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Health-related quality of life and all-cause mortality among older healthy individuals in Australia and the United States: a prospective cohort study

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Abstract

Purpose

Previous research has demonstrated that lower health-related quality of life (HRQoL) is associated with higher morbidity and mortality, especially in-patient groups. The association of HRQoL with all-cause mortality in community samples requires further investigation. This study aimed to examine whether HRQoL predicts all-cause mortality in older healthy community-dwelling people from Australia and the United States (U.S.) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. We also explored whether this association varies by gender or country.

Method

A prospective cohort of 19,106 individuals aged 65–98 years, who were without a dementia diagnosis or a known major life-limiting disease, and completed the 12-item short-form-HRQoL at recruitment (2010–2014). They were followed until June 2017. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours and clinical measures. Hazards ratios were estimated for every 10-unit increase in PCS or MCS.

Results

There were 1052 deaths over a median 4.7-years (interquartile range 3.6–5.7) of follow-up, with 11.9 events per 1000 person-years. Higher PCS was associated with lower all-cause mortality (HR 0.83, 95% CI 0.77, 0.89) in the entire sample, while higher MCS was associated with lower mortality among U.S. participants only (HR 0.78, 95% CI 0.63, 0.95). Gender differences in the association of either PCS or MCS with mortality were not observed.

Conclusion

Our large study provides evidence that HRQoL is inversely associated with all-cause mortality among initially healthy older people.

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Data availability

All individual participant data (re-identifiable) that underlie the results reported in this Manuscript, are available upon request to qualified researchers without limit of time, subject to approval of the analyses by the Principal Investigators and a standard data sharing agreement. Details regarding requests to access the data will be available through the web site (www.ASPREE.org). The data will then be made available through a web-based data portal safe haven at Monash University, Australia.

Code availability

Not applicable.

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Acknowledgements

We would like to thank the ASPREE participants who volunteered for this study, the general practitioners and staff of the medical clinics who support the study participants, and the trial staff and management team of the ASPREE study in Australia and the United States, and the ASPREE Investigator Group listed on www.aspree.org.

Funding

The ASPREE (ASPirin in Reducing Events in the Elderly) trial was mainly supported by grants from 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 (Australia) and the Victorian Cancer Agency (Australia). Other funding resources and collaborating organizations of the ASPREE study are listed on http://www.aspree.org. AZZP is supported by Monash International Tuition Scholarship (Medicine, Nursing, and Health Sciences) and Monash Graduate Scholarship (30072360). RFP is supported by a National Heart Foundation of Australia Postdoctoral Fellowship (101927). JR and CMR are supported by a National Health and Medical Research Council Dementia Research Leader Fellowship (APP 1135727) and Principal Research Fellowship (APP1136372) respectively. Funders had no role in the design and conduct of the study, in the collection, analysis, and interpretation of data and in the writing, review and submission of the manuscript.

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Authors and Affiliations

  1. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia

    Aung Zaw Zaw Phyo, Joanne Ryan, Robyn L. Woods, Christopher M. Reid, Mark R. Nelson, Danijela Gasevic & Rosanne Freak-Poli

  2. PSNREC, Univ Montpellier, INSERM, 34000, Montpellier, France

    Joanne Ryan

  3. Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia

    David A. Gonzalez-Chica & Nigel P. Stocks

  4. Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, 5005, Australia

    David A. Gonzalez-Chica

  5. School of Public Health, Curtin University, Perth, WA, 6102, Australia

    Christopher M. Reid

  6. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia

    Mark R. Nelson

  7. Berman Center for Outcomes and Clinical Research, Hennepin HealthCare Research Institute, Hennepin HealthCare, Minneapolis, MN, 55415, USA

    Anne M. Murray

  8. Division of Geriatrics, Department of Medicine, Hennepin HealthCare and University of Minnesota, Minneapolis, MN, 55415, USA

    Anne M. Murray

  9. Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK

    Danijela Gasevic

  10. Department of Epidemiology, Erasmus Medical Centre, 3015 GD, Rotterdam, The Netherlands

    Rosanne Freak-Poli

Authors
  1. Aung Zaw Zaw Phyo
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  2. Joanne Ryan
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  9. Nigel P. Stocks
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  10. Rosanne Freak-Poli
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Consortia

the ASPREE Investigator Group

Contributions

AMM, RLW, CMR, and MRN designed and conceptualized the ASPREE study. CMR designed process associated with acquisition of ASPREE data. NPS provided major role in the health-related quality of life component of ASPREE study. RLW provided major roles in the acquisition of ASPREE data. RF-P conceived the current study. RF-P, JR, and AZZP designed the current study. AZZP had full access to all the data in the study and analysed the data. AZZP, RF-P, and JR interpreted the data, with input from DAG-C, NPS and DG. AZZP wrote the initial manuscript draft and undertook revisions. All authors provided critical comments and approved the final version.

Corresponding author

Correspondence to Rosanne Freak-Poli.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

ASPREE (ASPirin in Reducing Events in the Elderly) trial is being 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 Harmonization Guidelines for Good Clinical Practice. ASPREE also follows the Code of Federal Regulations as it relates to areas of clinical research. The overall management and conduct of the ASPREE clinical trial is the responsibility of the ASPREE Steering Committee. The data of the present secondary data-analysis study was from a five-year ASPREE clinical trial (Trial Registration: International Standard Randomized Controlled Trial Number Register (ISRCTN 83772183) and clinicaltrials.gov (NCT 01038583)). The current secondary data analysis has been approved by the Monash University Human Research Ethics Committee (project ID: 21714). The ASPREE trial has been approved by multiple Institutional Review Boards in Australia and the U.S. (www.aspree.org).

Consent to participate

This study used data from a five-year ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial (Trial Registration: International Standard Randomized Controlled Trial Number Register (ISRCTN 83772183) and clinicaltrials.gov (NCT 01038583)). All individual participants of ASPREE clinical trial signed informed consent on participation.

Consent for publication

All authors gave their approval for submission.

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ASPREE Investigator Group listed on www.aspree.org.

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Phyo, A.Z.Z., Ryan, J., Gonzalez-Chica, D.A. et al. Health-related quality of life and all-cause mortality among older healthy individuals in Australia and the United States: a prospective cohort study. Qual Life Res 30, 1037–1048 (2021). https://doi.org/10.1007/s11136-020-02723-y

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