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

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Abstract

Purpose

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

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

HRQL:

Health-related quality of life

PCS:

Physical component summary (of SF-36)

MCS:

Mental component summary (of SF-36)

HRs:

Hazard ratios

CI:

Confidence interval

NHS:

Nurses’ Health Study

BMI:

Body mass index

LRTs:

Likelihood ratio tests

References

  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].

    Article  PubMed  Google Scholar 

  2. Testa, M. A., & Simonson, D. C. (1996). Assesment of quality-of-life outcomes. New England Journal of Medicine, 334(13), 835–840.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  21. Navarro, C. (2006). The national death index: A largely expected advance in the access to mortality data. Gaceta Sanitaria, 20(6), 421–423.

    Article  PubMed  Google Scholar 

  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.

  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. Ferrer, M., & Alonso, J. (1998). The use of the short form (SF)-36 questionnaire for older adults. Age and Ageing, 27(6), 755–756.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  37. Cary, N. C. (2001). SAS/STAT Guide for personal computers version 8.2.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was partly funded by FIS grant 06/0366.

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Authors and Affiliations

  1. CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, 2, 28029, Madrid, Spain

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

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  1. Andrea Otero-Rodríguez
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  2. Luz María León-Muñoz
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  3. Teresa Balboa-Castillo
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  4. José R. Banegas
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  5. Fernando Rodríguez-Artalejo
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  6. Pilar Guallar-Castillón
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Correspondence to Fernando Rodríguez-Artalejo.

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Otero-Rodríguez, A., León-Muñoz, L.M., Balboa-Castillo, T. et al. Change in health-related quality of life as a predictor of mortality in the older adults. Qual Life Res 19, 15–23 (2010). https://doi.org/10.1007/s11136-009-9561-4

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