group in Physical Component Summary (PCS) (86.25 vs 66.88, 85 vs 67.5, and 79.375 vs 63.12, respectively, all p < 0.01) and Mental Component Summary (MCS) (83.5 vs 73.38, 78.75 vs 67.62, and 78.75 vs 70.65, respectively, all p < 0.01).

Discussion and conclusion

Adults with NAFLD and polypharmacy have lower QoL than adults with NAFLD and non-polypharmacy. Number of medications had a significant negative impact on PCS, MCS, and all SF-36 domains except mental health, role physical limitation and role emotional limitation domains. Other factors that affect QoL negatively in NAFLD adult patients are female gender, obesity, diabetes, depression, and unemployment. Higher income had favorable effect on QoL.

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References

  1. Ludwig, J., Viggiano, T. R., McGill, D. B., & Oh, B. J. (1980). Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clinic Proceedings, 55(7), 434–438.

    CAS  PubMed  Google Scholar 

  2. Definition & Facts of NAFLD & NASH | NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved January 29, 2021, from https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts

  3. Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., et al. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328–357.

    Article  PubMed  Google Scholar 

  4. Cholankeril, G., Wong, R. J., Hu, M., Perumpail, R. B., Yoo, E. R., Puri, P., et al. (2017). Liver Transplantation for nonalcoholic steatohepatitis in the US: Temporal trends and outcomes. Digestive Diseases and Sciences, 62(10), 2915–2922.

    Article  PubMed  Google Scholar 

  5. Wong, R. J., Aguilar, M., Cheung, R., Perumpail, R. B., Harrison, S. A., Younossi, Z. M., et al. (2015). Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology, 148(3), 547–555.

    Article  PubMed  Google Scholar 

  6. Younossi, Z. M., Stepanova, M., Younossi, Y., Golabi, P., Mishra, A., Rafiq, N., et al. (2020). Epidemiology of chronic liver diseases in the USA in the past three decades. Gut, 69(3), 564–568.

    Article  PubMed  Google Scholar 

  7. Vernon, G., Baranova, A., & Younossi, Z. M. (2011). Systematic review: The epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Alimentary Pharmacology & Therapeutics, 34(3), 274–285.

    Article  CAS  Google Scholar 

  8. Williams, C. D., Stengel, J., Asike, M. I., Torres, D. M., Shaw, J., Contreras, M., et al. (2011). Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: A prospective study. Gastroenterology, 140(1), 124–131.

    Article  PubMed  Google Scholar 

  9. Bang, K. B., & Cho, Y. K. (2015). Comorbidities and metabolic derangement of NAFLD. Journal of Lifestyle Medicine, 5(1), 7–13.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Adams, L. A., Lymp, J. F., St. Sauver, J., Sanderson, S. O., Lindor, K. D., Feldstein, A., et al. (2005). The natural history of nonalcoholic fatty liver disease: A population-based cohort study. Gastroenterology, 129(1), 113–121.

    Article  PubMed  Google Scholar 

  11. Younossi, Z., & Henry, L. (2016). Contribution of alcoholic and nonalcoholic fatty liver disease to the burden of liver-related morbidity and mortality. Gastroenterology, 150(8), 1778–1785.

    Article  PubMed  Google Scholar 

  12. Mohamad, B., Shah, V., Onyshchenko, M., Elshamy, M., Aucejo, F., Lopez, R., et al. (2016). Characterization of hepatocellular carcinoma (HCC) in non-alcoholic fatty liver disease (NAFLD) patients without cirrhosis. Hepatology International, 10(4), 632–639.

    Article  PubMed  Google Scholar 

  13. Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17(1), 230.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bakaki, P. M., Horace, A., Dawson, N., Winterstein, A., Waldron, J., Staley, J., et al. (2018). Defining pediatric polypharmacy: A scoping review. PLoS ONE, 13(11), e0208047.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Gu, Q., Dillon, C. F., & Burt, V. L. (2010). Prescription drug use continues to increase: U.S. Prescription Drug Data for 2007–2008: (665492010–001). American Psychological Association. https://doi.org/10.1037/e665492010-001

    Article  Google Scholar 

  16. Kantor, E. D., Rehm, C. D., Haas, J. S., Chan, A. T., & Giovannucci, E. L. (2015). Trends in prescription drug use among adults in the United States From 1999–2012. JAMA, 314(17), 1818.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. HRQOL Concepts | CDC [Internet]. (2018). Retrieved February 9, 2021, from https://www.cdc.gov/hrqol/concept.htm

  18. Monica 1776 Main Street Santa, California 90401–3208. 36-Item Short Form Survey from the RAND Medical Outcomes Study [Internet]. Retrieved February 1, 2021, from https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html

  19. Ware, J. E., & Gandek, B. (1998). Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. Journal of Clinical Epidemiology, 51(11), 903–912.

    Article  PubMed  Google Scholar 

  20. Dan, A. A., Kallman, J. B., Wheeler, A., Younoszai, Z., Collantes, R., Bondini, S., et al. (2007). Health-related quality of life in patients with non-alcoholic fatty liver disease. Alimentary Pharmacology & Therapeutics, 26(6), 815–820.

    Article  CAS  Google Scholar 

  21. Assimakopoulos, K., Karaivazoglou, K., Tsermpini, E.-E., Diamantopoulou, G., & Triantos, C. (2018). Quality of life in patients with nonalcoholic fatty liver disease: A systematic review. Journal of Psychosomatic Research, 112, 73–80.

    Article  PubMed  Google Scholar 

  22. Sayiner, M., Stepanova, M., Pham, H., Noor, B., Walters, M., & Younossi, Z. M. (2016). Assessment of health utilities and quality of life in patients with non-alcoholic fatty liver disease. BMJ Open Gastroenteroligy, 3(1), e000106.

    Article  Google Scholar 

  23. Chawla, K. S., Talwalkar, J. A., Keach, J. C., Malinchoc, M., Lindor, K. D., & Jorgensen, R. (2016). Reliability and validity of the Chronic Liver Disease Questionnaire (CLDQ) in adults with non-alcoholic steatohepatitis (NASH). BMJ Open Gastroenterology, 3(1), e000069.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Patel, P. J., Hayward, K. L., Rudra, R., Horsfall, L. U., Hossain, F., Williams, S., et al. (2017). Multimorbidity and polypharmacy in diabetic patients with NAFLD. Medicine (Baltimore), 96, e6761.

    Article  Google Scholar 

  25. Spengler, E. K., & Loomba, R. (2015). Recommendations for diagnosis, referral for liver biopsy, and treatment of NAFLD and NASH. Mayo Clinic Proceedings, 90(9), 1233–1246.

    Article  PubMed  Google Scholar 

  26. Babcock, Z. R., Kogut, S. J., & Vyas, A. (2020). Association between polypharmacy and health-related quality of life among cancer survivors in the United States. Journal of Cancer Survivorship, 14(1), 89–99.

    Article  PubMed  Google Scholar 

  27. Schenker, Y., Park, S. Y., Jeong, K., Pruskowski, J., Kavalieratos, D., Resick, J., et al. (2019). Associations between polypharmacy, symptom burden, and quality of life in patients with advanced, life-limiting illness. Journal of General Internal Medicine, 34(4), 559–566.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Okoli, C., de los Rios, P., Eremin, A., Brough, G., Young, B., & Short, D. (2020). Relationship between polypharmacy and quality of life among people in 24 Countries living with HIV. Preventing Chronic Disease, 17, 190359.

    Article  Google Scholar 

  29. (2003). Nonalcoholic steatohepatitis clinical research network. Hepatology 37(2):244

  30. Monica 1776 Main Street Santa, California 90401–3208. 36-Item Short Form Survey (SF-36) Scoring Instructions [Internet]. Retrieved September 6, 2021, from https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form/scoring.html

  31. Standard_Operating_Procedures.pdf [Internet]. Retrieved December 13, 2021 from https://repository.niddk.nih.gov/media/studies/nafld_adult/Standard_Operating_Procedures.pdf

  32. Woźniak, I., Kolonko, A., Chudek, J., Nowak, Ł, Farnik, M., & Więcek, A. (2018). Influence of polypharmacy on the quality of life in stable kidney transplant recipients. Transplantation Proceedings, 50(6), 1896–1899.

    Article  PubMed  Google Scholar 

  33. Alexander, H. B., Broshek, D. K., & Quigg, M. (2018). Quality of life in adults with epilepsy is associated with anticonvulsant polypharmacy independent of seizure status. Epilepsy & Behavior, 78, 96–99.

    Article  Google Scholar 

  34. Vyas, A., Kang, F., & Barbour, M. (2020). Association between polypharmacy and health-related quality of life among US adults with cardiometabolic risk factors. Quality of Life Research, 29(4), 977–986.

    Article  PubMed  Google Scholar 

  35. Golabi, P., Otgonsuren, M., Cable, R., Felix, S., Koenig, A., Sayiner, M., et al. (2016). Non-alcoholic fatty liver disease (NAFLD) is associated with impairment of Health Related Quality of Life (HRQOL). Health and Quality of Life Outcomes, 14, 18.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kennedy-Martin, T., Bae, J. P., Paczkowski, R., & Freeman, E. (2017). Health-related quality of life burden of nonalcoholic steatohepatitis: A robust pragmatic literature review. Journal of Patient-Reported Outcomes, 2, 28.

    Article  PubMed  Google Scholar 

  37. Bezemer, G., Van Gool, A. R., Verheij-Hart, E., Hansen, B. E., Lurie, Y., Esteban, J. I., et al. (2012). Long-term effects of treatment and response in patients with chronic hepatitis C on quality of life. An international, multicenter, randomized, controlled study. BMC Gastroenterology, 12(1), 11.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Huber, Y., Boyle, M., Hallsworth, K., Tiniakos, D., Straub, B. K., Labenz, C., et al. (2019). Health-related quality of life in nonalcoholic fatty liver disease associates with hepatic inflammation. Clinical Gastroenterology and Hepatology, 17(10), 2085-2092.e1.

    Article  PubMed  Google Scholar 

  39. David, K., Kowdley, K. V., Unalp, A., Kanwal, F., Brunt, E. M., & Schwimmer, J. B. (2009). Quality of life in adults with nonalcoholic fatty liver disease: Baseline data from the nonalcoholic steatohepatitis clinical research network. Hepatology, 49(6), 1904–1912.

    Article  PubMed  Google Scholar 

  40. Alrasheed, M., Alsuhibani, A., Hincapie, A. L., Welge, J. (2021) Comparison of quality of life between men and women with chronic liver diseases using chronic liver disease questionnaire (CLDQ): A meta-analysis. In Pharmacoepidemiology and Drug Safety 2021 Aug 1 (Vol. 30, pp. 181–181). 111 RIVER ST, HOBOKEN 07030–5774, NJ USA: WILEY.

  41. Younossi, Z. M., Stepanova, M., Sulkowski, M., Naggie, S., Henry, L., & Hunt, S. (2016). Sofosbuvir and ledipasvir improve patient-reported outcomes in patients co-infected with hepatitis C and human immunodeficiency virus. Journal of Viral Hepatitis, 23(11), 857–865.

    Article  CAS  PubMed  Google Scholar 

  42. Dulai, P. S., Singh, S., Patel, J., Soni, M., Prokop, L. J., Younossi, Z., et al. (2017). Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis. Hepatology (Baltimore, MD), 65(5), 1557–1565.

    Article  CAS  Google Scholar 

  43. Hagström, H., Nasr, P., Ekstedt, M., Hammar, U., Stål, P., Hultcrantz, R., et al. (2017). Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. Journal of Hepatology, 67(6), 1265–1273.

    Article  PubMed  Google Scholar 

  44. Choi, J. M., Chung, G. E., Kang, S. J., Kwak, M.-S., Yang, J. I., Park, B., et al. (2021). Association between anxiety and depression and nonalcoholic fatty liver disease. Frontiers in Medicine, 7, 1068.

    Article  Google Scholar 

  45. Elliott, T. E., Renier, C. M., & Palcher, J. A. (2003). Chronic pain, depression, and quality of life: Correlations and predictive value of the SF-36. Chronic Pain, 4, 331.

    Google Scholar 

  46. McKee-Ryan, F., Song, Z., Wanberg, C. R., & Kinicki, A. J. (2005). Psychological and physical well-being during unemployment: A meta-analytic study. Journal of Applied Psychology, 90(1), 53.

    Article  PubMed  Google Scholar 

  47. Paul, K. I., & Moser, K. (2009). Unemployment impairs mental health: Meta-analyses. Journal of Vocational Behavior, 74(3), 264–282.

    Article  Google Scholar 

  48. Bartley, M. (1994). Unemployment and ill health: Understanding the relationship. Journal of Epidemiology and Community Health, 48(4), 333–337.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Rodriguez, E. (2001). Keeping the unemployed healthy: The effect of means-tested and entitlement benefits in Britain, Germany, and the United States. American Journal of Public Health, 91(9), 1403–1411.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Artazcoz, L., Benach, J., Borrell, C., & Cortes, I. (2004). Unemployment and mental health: Understanding the interactions among gender, family roles, and social class. American Journal of Public Health. https://doi.org/10.2105/AJPH.94.1.82

    Article  PubMed  PubMed Central  Google Scholar 

  51. Bunevicius, A. (2017). Reliability and validity of the SF-36 Health Survey Questionnaire in patients with brain tumors: A cross-sectional study. Health and Quality of Life Outcomes, 15, 92.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Brazier, J. E., Harper, R., Jones, N. M., O’Cathain, A., Thomas, K. J., Usherwood, T., et al. (1992). Validating the SF-36 health survey questionnaire: New outcome measure for primary care. BMJ, 305(6846), 160–164.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Failde, I., & Ramos, I. (2000). Validity and reliability of the SF-36 Health Survey Questionnaire in patients with coronary artery disease. Journal of Clinical Epidemiology, 53(4), 359–365.

    Article  CAS  PubMed  Google Scholar 

  54. McHorney, C. A., Ware, J. E., Lu, J. F. R., & Sherbourne, C. D. (1994). The MOS 36-item 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  CAS  PubMed  Google Scholar 

  55. Posthouwer, D., Plug, I., van der Bom, J. G., Fischer, K., Rosendaal, F. R., & Mauser-Bunschoten, E. P. (2005). Hepatitis C and health-related quality of life among patients with hemophilia. Haematologica, 90(6), 846–850.

    PubMed  Google Scholar 

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Acknowledgements

The NAFLD Adult and PIVENS were conducted by the NAFLD Adult and PIVENS investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The data from the NAFLD Adult and PIVENS reported here were supplied by the NIDDK Central Repositories. This manuscript was not prepared in collaboration with Investigators of the NAFLD Adult and PIVENS studies and does not necessarily reflect the opinions or views of the NAFLD Adult and PIVENS studies, the NIDDK Central Repositories, or the NIDDK.

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Authors and Affiliations

  1. James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave, Cincinnati, OH, 45267-0004, USA

    Marwan Alrasheed, Jeff Jianfei Guo, Alex C. Lin, Patricia R. Wigle & Ana L. Hincapie

  2. Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia

    Marwan Alrasheed

  3. American Heart Association, Chicago, USA

    Angelica Hardee

  4. School of Human Services, University of Cincinnati, Cincinnati, OH, 45221-0068, USA

    Angelica Hardee

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  1. Marwan Alrasheed
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Alrasheed, M., Guo, J.J., Lin, A.C. et al. The effect of polypharmacy on quality of life in adult patients with nonalcoholic fatty liver disease in the United States. Qual Life Res 31, 2481–2491 (2022). https://doi.org/10.1007/s11136-022-03090-6

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