Prevention Science

, Volume 16, Issue 1, pp 21–30 | Cite as

Associations Between Health-Related Quality of Life and Mortality in Older Adults

  • Derek S. BrownEmail author
  • William W. Thompson
  • Matthew M. Zack
  • Sarah E. Arnold
  • John P. Barile


This study measures the use and relative importance of different measures of health-related quality of life (HRQOL) as predictors of mortality in a large sample of older US adults. We used Cox proportional hazards models to analyze the association between general self-reported health and three “healthy days” (HDs) measures of HRQOL and mortality at short-term (90-day) and long-term (2.5 years) follow-up. The data were from Cohorts 6 through 8 of the Medicare Health Outcomes Survey, a national sample of older adults who completed baseline surveys in 2003–2005. At the long term, reduced HRQOL in general health and all categories of the HDs were separately and significantly associated with greater mortality (P < 0.001). In multivariate analysis of long-term mortality, at least one HD category remained significant for each measure, but the associations between mental health and mortality were inconsistent. For short-term mortality, the physical health measures had larger hazard ratios, but fewer categories were significant. Hazard ratios decreased over time for all measures of HRQOL except mental health. In conclusion, HRQOL measures were shown to be significant predictors of short- and long-term mortality, further supporting their value in health surveillance and as markers of risk for targeted prevention efforts. Although all four measures of HRQOL significantly predicted mortality, general self-rated health and age were more important predictors than the HDs.


Mortality Survival analysis Quality of life Medicare 


  1. Albrecht, G. L., & Devlieger, P. J. (1999). The disability paradox: High quality of life against all odds. Social Science and Medicine, 48, 977–988.CrossRefPubMedGoogle Scholar
  2. Andresen, E. M., Vahle, V. J., & Lollar, D. (2001). Proxy reliability: Health-related quality of life (HRQOL) measures for people with disability. Quality of Life Research, 10, 609–619.CrossRefPubMedGoogle Scholar
  3. Atherly, A., Hebert, P. L., & Maciejewski, M. L. (2005). An analysis of disenrollment from Medicare managed care plans by Medicare beneficiaries with diabetes. Medical Care, 43, 500–506.CrossRefPubMedGoogle Scholar
  4. Bowling, A. (1991). Measuring health: A review of quality of life measurement scales. Bristol, PA: Open University Press.Google Scholar
  5. Cavrini, G., Broccoli, S., Puccini, A., & Zoli, M. (2012). EQ-5D as a predictor of mortality and hospitalization in elderly people. Quality of Life Research, 21, 269–280.CrossRefPubMedGoogle Scholar
  6. CDC (Centers for Disease Control and Prevention). (2000). Measuring healthy days. Atlanta, GA: CDC.Google Scholar
  7. Cherepanov, D., Palta, M., & Fryback, D. G. (2010). Underlying dimensions of the five health-related quality-of-life measures used in utility assessment: Evidence from the National Health Measurement Study. Medical Care, 48, 718–725.PubMedCentralCrossRefPubMedGoogle Scholar
  8. Corti, M.-C., Guralnik, J. M., Ferrucci, L., Izmirlian, G., Leveille, S. G., Pahor, M., et al. (1999). Evidence for a black-white crossover in all-cause and coronary heart disease mortality in an older population: The North Carolina EPESE. American Journal of Public Health, 89, 308–314.PubMedCentralCrossRefPubMedGoogle Scholar
  9. Cox, D. R. (1972). Regression models and life-tables. Journal of the Royal Statistical Society, Series B, 34, 187–220.Google Scholar
  10. DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006a). Mortality prediction with a single general self-rated health question. A meta-analysis. Journal of General Internal Medicine, 21, 267–275.PubMedCentralCrossRefPubMedGoogle Scholar
  11. DeSalvo, K. B., Fan, V. S., McDonell, M. B., & Fihn, S. D. (2005). Predicting mortality and healthcare utilization with a single question. Health Services Research, 40, 1234–1246.PubMedCentralCrossRefPubMedGoogle Scholar
  12. DeSalvo, K. B., Fisher, W. P., Tran, K., Bloser, N., Merrill, W., & Peabody, J. (2006b). Assessing measurement properties of two single-item general health measures. Quality of Life Research, 15, 191–201.CrossRefPubMedGoogle Scholar
  13. Dominick, K. L., Ahern, F. M., Gold, C. H., & Heller, D. A. (2002). Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clinical and Experimental Research, 14, 499–508.CrossRefPubMedGoogle Scholar
  14. Ellis, B. H., Bannister, W. M., Cox, J. K., Fowler, B. M., Shannon, E. D., Drachman, D., et al. (2003). Utilization of the propensity score method: An exploratory comparison of proxy-completed to self-reported responses in the Medicare Health Outcomes Survey. Health and Quality of Life Outcomes, 1, 47. doi: 10.1186/1477-7525-1-47.PubMedCentralCrossRefPubMedGoogle Scholar
  15. Fayers, P., & Machin, D. (2007). Quality of life: The assessment, analysis, and interpretation of patient-reported outcomes. New York: Wiley.CrossRefGoogle Scholar
  16. Franks, P., Gold, M. R., & Fiscella, K. (2003). Sociodemographics, self-rated health, and mortality in the U.S. Social Science and Medicine, 56, 2505–2514.CrossRefPubMedGoogle Scholar
  17. Fryback, D. G., Dunham, N. C., Palta, M., Hanmer, J., Buechner, J., Cherepanov, D., et al. (2007). U.S. norms for six generic health-related quality-of-life indexes from the National Health Measurement Study. Medical Care, 45, 1162–1170.PubMedCentralCrossRefPubMedGoogle Scholar
  18. Gold, M., Phelps, D., Jacobson, G., & Neuman, T. (2010). Medicare Advantage 2010 data spotlight. Plan enrollment patterns and trends. Kaiser Family Foundation Medicare Policy Project, publication 8080. Retrieved from
  19. Hanmer, J., Lawrence, W. F., Anderson, J. P., Kaplan, R. M., & Fryback, D. G. (2006). Report of nationally representative values for the noninstitutionalized US adult population for 7 health-related quality-of-life scores. Medical Decision Making, 26, 391–400.CrossRefPubMedGoogle Scholar
  20. Heinze, G., & Schemper, M. (2003). Comparing the importance of prognostic factors in Cox and logistic regression using SAS. Computer Methods and Programs in Biomedicine, 71, 155–163.CrossRefPubMedGoogle Scholar
  21. Johnson, N. E. (2000). The racial crossover in comorbidity, disability, and mortality. Demography, 37, 267–283.CrossRefPubMedGoogle Scholar
  22. Korten, A. E., Jorm, A. F., Jiao, Z., Letenneur, L., Jacomb, P. A., Henderson, A. S., et al. (1999). Health, cognitive, and psychosocial factors as predictors of mortality in an elderly community sample. Journal of Epidemiology and Community Health, 53, 83–88.PubMedCentralCrossRefPubMedGoogle Scholar
  23. Lied, T. R., Sheingold, S. H., Landon, B. E., Shaul, J. A., & Cleary, P. D. (2003). Beneficiary reported experience and voluntary disenrollment in Medicare managed care. Health Care Financing Review, 25, 55–66.PubMedCentralPubMedGoogle Scholar
  24. Mello, M. M., Stearns, S. C., Norton, E. C., & Ricketts, T. C., 3rd. (2003). Understanding biased selection in Medicare HMOs. Health Services Research, 38, 961–992.PubMedCentralCrossRefPubMedGoogle Scholar
  25. Moriarty, D.G., Kobau, R., Zack, M.M., & Zahran, H.S. (2005). Tracking Healthy Days—A window on the health of older adults. Preventing Chronic Disease, 2, 1–8. Retrieved from
  26. Moriarty, D. G., Zack, M. M., & Kobau, R. (2003). The Centers for Disease Control and Prevention’s Healthy Days measures—Population tracking of perceived physical and mental health over time. Health and Quality of Life Outcomes, 1, 37. doi: 10.1186/1477-7525-1-37.PubMedCentralCrossRefPubMedGoogle Scholar
  27. Netuveli, G., & Blane, D. (2008). Quality of life in older ages. British Medical Bulletin, 85, 113–126.CrossRefPubMedGoogle Scholar
  28. Pratt, L. A. (2009). Serious psychological distress, as measured by the K6, and mortality. Annals of Epidemiology, 19, 202–209.CrossRefPubMedGoogle Scholar
  29. Quinten, C., Coens, C., Mauer, M., Comte, S., Sprangers, M. A., Cleeland, C., et al. (2009). Baseline quality of life as a prognostic indicator of survival: A meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncology, 10, 865–871.CrossRefPubMedGoogle Scholar
  30. Sargent-Cox, K. A., Anstey, K. J., & Luszcz, M. A. (2010). The choice of self-rated health measures matter when predicting mortality: Evidence from 10 years follow-up of the Australian longitudinal study of ageing. BMC Geriatrics, 10, 18. doi: 10.1186/1471-2318-10-18.PubMedCentralCrossRefPubMedGoogle Scholar
  31. Schemper, M. (1993). The relative importance of prognostic factors in studies of survival. Statistics in Medicine, 12, 2377–2382.CrossRefPubMedGoogle Scholar
  32. Schemper, M., & Stare, J. (1996). Explained variation in survival analysis. Statistics in Medicine, 15, 1999–2012.CrossRefPubMedGoogle Scholar
  33. Sondik, E. J., Huang, D. T., Klein, R. J., & Satcher, D. (2010). Progress toward the Healthy People 2010 goals and objectives. Annual Review of Public Health, 31, 271–281.CrossRefPubMedGoogle Scholar
  34. Spilker, B. (Ed.). (1995). Quality of life and pharmacoeconomics in clinical trials (2nd ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins.Google Scholar
  35. Steptoe, A., & Wardle, J. (2011). Positive affect measured using ecological momentary assessment and survival in older men and women. Proceedings of the National Academy of Sciences of the United States of America, 108, 18244–18248.PubMedCentralCrossRefPubMedGoogle Scholar
  36. Tsai, S. Y., Chi, L. Y., Lee, C. H., & Chou, P. (2007). Health-related quality of life as a predictor of mortality among community-dwelling older persons. European Journal of Epidemiology, 22, 19–26.CrossRefPubMedGoogle Scholar
  37. Vogt, T., Pope, C., Mullooly, J., & Hollis, J. (1994). Mental health status as a predictor of morbidity and mortality: A 15-year follow-up of members of a health maintenance organization. American Journal of Public Health, 84, 227–231.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Society for Prevention Research (outside the USA) 2013

Authors and Affiliations

  • Derek S. Brown
    • 1
    Email author
  • William W. Thompson
    • 2
  • Matthew M. Zack
    • 2
  • Sarah E. Arnold
    • 3
  • John P. Barile
    • 4
  1. 1.Brown SchoolWashington University in St. LouisSt. LouisUSA
  2. 2.Division of Behavioral Surveillance, Public Health Surveillance Program OfficeCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Public Health Economics Program, RTI InternationalResearch Triangle ParkUSA
  4. 4.Department of PsychologyUniversity of Hawai‘i at MānoaHonoluluUSA

Personalised recommendations