Quality of Life for 19,114 participants in the ASPREE (ASPirin in Reducing Events in the Elderly) study and their association with sociodemographic and modifiable lifestyle risk factors

  • Nigel P. StocksEmail author
  • David A. González-Chica
  • Robyn L. Woods
  • Jessica E. Lockery
  • Rory S. J. Wolfe
  • Anne M. Murray
  • Brenda Kirpach
  • Raj C. Shah
  • Mark R. Nelson
  • Christopher M. Reid
  • Michael E. Ernst
  • John J. McNeil
  • the ASPREE Investigator Group



To explore the relationship between sociodemographic and lifestyle variables with health-related quality of life (HRQoL) of a large cohort of ‘healthy’ older individuals.


The sample included individuals aged 65+ years from Australia (N = 16,703) and the USA (N = 2411) enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) multicentre placebo-controlled trial study and free of cardiovascular disease, dementia, serious physical disabilities or ‘fatal’ illnesses. The associations with the physical (PCS) and mental component scores (MCS) of HRQoL (SF-12 questionnaire) were explored using multiple linear regression models from data collected at baseline (2010–2014).


The adjusted PCS mean was slightly higher in the USA (49.5 ± 9.1) than Australia (48.2 ± 11.6; p < 0.001), but MCS was similar in both samples (55.7 ± 7.5 and 55.7 ± 9.6, respectively; p = 0.603). Males, younger participants, better educated, more active individuals, or those currently drinking 1–2 alcoholic drinks/day showed a better HRQoL (results more evident for PCS than MCS), while current heavy smokers had the lowest physical HRQoL in both countries. Neither age, walking time, nor alcohol intake was associated with MCS in either cohort.


Baseline HRQoL of ASPREE participants was higher than that reported in population-based studies of older individuals, but the associations between sociodemographic and lifestyle variables were consistent with the published literature. As the cohort ages and develops chronic diseases, ASPREE will be able to document HRQoL changes.


Health status Social Determinants of Health Global health Mental health Health-related quality of life 



The authors thank Dr Jodie Avery for her support in the interpretation of the results and review of this manuscript. We acknowledge the dedicated and skilled staff in Australia and the USA for the conduct of the trial. The authors also are most grateful to the ASPREE participants, who so willingly volunteered for this study, and the general practitioners and medical clinics who support the participants in the ASPREE study. We also appreciate the support of the collaborating/supporting organisations listed on


The work was mainly supported by the National Institute on Aging and the National Cancer Institute at the National Institutes of Health (grant number U01AG029824), the National Health and Medical Research Council of Australia (grant numbers 334047 and 1127060), Monash University, and the Victorian Cancer Agency. Other funding resources and collaborating organisations of the ASPREE study are listed on

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

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

Research involving human participants

This study was conducted in accordance with the Declaration of Helsinki 1964 as revised in 2008, the NHMRC Guidelines on Human Experimentation, the federal patient privacy (HIPAA) law and ICH-GCP guidelines and the International Conference of Harmonisation Guidelines for Good Clinical Practice. We also follow the Code of Federal Regulations as it relates to areas of clinical research. Multiple Institutional Review Board approvals were obtained in Australia and the USA.

Supplementary material

11136_2018_2040_MOESM1_ESM.docx (19 kb)
Online Resource 1 (DOCX 18 KB)
11136_2018_2040_MOESM2_ESM.tif (835 kb)
Online Resource 2 Physical and Mental component summary scores of health-related quality of life among individuals ≥ 65 years in Australia (N=16,703) and the United States (N = 2,411). ASPREE study, baseline (2010–2014) (TIF 835 KB)
11136_2018_2040_MOESM3_ESM.tif (2 mb)
Online Resource 3 Scatter plot of the relationship between age and the Physical (Fig. 2a) and Mental (Fig. 2b) component summary scores of health-related quality of life among individuals ≥ 65 years in Australia (N = 16,703) and the United States (N = 2411). ASPREE study, baseline (2010–2014). (TIF 2004 KB)
11136_2018_2040_MOESM4_ESM.docx (21 kb)
Online Resource 4 (DOCX 20 KB)
11136_2018_2040_MOESM5_ESM.docx (17 kb)
Online Resource 5 (DOCX 17 KB)


  1. 1.
    Salomon, J. A., Wang, H., Freeman, M. K., Vos, T., Flaxman, A. D., Lopez, A. D., & Murray, C. J. L. (2012). Healthy life expectancy for 187 countries, 1990–2010: A systematic analysis for the Global Burden Disease Study 2010. The Lancet, 380(9859), 2144–2162.Google Scholar
  2. 2.
    Banham, D., Hawthorne, G., Goldney, R., & Ratcliffe, J. (2014). Health-Related Quality of Life (HRQoL) changes in South Australia: Comparison of burden of disease morbidity and survey-based health utility estimates. Health and Quality of Life Outcomes, 12(1), 113.CrossRefGoogle Scholar
  3. 3.
    World Health Organization. (2015). World report on ageing and health. Geneva: World Health Organization. Accessed March 1, 2017, from
  4. 4.
    Gonzalez-Chica, D. A., Grande, D., Bowden, E., Musker, J., Hay, M., P., & Stocks, N. (2017). Are we reducing the risk of cardiovascular disease and improving the quality of life through preventive health care? Results of a population-based study in South Australia. PrevMed, 99, 164–170.Google Scholar
  5. 5.
    Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., Bullinger, M., Kaasa, S., Leplege, A., Prieto, L., & Sullivan, M. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: Results from the IQOLA Project. The Journal of Clinical Epidemiology, 51(11), 1171–1178.CrossRefGoogle Scholar
  6. 6.
    Frieling, M. A., Davis, W. R., & Chiang, G. (2013). The SF-36v2 and SF-12v2 health surveys in New Zealand: Norms, scoring coefficients and cross-country comparisons. Australian and New Zealand Journal of Public Health, 37(1), 24–31.CrossRefGoogle Scholar
  7. 7.
    Fryback, D. G., Dunham, N. C., Palta, M., Hanmer, J., Buechner, J., Cherepanov, D., Herrington, S. A., Hays, R. D., Kaplan, R. M., Ganiats, T. G., Feeny, D., & Kind, P. (2007). US norms for six generic health-related quality-of-life indexes from the National Health Measurement Study. Medical Care, 45(12), 1162–1170.CrossRefGoogle Scholar
  8. 8.
    Norman, R., Church, J., van den Berg, B., & Goodall, S. (2013). Australian health-related quality of life population norms derived from the SF-6D. Australian and New Zealand Journal of Public Health, 37(1), 17–23.CrossRefGoogle Scholar
  9. 9.
    Gonzalez-Chica, D. A., Adams, R., Dal Grande, E., Avery, J., Hay, P., & Stocks, N. (2017). Lower educational level and unemployment increase the impact of cardiometabolic conditions on the quality of life: Results of a population-based study in South Australia. Quality of Life Research, 26(6), 1521–1530.CrossRefGoogle Scholar
  10. 10.
    Ludt, S., Wensing, M., Szecsenyi, J., van Lieshout, J., Rochon, J., Freund, T., Campbell, S. M., & Ose, D. (2011). Predictors of health-related quality of life in patients at risk for cardiovascular disease in European primary care. PLoS ONE, 6(12), e29334.CrossRefGoogle Scholar
  11. 11.
    Maatouk, I., Wild, B., Herzog, W., Wesche, D., Schellberg, D., Schottker, B., Muller, H., Rothenbacher, D., Stegmaier, C., & Brenner, H. (2012). Longitudinal predictors of health-related quality of life in middle-aged and older adults with hypertension: Results of a population-based study. Journal of Hypertension, 30(7), 1364–1372.CrossRefGoogle Scholar
  12. 12.
    Milte, C. M., Thorpe, M. G., Crawford, D., Ball, K., & McNaughton, S. A. (2015). Associations of diet quality with health-related quality of life in older Australian men and women. Experimental Gerontology, 64, 8–16.CrossRefGoogle Scholar
  13. 13.
    Perales, F., del Pozo-Cruz, J., del Pozo-Cruz, J., & del Pozo-Cruz, B. (2014). On the associations between physical activity and quality of life: Findings from an Australian nationally representative panel survey. Quality of Life Research, 23(7), 1921–1933.CrossRefGoogle Scholar
  14. 14.
    Rosenkranz, R. R., Duncan, M. J., Rosenkranz, S. K., & Kolt, G. S. (2013). Active lifestyles related to excellent self-rated health and quality of life: Cross sectional findings from 194,545 participants in The 45 and Up Study. BMC Public Health, 13(1), 1071.CrossRefGoogle Scholar
  15. 15.
    Chen, G., Iezzi, A., McKie, J., Khan, M. A., & Richardson, J. (2015). Diabetes and quality of life: Comparing results from utility instruments and Diabetes-39. Diabetes Research and Clinical Practice, 109(2), 326–333.CrossRefGoogle Scholar
  16. 16.
    Tapp, R. J., Dunstan, D. W., Phillips, P., Tonkin, A., Zimmet, P. Z., & Shaw, J. E. (2006). Association between impaired glucose metabolism and quality of life: Results from the Australian diabetes obesity and lifestyle study. Diabetes Research and Clinical Practice, 74(2), 154–161.CrossRefGoogle Scholar
  17. 17.
    Naliboff, B. D., Kim, S. E., Bolus, R., Bernstein, C. N., Mayer, E. A., & Chang, L. (2012). Gastrointestinal and psychological mediators of health-related quality of life in IBS and IBD: A structural equation modeling analysis. The American Journal of Gastroenterology, 107(3), 451–459.CrossRefGoogle Scholar
  18. 18.
    Cleland, J., Lee, A., & Hall, S. (2007). Associations of depression and anxiety with gender, age, health-related quality of life and symptoms in primary care COPD patients. Family Practice, 24, 217–223.CrossRefGoogle Scholar
  19. 19.
    van der Zee-Neuen, A., Putrik, P., Ramiro, S., Keszei, A., de Bie, R., Chorus, A., & Boonen, A. (2016). Impact of chronic diseases and multimorbidity on health and health care costs: The additional role of musculoskeletal disorders. Arthritis Care & Research (Hoboken), 68(12), 1823–1831.CrossRefGoogle Scholar
  20. 20.
    De Smedt, D., Clays, E., Annemans, L., Doyle, F., Kotseva, K., Pająk, A., Prugger, C., Jennings, C., Wood, D., & De Bacquer, D. (2013). Health related quality of life in coronary patients and its association with their cardiovascular risk profile: Results from the EUROASPIRE III survey. International Journal of Cardiology, 168(2), 898–903.CrossRefGoogle Scholar
  21. 21.
    Gonzalez-Chica, D. A., Mnisi, Z., Avery, J., Duszynski, K., Doust, J., Tideman, P., Murphy, A., Burgess, J., Beilby, J., & Stocks, N. (2016). Effect of health literacy on quality of life amongst patients with ischaemic heart disease in Australian general practice. PLoS ONE, 11(3), e0151079.CrossRefGoogle Scholar
  22. 22.
    Allen, J., Inder, K. J., Harris, M. L., Lewin, T. J., Attia, J. R., & Kelly, B. J. (2013). Quality of life impact of cardiovascular and affective conditions among older residents from urban and rural communities. Health and Quality of Life Outcomes, 11(1), 140.CrossRefGoogle Scholar
  23. 23.
    O’Neil, A., Stevenson, C. E., Williams, E. D., Mortimer, D., Oldenburg, B., & Sanderson, K. (2013). The health-related quality of life burden of co-morbid cardiovascular disease and major depressive disorder in Australia: Findings from a population-based, cross-sectional study. Quality of Life Research, 22(1), 37–44.CrossRefGoogle Scholar
  24. 24.
    Gonzalez-Chica, D. A., Hill, C. L., Gill, T. K., Hay, P., Haag, D., & Stocks, N. (2017). Individual diseases or clustering of health conditions? Association between multiple chronic diseases and health-related quality of life in adults. Health and Quality of Life Outcomes, 15(1), 244.CrossRefGoogle Scholar
  25. 25.
    ASPREE Investigator Group. (2013). Study design of ASPirin in Reducing Events in the Elderly (ASPREE): A randomized, controlled trial. Contemporary Clinical Trials, 36(2), 555–564.CrossRefGoogle Scholar
  26. 26.
    McNeil, J. J., Woods, R. L., Nelson, M. R., Murray, A. M., Reid, C. M., Kirpach, B., Storey, E., Shah, R. C., Wolfe, R. S., Tonkin, A. M., Newman, A. B., Williamson, J. D., Lockery, J. E., Margolis, K. L., Ernst, M. E., Abhayaratna, W. P., Stocks, N., Fitzgerald, S. M., Trevaks, R. E., Orchard, S. G., Beilin, L. J., Donnan, G. A., Gibbs, P., Johnston, C. I., & Grimm, R. H. (2017). Baseline characteristics of participants in the ASPREE (ASPirin in Reducing Events in the Elderly) study. The Journals of Gerontology: Series A, 72(11), 1586–1593.CrossRefGoogle Scholar
  27. 27.
    Antithrombotic Trialists, C., Baigent, C., Blackwell, L., Collins, R., Emberson, J., Godwin, J., Peto, R., Buring, J., Hennekens, C., Kearney, P., Meade, T., Patrono, C., Roncaglioni, M. C., & Zanchetti, A. (2009). Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials. The Lancet, 373(9678), 1849–1860.CrossRefGoogle Scholar
  28. 28.
    Berger, J. S., Roncaglioni, M. C., Avanzini, F., Pangrazzi, I., Tognoni, G., & Brown, D. L. (2006). Aspirin for the primary prevention of cardiovascular events in women and men: A sex-specific meta-analysis of randomized controlled trials. JAMA, 295(3), 306–313.CrossRefGoogle Scholar
  29. 29.
    Rothwell, P. M., Price, J. F., Fowkes, F. G., Zanchetti, A., Roncaglioni, M. C., Tognoni, G., Lee, R., Belch, J. F., Wilson, M., Mehta, Z., & Meade, T. W. (2012). Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: Analysis of the time course of risks and benefits in 51 randomised controlled trials. The Lancet, 379(9826), 1602–1612.CrossRefGoogle Scholar
  30. 30.
    Ware, J. E. J., KosinskiI, M., & Keller, S. D. (1996). A 12-item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.CrossRefGoogle Scholar
  31. 31.
    Australian Bureau of Statistics. (2011). Census of population and housing: Socio-Economic Indexes for Areas (SEIFA). Canberra: Australian Bureau of Statistics, Australia. Accessed March 5, 2015, from
  32. 32.
    Gandek, B., Ware, J., Aaronson, N., Apolone, G., Bjorner, J., Brazier, J., Bullinger, M., Kaasa, S., Leplege, A., Prieto, L., & Sullivan, M. (1998). Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: Results from the IQOLA Project. Journal of Clinical Epidemiology, 51, 1171–1178.CrossRefGoogle Scholar
  33. 33.
    König, H.-H., Heider, D., Lehnert, T., Riedel-Heller, S. G., Angermeyer, M. C., Matschinger, H., Vilagut, G., Bruffaerts, R., Haro, J. M., de Girolamo, G., de Graaf, R., Kovess, V., & Alonso, J. (2010). Health status of the advanced elderly in six European countries: Results from a representative survey using EQ-5D and SF-12. Health and Quality of Life Outcomes, 8(1), 143.CrossRefGoogle Scholar
  34. 34.
    Der-Martirosian, C., Cordasco, K. M., & Washington, D. L. (2013). Health-related quality of life and comorbidity among older women veterans in the United States. Quality of Life Research, 22(10), 2749–2756.CrossRefGoogle Scholar
  35. 35.
    Avery, J., Grande, D. E., & Taylor, A. (2004). Quality of life in South Australia as measured by the SF-12 Health Status Questionnaire: Population norms for 2003: Trends from 1997 to 2003. South Australia: Department of Human Services, Population Research and Outcome Studies Unit. ISBN 0730893294. Accessed April 3, 2017, from
  36. 36.
    Gault, M. L., & Willems, M. E. (2013). Aging, functional capacity and eccentric exercise training. Aging Disease, 4(6), 351–363.CrossRefGoogle Scholar
  37. 37.
    MacNee, W., Rabinovich, R. A., & Choudhury, G. (2014). Ageing and the border between health and disease. European Respiratory Journal, 44(5), 1332–1352.CrossRefGoogle Scholar
  38. 38.
    Glisky, E. L. (2007). Changes in cognitive function in human aging. In D. R. Riddle (Ed.), Brain aging: Models, methods, and mechanisms. Boca Raton, FL: CRC Press/Taylor Francis.Google Scholar
  39. 39.
    Kremen, W. S., Lachman, M. E., Pruessner, J. C., Sliwinski, M., & Wilson, R. S. (2012). Mechanisms of age-related cognitive change and targets for intervention: Social interactions and stress. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 67(7), 760–765.CrossRefGoogle Scholar
  40. 40.
    Mishra, G., & Schofield, M. (1998). Norms for the physical and mental health component summary scores of the SF-36 for young, middle aged and older Australian women. Qual Life Res, 7, 215–220.CrossRefGoogle Scholar
  41. 41.
    Sattelmair, J., Pertman, J., Ding, E. L., Kohl, H. W., Haskell, W., & Lee, I. M. (2011). Dose response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation, 124(7), 789–784.CrossRefGoogle Scholar
  42. 42.
    Wolin, K. Y., Glynn, R. J., Colditz, G. A., Lee, I. M., & Kawachi, I. (2007). Long-term physical activity patterns and health-related quality of life in U.S. women. The American Journal of Preventive Medicine, 32(6), 490–499.CrossRefGoogle Scholar
  43. 43.
    Orfila, F., Ferrer, M., Lamarca, R., Tebe, C., Domingo-Salvany, A., & Alonso, J. (2006). Gender differences in health-related quality of life among the elderly: The role of objective functional capacity and chronic conditions. Social Science & Medicine, 63(9), 2367–2380.CrossRefGoogle Scholar
  44. 44.
    The World Bank. (2015). GINI index (World Bank estimate). Accessed April 3, 2017, from
  45. 45.
    Schneider, E. C., Sarnak, D. O., Squires, D., Shah, A., & Doty, M. M. (2017). Mirror, Mirror 2017: International comparison reflects flaws and opportunities for better U.S. Health Care. Accessed November 10, 2017, from
  46. 46.
    Blendon, R. J., Schoen, C., DesRoches, C. M., Osborn, R., Scoles, K. L., & Zapert, K. (2002). Inequities in health care: A five-country survey. Health Affairs (Millwood), 21(3), 182–191.CrossRefGoogle Scholar
  47. 47.
    Stringhini, S., Carmeli, C., Jokela, M., Avendano, M., McCrory, C., d’Errico, A., Bochud, M., Barros, H., Costa, G., Chadeau-Hyam, M., Delpierre, C., Gandini, M., Fraga, S., Goldberg, M., Giles, G. G., Lassale, C., Kenny, R. A., Kelly-Irving, M., Paccaud, F., Layte, R., Muennig, P., Marmot, M. G., Ribeiro, A. I., Severi, G., Steptoe, A., Shipley, M. J., Zins, M., Mackenbach, J. P., Vineis, P., Kivimaki, M., & for the LIFEPATH Consortium. (2018). Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: Multi-cohort population based study. BMJ, 360, k1046.CrossRefGoogle Scholar
  48. 48.
    Ross, C., & Van Willigen, M. (1997). Education and the subjective quality of life. Journal of Health and Social Behavior, 38(3), 275–297.CrossRefGoogle Scholar
  49. 49.
    Raggi, A., Corso, B., Minicuci, N., Quintas, R., Sattin, D., De Torres, L., Chatterji, S., Frisoni, G. B., Haro, J. M., Koskinen, S., Martinuzzi, A., Miret, M., Tobiasz-Adamczyk, B., & Leonardi, M. (2016). Determinants of quality of life in ageing populations: Results from a cross-sectional study in Finland, Poland and Spain. PLoS ONE, 11(7), e0159293.CrossRefGoogle Scholar
  50. 50.
    Coste, J., Quinquis, L., D’Almeida, S., & Audureau, E. (2014). Smoking and health-related quality of life in the general population. independent relationships and large differences according to patterns and quantity of smoking and to gender. PLoS ONE, 9(3), e91562.CrossRefGoogle Scholar
  51. 51.
    McClave, A. K., Dube, S. R., Strine, T. W., & Mokdad, A. H. (2009). Associations between health-related quality of life and smoking status among a large sample of U.S. adults. Preventive Medicine, 48(2), 173–179.CrossRefGoogle Scholar
  52. 52.
    Wilson, D., Parsons, J., & Wakefield, M. (1999). The health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers. Preventive Medicine, 29(3), 139–144.CrossRefGoogle Scholar
  53. 53.
    Vogl, M., Wenig, C. M., Leidl, R., & Pokhrel, S. (2012). Smoking and health-related quality of life in English general population: Implications for economic evaluations. BMC Public Health, 12(1), 203.CrossRefGoogle Scholar
  54. 54.
    Zale, E. L., Maisto, S. A., & Ditre, J. W. (2015). Interrelations between pain and alcohol: An integrative review. Clinical Psychology Review, 37, 57–71.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Nigel P. Stocks
    • 1
    Email author
  • David A. González-Chica
    • 1
    return OK on get
  • Robyn L. Woods
    • 2
  • Jessica E. Lockery
    • 2
  • Rory S. J. Wolfe
    • 2
  • Anne M. Murray
    • 3
  • Brenda Kirpach
    • 3
  • Raj C. Shah
    • 4
  • Mark R. Nelson
    • 2
    • 5
  • Christopher M. Reid
    • 2
    • 6
  • Michael E. Ernst
    • 7
  • John J. McNeil
    • 2
  • the ASPREE Investigator Group
  1. 1.Discipline of General Practice, Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
  2. 2.Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
  3. 3.Berman Center for Outcomes and Clinical Research, Minneapolis Medical Research FoundationHennepin County Medical CenterMinneapolisUSA
  4. 4.Department of Family Medicine and Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoUSA
  5. 5.Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
  6. 6.School of Public HealthCurtin UniversityPerthAustralia
  7. 7.Department of Pharmacy Practice and Science, College of Pharmacy, Department of Family Medicine, Carver College of MedicineUniversity of IowaIowa CityUSA

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