Quality of Life Research

, Volume 19, Issue 1, pp 15–23 | Cite as

Change in health-related quality of life as a predictor of mortality in the older adults

  • Andrea Otero-Rodríguez
  • Luz María León-Muñoz
  • Teresa Balboa-Castillo
  • José R. Banegas
  • Fernando Rodríguez-Artalejo
  • Pilar Guallar-Castillón



We examined whether changes in health-related quality of life (HRQL) predict subsequent mortality among the Spanish elderly.


Prospective cohort study of 2,373 persons, representative of the Spanish population aged 60 and older. HRQL was measured in 2001 and 2003 using the SF-36 health questionnaire. Cox regression models were used to examine the association of changes in the physical and mental component summary (PCS and MCS) scores of HRQL from 2001 to 2003 with all-cause mortality through 2007.


Two hundred twelve deaths were ascertained from 2003 to 2007. The hazard ratios for mortality across categories of PCS change were as follows: 2.12 (95% confidence interval [CI] 1.39–3.24) for a > 10-point decline; 1.51 (1.01–2.28) for a 6- to 10-point decline; 1 for the reference category, a change of −5 to +5 points; 0.83 (0.51–1.34) for a 6- to 9-point improvement and 0.68 (0.42–1.09) for a > 10-point improvement; P for linear trend <0.001. The associations between changes in the MCS and mortality showed the same direction, but were of a lower magnitude and attained statistical significance (P < 0.05) only for a > 10-point decline in MCS.


Changes in HRQL predict mortality in the older adults. A decline in HRQL should alert to a worse vital prognosis and stimulate the search for the possible determinants of such decline.


Health-related quality of life Mortality Older adults Spain 



Health-related quality of life


Physical component summary (of SF-36)


Mental component summary (of SF-36)


Hazard ratios


Confidence interval


Nurses’ Health Study


Body mass index


Likelihood ratio tests


  1. 1.
    Hickey, A., Barker, M., McGee, H., & O’Boyle, C. (2005). Measuring health-related quality of life in older patient populations: A review of current approaches. Pharmacoeconomics, 23(10), 971–993 [Review].CrossRefPubMedGoogle Scholar
  2. 2.
    Testa, M. A., & Simonson, D. C. (1996). Assesment of quality-of-life outcomes. New England Journal of Medicine, 334(13), 835–840.CrossRefPubMedGoogle Scholar
  3. 3.
    Rumsfeld, J. S., MaWhinney, S., McCarthy, M., Jr., Shroyer, A. L., VillaNueva, C. B., O’Brien, M., et al. (1999). Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. Participants of the department of veterans affairs cooperative study group on processes, structures, and outcomes of care in cardiac surgery. JAMA, 281(14), 1298–1303.CrossRefPubMedGoogle Scholar
  4. 4.
    Rodriguez-Artalejo, F., Guallar-Castillon, P., Pascual, C. R., Otero, C. M., Montes, A. O., Garcia, A. N., et al. (2005). Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Archives of Internal Medicine, 165(11), 1274–1279.CrossRefPubMedGoogle Scholar
  5. 5.
    Domingo-Salvany, A., Lamarca, R., Ferrer, M., Garcia-Aymerich, J., Alonso, J., Felez, M., et al. (2002). Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 166(5), 680–685.CrossRefPubMedGoogle Scholar
  6. 6.
    Singh, J. A., Nelson, D. B., Fink, H. A., & Nichol, K. L. (2005). Health-related quality of life predicts future health care utilization and mortality in veterans with self-reported physician-diagnosed arthritis: The veterans arthritis quality of life study. Seminars in Arthritis and Rheumatism, 34(5), 755–765.CrossRefPubMedGoogle Scholar
  7. 7.
    Fan, V. S., Au, D. H., McDonell, M. B., & Fihn, S. D. (2004). Intraindividual change in SF-36 in ambulatory clinic primary care patients predicted mortality and hospitalizations. Journal of Clinical Epidemiology, 57(3), 277–283.CrossRefPubMedGoogle Scholar
  8. 8.
    Lee, Y. (2000). The predictive value of self assessed general, physical, and mental health on functional decline and mortality in older adults. Journal of Epidemiology and Community Health, 54(2), 123–129.CrossRefPubMedGoogle Scholar
  9. 9.
    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(1), 19–26.CrossRefPubMedGoogle Scholar
  10. 10.
    Kaplan, M. S., Berthelot, J. M., Feeny, D., McFarland, B. H., Khan, S., & Orpana, H. (2007). The predictive validity of health-related quality of life measures: Mortality in a longitudinal population-based study. Quality of Life Research, 16(9), 1539–1546.CrossRefPubMedGoogle Scholar
  11. 11.
    Myint, P. K., Luben, R. N., Surtees, P. G., Wainwright, N. W., Welch, A. A., Bingham, S. A., et al. (2006). Relation between self-reported physical functional health and chronic disease mortality in men and women in the European prospective investigation into cancer (EPIC-Norfolk): A prospective population study. Annals of Epidemiology, 16(6), 492–500.CrossRefPubMedGoogle Scholar
  12. 12.
    Zahran, H. S., Kobau, R., Moriarty, D. G., Zack, M. M., Holt, J., & Donehoo, R. (2005). Health-related quality of life surveillance—United States, 1993–2002. MMWR Surveillance Summaries, 54(4), 1–35.Google Scholar
  13. 13.
    Knight, E. L., Ofsthun, N., Teng, M., Lazarus, J. M., & Curhan, G. C. (2003). The association between mental health, physical function, and hemodialysis mortality. Kidney International, 63(5), 1843–1851.CrossRefPubMedGoogle Scholar
  14. 14.
    Kroenke, C. H., Kubzansky, L. D., Adler, N., & Kawachi, I. (2008). Prospective change in health-related quality of life and subsequent mortality among middle-aged and older women. American Journal of Public Health, 98(11), 2085–2091.Google Scholar
  15. 15.
    Leon-Munoz, L. M., Guallar-Castillon, P., Banegas, J. R., Gutierrez-Fisac, J. L., Lopez-Garcia, E., Jimenez, F. J., et al. (2005). Changes in body weight and health-related quality-of-life in the older adult population. International Journal of Obesity (London), 29(11), 1385–1391.CrossRefGoogle Scholar
  16. 16.
    Lopez-Garcia, E., Banegas, J. R., Graciani, A., Gutierrez-Fisac, J. L., Alonso, J., & Rodriguez-Artalejo, F. (2003). Population-based reference values for the Spanish version of the SF-36 health survey in the elderly. Medicina Clínica (Barcelona), 120(15), 568–573.CrossRefGoogle Scholar
  17. 17.
    Galan, I., Rodriguez-Artalejo, F., & Zorilla, B. (2004). Reproducibility of a telephone questionnaire on risk factors associated with behavior and preventive practices. Gaceta Sanitaria, 18(2), 118–128.CrossRefPubMedGoogle Scholar
  18. 18.
    Galan, I., Rodriguez-Artalejo, F., & Zorrilla, B. (2004). Telephone versus face-to-face household interviews in the assessment of health behaviors and preventive practices. Gaceta Sanitaria, 18(6), 440–450.CrossRefPubMedGoogle Scholar
  19. 19.
    Nelson, D. E., Holtzman, D., Bolen, J., Stanwyck, C. A., & Mack, K. A. (2001). Reliability and validity of measures from the behavioral risk factor surveillance system (BRFSS). Sozial- und Praventivmedizin, 46(Suppl 1), S3–S42.PubMedGoogle Scholar
  20. 20.
    Nelson, D. E., Powell-Griner, E., Town, M., & Kovar, M. G. (2003). A comparison of national estimates from the national health interview survey and the behavioral risk factor surveillance system. American Journal of Public Health, 93(8), 1335–1341.CrossRefPubMedGoogle Scholar
  21. 21.
    Navarro, C. (2006). The national death index: A largely expected advance in the access to mortality data. Gaceta Sanitaria, 20(6), 421–423.CrossRefPubMedGoogle Scholar
  22. 22.
    Alonso, J. (2000). Manual de puntuación de la versión española del cuestionario de salud SF-36. Institut municipal d’ Investigació Médica (IMIM) ed. Barcelona.Google Scholar
  23. 23.
    Alonso, J., Regidor, E., Barrio, G., Prieto, L., Rodríguez, C., & de la, F. L. (1998). Population reference values of the Spanish version of the health questionnaire SF-36. Medicina Clínica (Barcelona), 111(11), 410–416.Google Scholar
  24. 24.
    Ferrer, M., & Alonso, J. (1998). The use of the short form (SF)-36 questionnaire for older adults. Age and Ageing, 27(6), 755–756.CrossRefPubMedGoogle Scholar
  25. 25.
    Alonso, J., Prieto, L., & Anto, J. M. (1995). The Spanish version of the SF-36 health survey (the SF-36 health questionnaire): An instrument for measuring clinical results. Medicina Clínica (Barcelona), 104(20), 771–776.Google Scholar
  26. 26.
    Garcia, M., Rohlfs, I., Vila, J., Sala, J., Pena, A., Masia, R., et al. (2005). Comparison between telephone and self-administration of short form health survey questionnaire (SF-36). Gaceta Sanitaria, 19(6), 433–439.CrossRefPubMedGoogle Scholar
  27. 27.
    Garcia, E. L., Banegas, J. R., Perez-Regadera, A. G., Cabrera, R. H., & Rodriguez-Artalejo, F. (2005). Social network and health-related quality of life in older adults: A population-based study in Spain. Quality of Life Research, 14(2), 511–520.CrossRefPubMedGoogle Scholar
  28. 28.
    Guallar-Castillon, P., Santa-Olalla, P. P., Banegas, J. R., Lopez, E., & Rodriguez-Artalejo, F. (2004). Physical activity and quality of life in older adults in Spain. Medicina Clínica (Barcelona), 123(16), 606–610.CrossRefGoogle Scholar
  29. 29.
    Guallar-Castillon, P., Sendino, A. R., Banegas, J. R., Lopez-Garcia, E., & Rodriguez-Artalejo, F. (2005). Differences in quality of life between women and men in the older population of Spain. Social Science and Medicine, 60(6), 1229–1240.CrossRefPubMedGoogle Scholar
  30. 30.
    Lopez-Garcia, E., Banegas, B., Jr., Gutierrez-Fisac, J. L., Perez-Regadera, A. G., Ganan, L. D., & Rodriguez-Artalejo, F. (2003). Relation between body weight and health-related quality of life among the elderly in Spain. International Journal of Obesity and Related Metabolic Disorders, 27(6), 701–709.CrossRefPubMedGoogle Scholar
  31. 31.
    Gutierrez-Fisac, J. L., Lopez, E., Banegas, J. R., Graciani, A., & Rodriguez-Artalejo, F. (2004). Prevalence of overweight and obesity in elderly people in Spain. Obesity Research, 12(4), 710–715.CrossRefPubMedGoogle Scholar
  32. 32.
    Bush, T. L., Miller, S. R., Golden, A. L., & Hale, W. E. (1989). Self-report and medical record report agreement of selected medical conditions in the elderly. American Journal of Public Health, 79(11), 1554–1556.CrossRefPubMedGoogle Scholar
  33. 33.
    Harlow, S. D., & Linet, M. S. (1989). Agreement between questionnaire data and medical records. The evidence for accuracy of recall. American Journal of Epidemiology, 129(2), 233–248.PubMedGoogle Scholar
  34. 34.
    Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 Health survey. Manual and interpretation guide. The Health Institute, New England Medical Center ed. Boston.Google Scholar
  35. 35.
    Vilagut, G., Ferrer, M., Rajmil, L., Rebollo, P., Permanyer-Miralda, G., Quintana, J. M., et al. (2005). The Spanish version of the short form 36 health survey: A decade of experience and new developments. Gaceta Sanitaria, 19(2), 135–150.CrossRefPubMedGoogle Scholar
  36. 36.
    Cain, K. C., Kronmal, R. A., & Kosinski, A. S. (1992). Analysing the relationship between change in a risk factor and risk of disease. Statistics in Medicine, 11(6), 783–797.CrossRefPubMedGoogle Scholar
  37. 37.
    Cary, N. C. (2001). SAS/STAT Guide for personal computers version 8.2.Google Scholar
  38. 38.
    Alonso, J., Ferrer, M., Gandek, B., Ware, J. E., Jr., Aaronson, N. K., 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(2), 283–298.CrossRefPubMedGoogle Scholar
  39. 39.
    Cunningham, W. E., Nakazono, T. T., Tsai, K. L., & Hays, R. D. (2003). Do differences in methods for constructing SF-36 physical and mental health summary measures change their associations with chronic medical conditions and utilization? Quality of Life Research, 12(8), 1029–1035.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Andrea Otero-Rodríguez
    • 1
  • Luz María León-Muñoz
    • 1
  • Teresa Balboa-Castillo
    • 1
  • José R. Banegas
    • 1
  • Fernando Rodríguez-Artalejo
    • 1
  • Pilar Guallar-Castillón
    • 1
  1. 1.CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of MedicineUniversidad Autónoma de MadridMadridSpain

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