Factors Influencing Health-related Quality of Life of Young Adults and Elderly with Multimorbiditiy: A Secondary Analysis of the 2013 Korea Health Panel Data

Seunyoung Joe; Insook Lee; Bohyun Park

doi:10.12799/jkachn.2016.27.4.358

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Original Article
Factors Influencing Health-related Quality of Life of Young Adults and Elderly with Multimorbiditiy: A Secondary Analysis of the 2013 Korea Health Panel Data: Seunyoung Joe, Insook Lee, Bohyun Park; Journal of Korean Academy of Community Health Nursing 2016;27(4):358-369.
DOI: https://doi.org/10.12799/jkachn.2016.27.4.358
Published online: December 31, 2016

¹Korea Armed Forces Nursing Academy, Daejeon, Korea.

²Department of Nursing, Changwon National University, Changwon, Korea.

• Received: June 3, 2016 • Revised: November 16, 2016 • Accepted: December 5, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
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Abstract

Purpose
This study was to identify health-related quality of life of Korean young adults and elderly with multimorbidity and to examine factors influencing their health-related quality of life.
Methods
Health-related quality of life was measured by the Korean version of the EQ-5D. Using a descriptive study, the study incorporated a secondary analysis of the Korean version of the EQ-5D data from the 8th wave of the Korea Health Panel Survey in 2013. Selected demographic data and the Korean version of the EQ-5D were analyzed using χ²-test, t-test, ANOVA and multiple regression analysis.
Results
Education, drinking, type of health insurance, and number of chronic disease significantly affected the health-related quality of life in the young adults with multimorbidity. Educational level, occupational type, drinking, physical activity, number of chronic disease, unmet healthcare need and the type of multimorbidity significantly affected the health-related quality of life in the elderly with multimorbidity.
Conclusion
The factors influencing health-related quality of life were different for young adults versus elderly with multimorbidity. Therefore, there is a need for age-specific health care programs that may improve health-related quality of life of adults with multimorbidity.
Key Words: Multimorbidity; Chronic disease; Quality of life; Young adults; Elderly

Table 1

Combinations of Multimorbidity (N=1,006)

Combination of multimorbidity			Total	Young and middle-aged adults	Older adults
1st Disease	2nd Disease	3rd Disease	n (%)	n (%)	n (%)
Hypertension	Diabetes	Hyperlipidemia	263 (26.1)	63 (33.2)	200 (24.5)
Hypertension	Diabetes	Arthritis	178 (17.7)	14 (7.4)	164 (20.1)
Hypertension	Hyperlipidemia	Arthritis	173 (17.2)	28 (14.7)	145 (17.8)
Hypertension	Arthritis	Lumbar pain	34 (3.4)	2 (1.1)	32 (3.9)
Hypertension	Hyperlipidemia	Angina	33 (3.3)	10 (5.3)	23 (2.8)
Hypertension	Arthritis	Angina	29 (2.9)	1 (0.5)	28 (3.4)
Hypertension	Arthritis	Osteoporosis	28 (2.8)	1 (0.5)	27 (3.3)
Hypertension	Diabetes	Angina	25 (2.5)	9 (4.7)	16 (2.0)
Hypertension	Arthritis	Disc herniation	24 (2.4)	6 (3.2)	18 (2.2)
Diabetes	Hyperlipidemia	Arthritis	21 (2.1)	9 (4.7)	12 (1.5)
Hypertension	Hyperlipidemia	Crebral infarction	18 (1.8)	5 (2.6)	13 (1.6)
Hypertension	Diabetes	Stroke	17 (1.7)	1 (0.5)	16 (2.0)
Hypertension	Arthritis	Stroke	15 (1.5)	0 (0.0)	15 (1.8)
Hypertension	Diabetes	Lumbar pain	13 (1.3)	1 (0.5)	12 (1.5)
Hypertension	Hyperlipidemia	Spinal stenosis	13 (1.3)	5 (2.6)	8 (1.0)
Hypertension	Diabetes	Crebral infarction	12 (1.2)	2 (1.1)	10 (1.2)
Hypertension	Diabetes	Disc herniation	12 (1.2)	3 (1.6)	9 (1.1)
Hypertension	Hyperlipidemia	Gout	12 (1.2)	5 (2.6)	7 (0.9)
Hypertension	Hyperlipidemia	Disc herniation	12 (1.2)	8 (4.2)	4 (0.5)
Hypertension	Hyperlipidemia	Osteoporosis	12 (1.2)	1 (0.5)	11 (1.3)
Hypertension	Arthritis	Crebral infarction	12 (1.2)	3 (1.6)	9 (1.1)
Hypertension	Hyperlipidemia	Allergic rhinitis	10 (1.0)	8 (4.2)	2 (0.2)
Hypertension	Hyperlipidemia	Rheumatoid arthritis	10 (1.0)	2 (1.1)	8 (1.0)
Hypertension	Arthritis	Ischemic heart disease	10 (1.0)	0 (0.0)	10 (1.2)
Hypertension	Arthritis	Spinal stenosis	10 (1.0)	0 (0.0)	10 (1.2)
Hypertension	Arthritis	Frozen shoulder	10 (1.0)	3 (1.6)	7 (0.9)
Total			1,006 (100.0)	190 (100.0)	816 (100.0)

Table 2

General and Medical related Characteristics of Participants (N=1,006)^†

Characteristics	Categories	Total (N=1,006)	Young and middle-aged adults (N=190)	Older adults (N=816)
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD
Age (year)		71.99±8.87	58.00±5.24	75.25±5.86
Gender	Male	289 (28.7)	73 (38.4)	216 (26.5)
Gender	Female	717 (71.3)	117 (61.6)	600 (73.5)
Educational level	≤Middle school	743 (73.9)	98 (51.6)	645 (79.0)
	High school	186 (18.5)	61 (32.1)	125 (15.3)
	≥Bachelors	77 (7.7)	31 (16.3)	46 (5.6)
Annual income of household (million won)		27.03±31.73	43.29±52.40	23.25±23.00
	1 quintile (bottom 20%)	374 (37.2)	33 (17.4)	341 (41.8)
	2 quintile (20~40%)	245 (24.4)	31 (16.3)	214 (26.2)
	3 quintile (40~60%)	175 (17.4)	44 (23.2)	131 (16.1)
	4 quintile (60~80%)	123 (12.2)	46 (24.2)	77 (9.4)
	5 quintile (above 80%)	88 (8.8)	36 (18.9)	52 (6.4)
Religion	Seoul	136 (13.5)	29 (15.3)	107 (13.1)
	Metropolitan city	249 (24.8)	49 (25.8)	200 (24.5)
	Province	621 (61.7)	112 (58.9)	509 (62.4)
Occupational type	Unemployed	681 (67.7)	75 (39.5)	606 (74.3)
	Paid worker	141 (14.0)	73 (38.4)	68 (8.3)
	Businessman, self-employed	118 (11.7)	29 (15.3)	89 (10.9)
	Unpaid family worker	66 (6.6)	13 (6.8)	53 (6.5)
Smoking	Never smoke	704 (71.5)	123 (66.1)	581 (72.8)
	Former smoker/current nonsmoker	182 (18.5)	34 (18.3)	148 (18.5)
	Current smoker	98 (10.0)	29 (15.6)	69 (8.6)
Drinking	Non drinker	590 (60.0)	71 (38.2)	519 (65.0)
	Moderate drinker	293 (29.8)	67 (36.0)	226 (28.3)
	Heavy drinker	101 (10.3)	48 (25.8)	53 (6.6)
Moderate physical activity	<3 times a week	721 (73.3)	119 (64.0)	602 (75.4)
Moderate physical activity	≥3 times a week	263 (26.7)	67 (36.0)	196 (24.6)
Type of health insurance	National health insurance	911 (90.6)	171 (90.0)	740 (90.7)
Type of health insurance	Medical care assistance	95 (9.4)	19 (10.0)	76 (9.3)
Number of chronic disease		5.75±2.29	5.03±2.12	5.92±2.30
	3~6	692 (68.8)	153 (80.5)	539 (66.1)
	7~9	242 (24.1)	29 (15.3)	213 (26.1)
	≥10	72 (7.2)	8 (4.2)	64 (7.8)
Type of multimorbidity	Not included musculoskeletal condition	378 (37.6)	98 (51.6)	280 (34.3)
Type of multimorbidity	Included musculoskeletal condition	628 (62.4)	92 (48.4)	536 (65.7)
Unmet healthcare needs	Unmet healthcare needs	217 (22.1)	44 (23.7)	173 (21.7)
Unmet healthcare needs	Not unmet healthcare needs	767 (77.9)	142 (76.3)	625 (78.3)

^† Missing data excluded.

Table 3

Health-related Quality of Life by General and Medical related Characteristics of Participants (N=1,006)^†

Characteristics		Young and middle-aged adults (N=190)		Older adults (N=816)
Characteristics		M±SD	t or F (p)	M±SD	t or F (p)
HRQOL		0.87±0.12		0.84±0.12	3.30‡ (.001)
Gender	Male	0.87±0.15	−0.27 (.791)	0.88±0.09	6.99 (<.001)
Gender	Female	0.87±0.09	−0.27 (.791)	0.82±0.13	6.99 (<.001)
Educational level	≤Middle school^a	0.87±0.11	4.21 (.016) a, b<c	0.83±0.12	11.75 (<.001) a<b, c
	High school^b	0.85±0.15		0.87±0.10
	≥Bachelors^c	0.92±0.05		0.88±0.09
Annual income of household (million won)	1 quintile (bottom 20%)^a	0.80±0.14	4.59 (.001) a<e	0.82±0.13	2.97 (.019) a<d
	2 quintile (20~40%)^b	0.88±0.12		0.84±0.12
	3 quintile (40~60%)^c	0.88±0.08		0.85±0.12
	4 quintile (60~80%)^d	0.86±0.14		0.86±0.11
	5 quintile (above 80%)^e	0.92±0.05		0.86±0.11
Religion	Seoul	0.88±0.08	0.24 (.789)	0.85±0.11	0.90 (.408)
	Metropolitan city	0.87±0.11		0.83±0.13
	Province	0.87±0.13		0.84±0.12
Occupational type	Unemployed^a	0.84±0.16	2.20 (.090)	0.82±0.13	10.98 (<.001) a<b, c b>d
	Paid worker^b	0.89±0.08		0.89±0.07
	Businessman, self-employed^c	0.89±0.08		0.88±0.09
	Unpaid family worker^d	0.88±0.10		0.85±0.09
Smoking	Never smoke^a	0.88±0.09	1.18 (.311)	0.83±0.13	5.83 (.003) a<b
	Former smoker/current nonsmoker^b	0.85±0.18		0.86±0.10
	Current smoker^c	0.85±0.13		0.85±0.11
Drinking	Non drinker^a	0.85±0.14	2.59 (.078)	0.82±0.13	16.45 (<.001) a<b, c
	Moderate drinker^b	0.88±0.11		0.86±0.09
	Heavy drinker^c	0.89±0.09		0.89±0.08
Moderate physical activity	<3 times a week	0.86±0.13	−2.17 (.031)	0.83±0.13	−5.65 (<.001)
Moderate physical activity	≥3 times a week	0.89±0.08	−2.17 (.031)	0.87±0.09	−5.65 (<.001)
Type of health insurance	National health insurance	0.88±0.11	2.69 (.015)	0.84±0.12	3.34 (.001)
Type of health insurance	Medical care assistance	0.77±0.16	2.69 (.015)	0.79±0.11	3.34 (.001)
Number of chronic disease	3~6^a	0.89±0.11	9.50 (<.001) a>b>c	0.85±0.10	30.45 (<.001) a>b>c
	7~9^b	0.82±0.14		0.82±0.12
	≥10^c	0.75±0.11		0.74±0.20
Type of multimorbidity	Not included musculoskeletal condition	0.86±0.14	−1.05 (.297)	0.86±0.13	3.68 (<.001)
Type of multimorbidity	Included musculoskeletal condition	0.88±0.08	−1.05 (.297)	0.83±0.12	3.68 (<.001)
Unmet healthcare needs	Unmet healthcare needs	0.86±0.13	−0.90 (.369)	0.79±0.13	−6.33 (<.001)
Unmet healthcare needs	Not unmet healthcare needs	0.88±0.11	−0.90 (.369)	0.85±0.11	−6.33 (<.001)

HRQOL=health-related quality of life; ^†Missing data excluded; ^‡Result of indepent t-test between young and middle-aged, and older adult.

Table 4

Factors influencing HRQOL of Participants (N=1,006)^†

Variables	Model 1			Model 2
	Young and middle-aged adults (n=190)			Older adults (n=816)
	B	t	p	B	t	p
Female (Male=0)	0.01	0.42	.676	−0.02	−1.23	.220
Education (Below middle school=0)
High school	0.00	−0.14	.888	0.03	2.68	.008
≥Bachelors	0.07	2.58	.011	0.03	1.53	.126
Annual income of household (million won)	0.35	0.21	.831	−0.30	−0.16	.873
Occupational type (Paid worker=0)
Unemployed	0.00	−0.21	.830	−0.04	−2.72	.007
Businessman/self-employed	0.01	0.48	.633	−0.01	−0.66	.507
Unpaid family worker	−0.02	−0.45	.657	−0.02	−1.00	.320
Smoking (Never smoke=0)
Former smoker/current nonsmoker	−0.05	−1.66	.100	−0.01	−0.39	.694
Current smoker	−0.07	−2.19	.030	−0.01	−0.69	.488
Drinking (Non drinker=0)
Moderate drinker	0.02	1.01	.314	0.03	3.07	.002
Heavy drinker	0.05	2.04	.043	0.02	1.01	.315
Moderate physical activity (<3 times a week=0)
More than 3 times a week	0.02	0.91	.362	0.02	2.45	.015
Type of health insurance (NHI=0)
Medical care assistance	−0.04	−1.35	.180	−0.01	−0.71	.476
Number of chronic disease	−0.01	−3.66	<.001	−0.01	−6.35	<.001
Type of multimorbidity (NMC=0)
Included musculoskeletal condition	0.01	0.56	.575	−0.03	−3.08	.002
Unmet healthcare needs (Yes=0)
Not unmet healthcare needs	0.01	0.31	.754	0.05	5.15	<.001
	R²=.24, Adj. R²=.17, F=3.30, p<.001 R²=.19, Adj. R²=.17, F=11.33, p<.001

NHI=national health insurance; NMC=not included musculoskeletal condition; ^†Missing data excluded.

Dependent variable : health-related quality of life (EQ-5D index)

Note. Predictors : (constant), gender, educational level, annual income of household (million won), occupational type, smoking, drinking, moderate physical activity, type of health insurance, number of chronic disease, type of multimorbidity, unmet healthcare needs.

NOTES

This research is financially supported by Changwon National University in 2015~2016.

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