The impact of chronic hepatitis C and co-morbid illnesses on health-related quality of life
- First Online:
- 123 Downloads
Determine the relative impact of chronic hepatitis C (CHC) and co-morbid illnesses on health-related quality of life (HRQoL) in 3023 randomly selected veterans with known hepatitis C virus antibody (anti-HCV) status who previously completed a veteran-specific HRQoL questionnaire (SF-36V).
Multiple regression analyses were performed to measure the relative contribution of anti-HCV status, four demographic variables, and ten common medical and six psychiatric co-morbidities to HRQoL between 303 anti-HCV(+) and 2720 anti-HCV(−) patients.
Anti-HCV(+) veterans were younger, reported a lower HRQoL on seven of eight 36-Item Short Form Health Survey for Veterans (SF-36V) subscales (P ≤ 0.001) and the mental component summary (MCS) scale (P < 0.001). The ten medical and six psychiatric co-morbidities had variable impact on predicting lower HRQoL in both groups. After adjusting for demographic variables and co-morbid illnesses, we found that anti-HCV(+) patients reported a significantly lower MCS score (P < 0.001) and a trend toward a lower physical component summary (PCS) score (P < 0.07) compared to anti-HCV(−) veterans. Among the anti-HCV(+) veterans, co-morbid medical illnesses contributed to impaired PCS but not to MCS.
Veterans with CHC were younger than HCV(−) veterans and hence less likely to have other co-morbid medical illnesses. Medical co-morbidities seen in those veterans with CHC contribute to impaired PCS but not MCS. Anti-HCV(+) status negatively affects HRQoL, particularly MCS, independently of medical and psychiatric co-morbidities.
KeywordsChronic hepatitis C Co-morbid conditions Quality of life Veterans
Antibody to hepatitis C virus
Chronic hepatitis C
Chronic obstructive pulmonary disease
Hepatitis C virus
Health-related quality of life
Ninth version of the Clinical Modification of the International Classification of Diseases
Item response theory
Mental component summary
Physical component summary
Posttraumatic stress disorder
36-Item Short Form Health Survey
36-Item Short Form Health Survey for Veterans
VA Palo Alto Health Care System
Veterans Health Affairs
Veterans Integrated Service Network
- 4.Davis, G. L., Balart, L. A., Schiff, E. R., et al. (1994). Assessing health-related quality of life in chronic hepatitis C using the sickness impact profile. Clinical Therapeutics, 16, 334–343 (discussion 271–272).Google Scholar
- 18.Kizer, K.W. (2000). Re-engineering the Veterans health care system. In P. Ramsaroop, M. Ball, D. Beaulieuu, et al. (Eds.). Advancing federal sector health care (pp. 79–96). New York: Springer Verlag.Google Scholar
- 23.Fortin, M., Lapointe, L., Hudon, C., et al. (2004) Multimorbidity and quality of life in primary care : A systemic review. Health and quality of life outcomes, 2, 51.Google Scholar
- 25.Kazis , L. E. (2000). The Veterans SF36 health status questionnaire: development and application in the Veterans Health Administration. Medical Outcomes Trust Monitor, 5, 1–2.Google Scholar
- 27.Ware, J. E., Kosinsky, M., & Keller, S. D. (1994). Physical and mental health summary scales: A users manual. Nosto, MA: The Health Institute, New England Medical Center.Google Scholar
- 28.Kazis, L. E., Skinner, K., Rogers, W., et al. (1998). Health status and outcomes of veterans: physical and mental component summary scores (SF-36V). National Survey of Ambulatory Care Patients, Mid-year Executive Report. Washington D.C.: Department of Veteran Affairs, Veterans Health Administration, Office of Quality and Performance.Google Scholar
- 37.Raczek, A. E., Ware, J. E., Bjorner, J. B., Gandek, B., et al. (1998) 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. Journal of Clinical Epidemiology, 51, 1203–1214.PubMedCrossRefGoogle Scholar
- 38.Ware, J. E., Bjorner, J., & Kosinski, M. (2000) Practical implications of item response theory and computerized adaptive testing: A brief summary of ongoing studies of widely used headache impact scales. Medical Care, 38[Suppl 9], II73–II82.Google Scholar
- 39.Wolinsky, F. D., Coe, R. M., Mosely, R. R., 2nd, et al. (1985). Veterans’ and nonveterans’ use of health services. A comparative analysis. Medical Care, 23, 1358–1371.Google Scholar