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Lee YX, Auwerda ST, Jellema K, Vliet Vlieland TPM, Arwert HJ. Ethnic disparities in long-term outcomes and health care usage after stroke in the Netherlands. Disabil Health J 2024; 17:101582. [PMID: 38246799 DOI: 10.1016/j.dhjo.2024.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Poststroke health-related quality of life (HRQOL) is an important outcome that may be influenced by ethnicity. OBJECTIVE To compare long-term HRQOL, mental health and healthcare utilization between stroke survivors with a European (EUB) and non-European background (NEUB) in a hospital population. METHODS In this retrospective cohort study patients completed questionnaires 2-5 years after stroke. Assessments included the EuroQol-5D-3L (EQ-5D), Short Form (SF-36, with physical and mental component summary scales, PCS and MCS), Hospital Anxiety and Depression Scale (HADS; scores ≥8 indicate clinically relevant complaints) and a questionnaire on the usage of services from physicians and/or healthcare professionals (HCP) in the past 6 months. Linear and logistic regression analysis was used, adjusted for age, sex, level of education and functional outcome. RESULTS We included 207 patients (169 EUB, 38 NEUB); mean age 63.8 years (SD 14.4); 60.4 % male; mean follow up 36.3 months (SD 9.9). The EQ-5D and the PCS were higher in EUB versus NEUB patients (42.9 vs 35.4, p < 0.01; 0.76 vs 0.60, p < 0.01). The MCS showed a comparable, non-significant trend. The percentage of patients with HADS depression ≥8 was higher in NEUB patients versus EUB patients (54.3 % vs 29.8 %; p > 0.01). Significantly more NEUB patients had visited two or more physicians in the past six months compared to EUB patients (52.0 % vs 26.0 %; p = 0.01) whereas the use of services from HCP was similar. CONCLUSIONS NEUB stroke patients had worse outcomes regarding HRQOL and depressive symptoms compared to EUB patients. NEUB patients visited more physicians.
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Affiliation(s)
- Y X Lee
- Haaglanden Medical Center, Department of Neurology, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
| | - S T Auwerda
- Basalt Rehabilitation Center, Vrederustlaan 180, 2543 SW, The Hague, the Netherlands.
| | - K Jellema
- Haaglanden Medical Center, Department of Neurology, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
| | - T P M Vliet Vlieland
- Leiden Universitary Medical Center, Department of Orthopaedics, Rehabilitation and Physical Therapy, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
| | - H J Arwert
- Haaglanden Medical Center, Department of Rehabilitation, Lijnbaan 32, 2512 VA, The Hague, the Netherlands; Basalt Rehabilitation Center, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
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Niemeyer MJS, Jochems D, Van Ditshuizen JC, de Kanter J, Cremers L, van Hattem M, Den Hartog D, Houwert RM, Leenen LPH, van Wessem KJP. Clinical outcomes and end-of-life treatment in 596 patients with isolated traumatic brain injury: a retrospective comparison of two Dutch level-I trauma centers. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02407-5. [PMID: 38226991 DOI: 10.1007/s00068-023-02407-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/12/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE With an increasingly older population and rise in incidence of traumatic brain injury (TBI), end-of-life decisions have become frequent. This study investigated the rate of withdrawal of life sustaining treatment (WLST) and compared treatment outcomes in patients with isolated TBI in two Dutch level-I trauma centers. METHODS From 2011 to 2016, a retrospective cohort study of patients aged ≥ 18 years with isolated moderate-to-severe TBI (Abbreviated Injury Scale (AIS) head ≥ 3) was conducted at the University Medical Center Rotterdam (UMC-R) and the University Medical Center Utrecht (UMC-U). Demographics, radiologic injury characteristics, clinical outcomes, and functional outcomes at 3-6 months post-discharge were collected. RESULTS The study population included 596 patients (UMC-R: n = 326; UMC-U: n = 270). There were no statistical differences in age, gender, mechanism of injury, and radiologic parameters between both institutes. UMC-R patients had a higher AIShead (UMC-R: 5 [4-5] vs. UMC-U: 4 [4-5], p < 0.001). There was no difference in the prehospital Glasgow Coma Scale (GCS). However, UMC-R patients had lower GCSs in the Emergency Department and used more prehospital sedation. Total in-hospital mortality was 29% (n = 170), of which 71% (n = 123) occurred after WLST. Two percent (n = 10) remained in unresponsive wakefulness syndrome (UWS) state during follow-up. DISCUSSION This study demonstrated a high WLST rate among deceased patients with isolated TBI. Demographics and outcomes were similar for both centers even though AIShead was significantly higher in UMC-R patients. Possibly, prehospital sedation might have influenced AIS coding. Few patients persisted in UWS. Further research is needed on WLST patients in a broader spectrum of ethics, culture, and complex medical profiles, as it is a growing practice in modern critical care. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Menco J S Niemeyer
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Denise Jochems
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan C Van Ditshuizen
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Trauma Center Southwest Netherlands, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Janneke de Kanter
- Department of Radiology, UMC Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lotte Cremers
- Department of Radiology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Martijn van Hattem
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Trauma Center Southwest Netherlands, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roderick Marijn Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Karlijn J P van Wessem
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Yang C, Liu P, Huang W, Zhou Y, Liu C, Gao T, Zhong F. Relationship between three dietary indices and health-related quality of life among rural elderly in China: a cross-sectional study. Front Nutr 2023; 10:1259227. [PMID: 37927509 PMCID: PMC10624226 DOI: 10.3389/fnut.2023.1259227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This study aimed to explore the association between health-related quality of life (HRQOL) and diet quality using three evidence-based dietary indices among older people in rural China. Methods This cross-sectional study included 1,258 rural older people (mean age 72.32 years; 55.6% female). HRQOL was assessed using the European Five Dimension Health Scale (EQ-5D), and dietary intake was assessed using a Food Frequency Questionnaire. Three dietary scoring indices, including the Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension, and Dietary Diversity Score (DDS), were calculated to assess and analyze the relationship between these dietary indices and quality of life. Results The EQ-5D score was 0.95 ± 0.10, and the EQ-Visual Analog Scale (VAS) score was 76.76 ± 14.44. All three groups with higher dietary indices had higher quality of life scores. After controlling for covariates in multivariate adjusted binary logistic regression analyzes, participants in the top tertile of DDS had higher quality of life scores than those in the bottom tertile. DDS was consistently associated with EQ-5D (Model 2: OR = 1.567, p = 0.001; Model3: OR = 1.351, p = 0.044) and EQ-VAS (Model 2: OR = 1.830, p < 0.001; Model 3: OR = 1.383, p = 0.047), significantly different from the other groups. Conclusion Older people in rural China who adhere to various foods experience a better quality of healthy life.
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Affiliation(s)
- Chen Yang
- Qingdao University School of Public Health, Qingdao, China
| | - Peijun Liu
- Qingdao University School of Public Health, Qingdao, China
| | - Wenjing Huang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ying Zhou
- Qingdao University School of Public Health, Qingdao, China
| | - Cuiping Liu
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Tianlin Gao
- Qingdao University School of Public Health, Qingdao, China
| | - Feng Zhong
- Qingdao University School of Public Health, Qingdao, China
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Shi Z, Mao Z, Xue S, Chen G, Li S. What is the relationship between health-related quality of life among scoliosis patients and their caregiver burden? A cross-sectional study in China. BMC Psychol 2023; 11:346. [PMID: 37858224 PMCID: PMC10588232 DOI: 10.1186/s40359-023-01375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Caregivers play a vital role in the recovery of scoliosis patients, but limited studies evaluate the caregivers' HRQoL and burden in health care. This study aimed to explore the health-related quality of life (HRQoL) of scoliosis patients and their caregivers, and identify the factors influencing caregiver burden in Eastern China. METHODS This cross-sectional study was conducted from August 2018 to January 2019 at the Shandong Provincial Hospital, Jinan, China. The HRQoL of scoliosis patients was measured by the Scoliosis Research Society-22r (SRS-22r), five-level EQ-5D (EQ-5D-5L) and Child Health Utility 9D (CHU9D). The caregivers' questionnaires consist of the EQ-5D-5L, WHO-five wellbeing index (WHO-5), 22-item Zarit Caregiver Burden Interview (ZBI-22) and Social Support Rating Scale (SSRS). Spearman correlation coefficients were used to estimate the relationship among caregivers' burden, social support, HRQoL, and SWB. Cohen's effect size (Cohen's d) was used to assess the ZBI-22 total score between different groups. Multiple stepwise hierarchical linear regression models were conducted to assess the associated factors of caregiver burden. RESULTS There were 59 scoliosis patients and their caregivers (n = 59) included in the analysis. The mean health state utility of adolescent scoliosis patients (n = 39) was 0.718 (95%CI: 0.654, 0.782) based on CHU9D and adult scoliosis patients (n = 20) was 0.663 (95%CI: 0.471, 0.855) based on EQ-5D-5L. The mean health state utility of male scoliosis patients (0.792/0.667) was higher than females (0.681/0.662) based on CHU9D and EQ-5D-5L (p > 0.05), respectively. The ZBI-22 total score of scoliosis patients' caregivers was 27.86 (SD: 20.59). Scoliosis patients' HRQoL was significantly inversely correlated with caregiver burden, and the HRQoL and subjective wellbeing (SWB) of caregivers were moderately and inversely correlated with caregiver burden. The regression results showed that the patients' age and caregivers' SWB were key characteristics associated with caregiver burden. CONCLUSIONS The caregiver burden of adolescent patients was higher than that of adult patients, and the satisfaction rate of adolescent scoliosis patients was higher than that of adult scoliosis patients. Improving the functional state of scoliosis patients and providing appropriate nursing practice education from health professionals would be necessary to effectively improve caregivers SWB and alleviate caregiver burden.
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Affiliation(s)
- Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, 250012, Jinan, China
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, 2000, Belgium
| | - Shiwen Xue
- National Center for Respiratory Medicine, Guangzhou, 510000, China
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China
- National Clinical Research Center for Respiratory Disease, Guangzhou, 510000, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510000, China
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, 3145, Australia
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, 250012, Jinan, China.
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Li X, Zhao K, Li K, Wang W, Feng S, Wu J, He X, Xie S, Hu H, Fan J, Fu Q, Xie F. China Health Related Outcomes Measures (CHROME): development of a descriptive system to support cardiovascular disease specific preference-based measure for the Chinese population. Qual Life Res 2023:10.1007/s11136-023-03416-y. [PMID: 37119354 DOI: 10.1007/s11136-023-03416-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE Preference-based measures have been increasingly recommended to measure health outcomes for economic evaluation. However, none of existing cardiovascular disease (CVD)-specific health-related quality of life (HRQoL) instruments are preference-based. This study aimed to develop the descriptive system of preference-based HRQoL instrument for Chinese patients with CVDs under the Initiative of China Health Related Outcomes Measures (CHROME). METHODS Qualitative face-to-face interviews were conducted with Chinese patients with CVDs. Content analysis was employed to generate candidate items for the instrument. Then expert consultation and cognitive debriefing interviews were conducted to guide further selection and revision of the items. RESULTS We interviewed 127 CVD patients with 67.7% being male and 63.8% living in the urban area. A hierarchical code book comprised of four themes, 20 categories, 62 sub-categories, and 207 codes, was developed. Candidate items were selected based on the criteria set by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology and ISPOR PRO guidance. An online survey and meeting with an expert advisory panel (n = 15) followed by cognitive debriefing interviews with 20 patients and 13 physicians were conducted to further select and revise the candidate items. The descriptive system of CHROME-CVD consists of 14 items, namely frequency and severity of chest pain, chest tightness, palpitation, shortness of breath, dizziness, fatigue, appetite, sleeping, mobility, daily activities, depression, worry, and social relationship. Four or five level responses were selected based on cognitive debriefing results to each item. CONCLUSION The current study developed the descriptive system (items and response options) of CHROME-CVD, the future CVD-specific preference-based HRQoL instrument for Chinese CVD patients.
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Affiliation(s)
- Xue Li
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Kun Zhao
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kexin Li
- China Alliance for Rare Disease, Beijing, China
| | - Wenjun Wang
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China
| | - Siting Feng
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Shitong Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Hao Hu
- Liaoning Institute of Basic Medicine, Liaoning, China
| | - Jing Fan
- National Center for Cardiovascular Diseases, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Fu
- China National Health Development Research Center, 9 Chegongzhuang Street, Xicheng District, Beijing, 100444, China.
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
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Wang D, Xie S, Wu J, Sun B. The trend in quality of life of Chinese population: analysis based on population health surveys from 2008 to 2020. BMC Public Health 2023; 23:167. [PMID: 36694154 PMCID: PMC9873389 DOI: 10.1186/s12889-023-15075-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Quality of life (QoL) is one of the most important indicators for evaluating an individual's overall health status. However, evidence exploring the trend in QoL of the Chinese population is still lacking. This study aimed to investigate the trend in QoL of the Chinese population measured by the EQ-5D from 2008 to 2020, as well as compare the changing trends in QoL categorized by populations with different socio-demographic characteristics. METHODS Data were obtained from the 2008, 2013, and 2020 waves of the Health Services Surveys conducted in Tianjin, China. Respondents completed the EQ-5D (EQ-5D-3L in 2008 and 2013 and EQ-5D-5L in 2020) through face-to-face interviews or self-administration. Responses of the EQ-5D-3L in 2008 and 2013 were mapped onto the EQ-5D-5L responses, and then converted to utility values using the Chinese value set. The trend in QoL was explored by comparing the percentage of any reported problems on each EQ-5D dimension and the corresponding utility values across the three waves. Subgroup analyses were performed to compare trends in utility values stratified by socio-demographic indicators. The effect of the time variable (year) on utility values was assessed by multiple linear regression analyses using the pooled data. RESULTS By analyzing and comparing the three waves of the data (N = 25,939 in the 2008 wave, N = 22,138 in 2013, and N = 19,177 in 2020), an upward trend was observed in the percentages of reporting problems on all five dimensions (p < 0.001), resulting in a decreasing trend in utility values (2008: 0.948, 2013: 0.942, 2020: 0.939, p < 0.001). Utility values declined more over time among the female, the elder, the recipients of medical assistance, the widowed, the unemployed, and respondents with primary or lower education. The effect of the year (Coef. for 2013 = - 0.009, p < 0.001; Coef. for 2020 = - 0.010, p < 0.001) confirmed the downward trend in the utility values. CONCLUSIONS The overall QoL of the Chinese population decreased over the period from 2008 to 2020. The QoL of the disadvantaged or vulnerable populations in terms of socioeconomic characteristics declined more over time.
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Affiliation(s)
- Dingyao Wang
- grid.33763.320000 0004 1761 2484School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072 China ,grid.33763.320000 0004 1761 2484Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Shitong Xie
- grid.33763.320000 0004 1761 2484School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072 China ,grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China. .,Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Bei Sun
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, 300072, China.
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Wu J, He X, Chen P, Xie S, Li X, Hu H, Zhao K, Xie F. China Health Related Outcomes Measures (CHROME): Development of a New Generic Preference-Based Measure for the Chinese Population. PHARMACOECONOMICS 2022; 40:957-969. [PMID: 35844001 PMCID: PMC9288864 DOI: 10.1007/s40273-022-01151-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Existing generic preference-based measures were all developed in Western countries. Evidence shows that the Chinese population may have different perceptions about health and health-related quality of life. This study aimed at developing a descriptive system of a new generic preference-based measure under the initiative of China Health Related Outcomes Measures (CHROME). METHODS Qualitative data were collected through semi-structured interviews conducted in-person or online. Respondents were recruited from both the general public and populations with chronic diseases. Open-ended questions about the respondent's perception of general health and important aspects of health-related quality of life were asked. Probing questions based on a systematic review of existing generic preference-based measures were also used. The framework analysis was used to synthesize the qualitative data. Candidate items for the descriptive system were selected following the ISPOR and COSMIN guidelines. Expert panel review and cognitive debriefings were conducted for further revisions. RESULTS Qualitative interviews were conducted among 68 respondents, with 48.5% male and a mean age of 47.8 years (range 18-81 years). In total, 1558 codes were identified and then aggregated to 31 sub-themes and corresponding six themes to inform the development of the initial version of the descriptive system. Feedback from the expert panel survey and meeting (n = 15) and the cognitive debriefing interviews (n = 30) was incorporated into the revised version of the measure. Finally, the generic version of CHROME (CHROME-G) included 12 items across six domains, namely, pain, fatigue, appetite, mobility, vision, hearing, sleeping, daily activities, depression, worry, memory, and social interactions. The descriptive system used a mix of four-level and five-level response options and a 7-day recall period. CONCLUSIONS The CHROME-G is the first generic preference-based measure to be developed based on the inputs from the Chinese populations.
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Affiliation(s)
- Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Pinan Chen
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Xue Li
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Health Technology Assessment, China National Health Development Research Centre, Beijing, China
| | - Hao Hu
- Liaoning Institute of Basic Medicine, Liaoning, China
| | - Kun Zhao
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China.
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
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Xie S, Wang D, Wu J, Liu C, Jiang W. Comparison of the measurement properties of SF-6Dv2 and EQ-5D-5L in a Chinese population health survey. Health Qual Life Outcomes 2022; 20:96. [PMID: 35710429 PMCID: PMC9202323 DOI: 10.1186/s12955-022-02003-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/04/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND SF-6Dv2, the latest version of SF-6D, has been developed recently, and its measurement properties remain to be evaluated and compared with the EQ-5D-5L. The aim of this study was to assess and compare the measurement properties of the SF-6Dv2 and the EQ-5D-5L in a large-sample health survey among the Chinese population. METHODS Data were obtained from the 2020 Health Service Survey in Tianjin, China. Respondents were randomly selected and invited to complete both the EQ-5D-5L and SF-6Dv2 through face-to-face interviews or self-administration. Health utility values were calculated by the Chinese value sets for the two measures. Ceiling and floor effects were firstly evaluated. Convergent validity and discriminate validity were examined using Spearman's rank correlation and effect sizes, respectively. The agreement was assessed using intraclass correlation coefficients (ICC). Sensitivity was compared using relative efficiency and receiver operating characteristic. RESULTS Among 19,177 respondents (49.3% male, mean age 55.2 years, ranged 18-102 years) included in this study, the mean utility was 0.939 (0.168) for EQ-5D-5L and 0.872 (0.184) for SF-6Dv2. A higher ceiling effect was observed in EQ-5D-5L than in SF-6Dv2 (72.8% vs. 36.1%). The Spearman's rank correlation (range: 0.30-0.69) indicated an acceptable convergent validity between the dimensions of EQ-5D-5L and SF-6Dv2. The SF-6Dv2 showed slightly better discriminative capacities than the EQ-5D-5L (ES: 0.126-2.675 vs. 0.061-2.256). The ICC between the EQ-5D-5L and SF-6Dv2 utility values of the total sample was 0.780 (p < 0.05). The SF-6Dv2 had 29.0-179.2% higher efficiency than the EQ-5D-5L at distinguishing between respondents with different external health indicators, while the EQ-5D-5L was found to be 8.2% more efficient at detecting differences in self-reported health status than the SF-6Dv2. CONCLUSIONS Both the SF-6Dv2 and EQ-5D-5L have been demonstrated to be comparably valid and sensitive when used in Chinese population health surveys. The two measures may not be interchangeable given the moderate ICC and the systematic difference in utility values between the SF-6Dv2 and EQ-5D-5L. Further research is warranted to compare the test-retest reliability and responsiveness.
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Affiliation(s)
- Shitong Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,School of Pharmaceutical Science and Technology, Tianjin University, Room 209, 24th Building, 92th Weijin Road, Nankai District, Tianjin, 300072, China
| | - Dingyao Wang
- School of Pharmaceutical Science and Technology, Tianjin University, Room 209, 24th Building, 92th Weijin Road, Nankai District, Tianjin, 300072, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Room 209, 24th Building, 92th Weijin Road, Nankai District, Tianjin, 300072, China. .,Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Chunyu Liu
- Tianjin Health Information Research Center (Tianjin Health Development Research Center), Tianjin, China
| | - Wenchen Jiang
- Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, 6th Changjiang Road, Nankai District, Tianjin, 300100, China.
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Li M, Bao Z, Lv G, Zhou J, Chen P, Luo N. Culture-Related Health Disparities in Quality of Life: Assessment of Instrument Dimensions Among Chinese. Front Public Health 2021; 9:663904. [PMID: 34178922 PMCID: PMC8221419 DOI: 10.3389/fpubh.2021.663904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Health-related quality of life (HRQoL) is one of the major focuses of primary care. However, HRQoL instruments used in China are mainly developed from Western countries. Such instruments may not cover all important health concepts valued by the Chinese as health is a culture-specific concept. Objectives: The objectives of this study are to identify culture-specific health dimensions and culture-related health disparities in primary care that are considered important by Chinese living in China. Methods: A purposive sample of 164 adult Chinese (67 healthy persons and 97 patients) were interviewed face to face. In-depth open-ended questions were asked to elicit culture-specific dimensions of quality of life in primary care settings in China. Results: Twelve health dimensions were identified. Five most frequently mentioned dimensions were: mood (N = 52, 31.71%), physical activities (N = 48, 29.27%), work (N = 40, 24.39%), diet (N = 32, 19.51%), and vitality (N = 28, 17.07%). Significantly more healthy persons reported mood (49.25 vs. 19.59%, P < 0.001), mindset (16.42 vs. 0.00%, P < 0.001), and self-care (11.94 vs. 2.06%, P = 0.016) characterizing good HRQoL, while more patients emphasized on work (4.48 vs. 38.14%, P < 0.001). Diet and vitality appeared to be culture-specific dimensions related to health among Chinese. Conclusions: To better adapt or develop HRQoL instruments for Chinese, dimensions or items regarding diet might be included and disparities in the meaning of vitality between Chinese and Western cultures should be considered.
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Affiliation(s)
- Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Zhang Bao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Gang Lv
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianying Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Pingyu Chen
- Department of Health Economics, China Pharmaceutical University, Nanjing, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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10
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Mao Z, Ahmed S, Graham C, Kind P, Sun YN, Yu CH. Similarities and Differences in Health-Related Quality of Life Concepts Between the East and the West: A Qualitative Analysis of the Content of Health-Related Quality of Life Measures. Value Health Reg Issues 2021; 24:96-106. [DOI: 10.1016/j.vhri.2020.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/15/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
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11
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Leilei D, Pengpeng Y, Haagsma JA, Ye J, Yuan W, Yuliang E, Xiao D, Xin G, Cuirong J, Linhong W, Bannick MS, Mountjoy-Venning WC, Hawley CN, Liu Z, Smith M, James SL, Vos T, Murray CJL. The burden of injury in China, 1990-2017: findings from the Global Burden of Disease Study 2017. LANCET PUBLIC HEALTH 2020; 4:e449-e461. [PMID: 31493842 PMCID: PMC6739690 DOI: 10.1016/s2468-2667(19)30125-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
Abstract
Background A comprehensive evaluation of the burden of injury is an important foundation for selecting and formulating strategies of injury prevention. We present results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 of non-fatal and fatal outcomes of injury at the national and subnational level, and the changes in burden for key causes of injury over time in China. Methods Using the methods and results from GBD 2017, we describe the burden of total injury and the key causes of injury based on the rates of incidence, cause-specific mortality, and disability-adjusted life years (DALYs) in China estimated using DisMod-MR 2.1. We additionally evaluated these results at the provincial level for the 34 subnational locations of China in 2017, measured the change of injury burden from 1990 to 2017, and compared age-standardised DALYs due to injuries at the provincial level against the expected rates based on the Socio-demographic Index (SDI), a composite measure of development of income per capita, years of education, and total fertility rate. Findings In 2017, in China, there were 77·1 million (95% uncertainty interval [UI] 72·5–81·6) new cases of injury severe enough to warrant health care and 733 517 deaths (681 254–767 006) due to injuries. Injuries accounted for 7·0% (95% UI 6·6–7·2) of total deaths and 10·0% (9·5–10·5) of all-cause DALYs in China. In 2017, there was a three-times variation in age-standardised injury DALY rates between provinces of China, with the lowest value in Macao and the highest in Yunnan. Between 1990 and 2017, the age-standardised incidence rate of all injuries increased by 50·6% (95% UI 46·6–54·6) in China, whereas the age-standardised mortality and DALY rates decreased by 44·3% (41·1–48·9) and 48·1% (44·6–51·8), respectively. Between 1990 and 2017, all provinces of China experienced a substantial decline in DALY rates from all injuries ranging from 16·3% (3·1–28·6) in Shanghai and 60·4% (53·7–66·1) in Jiangxi. Age-standardised DALY rates for drowning; injuries from fire, heat and hot substances; adverse effects of medical treatments; animal contact; environmental heat and cold exposure; self-harm; and executions and police conflict each declined by more than 60% between 1990 and 2017. Interpretation Between 1990 and 2017, China experienced a decrease in the age-standardised DALY and mortality rates due to injury, despite an increase in the age-standardised incidence rate. These trends occurred in all provinces. The divergent trends in terms of incidence and mortality indicate that with rapid sociodemographic improvements, the case fatality of injuries has declined, which could be attributed to an improving health-care system but also to a decreasing severity of injuries over this time period. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Duan Leilei
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ye Pengpeng
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juanita A Haagsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jin Ye
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wang Yuan
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Er Yuliang
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Deng Xiao
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gao Xin
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ji Cuirong
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wang Linhong
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Marlena S Bannick
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Caitlin N Hawley
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mari Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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12
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Hunt C, Zahid S, Ennis N, Michalak A, Masanic C, Vaidyanath C, Bhalerao S, Cusimano MD, Baker A. Quality of life measures in older adults after traumatic brain injury: a systematic review. Qual Life Res 2019; 28:3137-3151. [PMID: 31522371 PMCID: PMC6864113 DOI: 10.1007/s11136-019-02297-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND On average older adults experiencing TBI are hospitalized four times as often, have longer hospital stays, and experience slower recovery trajectories and worse functional outcomes compared to younger populations with the same injury severity. A standard measure of Qol for older adults with TBI would facilitate accurate and reliable data across the individual patient care continuum and across clinical care settings, as well as support more rigorous research studies of metadata. PURPOSE The aim of this systematic review was to investigate patient reported Qol measures in studies with older adults post TBI. METHOD A systematic review was carried out focusing on the various tools to measure Qol in older adults, ≥ 65 years of age with a diagnosis of TBI. Data bases searched included Medline, Embase, PubMed, CINAHL, and PsychInfo from date of inception to September 25, 2017. RESULTS A total of 20 articles met the inclusion criteria. Nine different tools were identified. CONCLUSIONS Findings based on the comparison of reliability and construct validity of the Qol measures reported in this review suggest that no single instrument is superior to all others for our study population. Future research in this field should include the enrollment of larger study samples of older adults. Without these future efforts, the ability to detect an optimal Qol measure will be hindered.
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Affiliation(s)
- Cindy Hunt
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | | | - Naomi Ennis
- Department of Psychology, Ryerson University, Toronto, ON Canada
| | - Alicja Michalak
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Cheryl Masanic
- St. Michael’s Head Injury Clinic and UHN Toronto Rehabilitation Clinic Toronto, Toronto, ON Canada
| | - Chantal Vaidyanath
- St. Michael’s Head Injury Clinic and UHN Toronto Rehabilitation Clinic Toronto, Toronto, ON Canada
| | | | - Michael D. Cusimano
- Department of Surgery, Division of Neurosurgery, Injury Prevention Research Office, Keenan Research Centre, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Andrew Baker
- Departments of Anesthesia and Critical Care, Keenan Research Centre for Biomedical Science, St. Michael’s Hospital Toronto, University of Toronto, Toronto, ON Canada
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13
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Voormolen DC, Polinder S, von Steinbuechel N, Vos PE, Cnossen MC, Haagsma JA. The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury. Injury 2019; 50:1068-1074. [PMID: 30554897 DOI: 10.1016/j.injury.2018.12.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/16/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
A subset of mild traumatic brain injury (mTBI) patients experience post-concussion symptoms. When a cluster of post-concussion symptoms persists for over three months, it is referred to as post-concussion syndrome (PCS). Little is known about the association between PCS and Health-Related Quality of Life (HRQoL) after mTBI. The aims of this study were to assess the implications of PCS on HRQoL six months after mTBI and the relationship between PCS and HRQoL domains. A prospective observational cohort study was conducted among a sample of mTBI patients. Follow-up postal questionnaires at six months after emergency department (ED) admission included socio-demographic information, the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), and HRQoL measured with the 36-item Short-Form Health Survey (SF-36) and the Perceived Quality of Life Scale (PQoL). In total, 731 mTBI patients were included, of whom 38.7% were classified as suffering from PCS. Patients with PCS had significantly lower scores on all SF-36 domains, lower physical and mental component summary scores and lower mean PQoL scores compared to patients without PCS. All items of the RPQ were negatively correlated to all SF-36 domains and PQoL subscale scores, indicating that reporting problems on any of the RPQ symptoms was associated with a decrease on different aspects of an individuals' HRQoL. To conclude, PCS is common following mTBI and patients with PCS have a considerably lower HRQoL. A better understanding of the relationship between PCS and HRQoL and possible mediating factors in this relationship could improve intervention strategies, the recovery process for mTBI patients and benchmarking.
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Affiliation(s)
- Daphne C Voormolen
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands.
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands.
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, Georg-August-University, Göttingen, Germany.
| | - Pieter E Vos
- Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands.
| | - Maryse C Cnossen
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands.
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands; Department of Emergency Medicine, Erasmus University Medical Center Rotterdam, the Netherlands.
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14
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Medhi GK, Sarma J, Bhattacharyya H, Pala S, Visi V, Bora PJ. Sociodemographic variations in health-related quality of life (HRQOL) among elderly individuals in an urban locality in India. J Family Med Prim Care 2019; 8:2473-2477. [PMID: 31463279 PMCID: PMC6691467 DOI: 10.4103/jfmpc.jfmpc_340_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Elderly population is growing rapidly in India. To direct public health actions to improve quality of life among elderly, it is important to understand the sociodemographic factors associated with quality of life. The aim of study was to assess health-related quality of life (HRQOL) among urban elderly in a setting of Assam, India, and to examine how HRQOL varied across different sociodemographic groups among the elderly populations. Materials and Methods: A cross-sectional study was carried among elderly aged ≥60 involving 300 participants. Eight domains of HRQOL of participants were measured using RAND SF-36. Analysis of variance test was used to examine sociodemographic differences in HRQOL. Results: The BP domain had highest (71.78 ± 22.25) and GH had lowest mean HRQOL score (48 ± 16.93). Males had significantly higher HRQOL score than females only in BP domain. Age gradients were observed with respect to HRQOl scores in five domains, with youngest age group having the best and oldest age group having the poorest HRQOL. Financially dependent subjects had lower HRQOL in five domains than those who were financially independent. Significant associations between education and HRQOL were found only in physical components of HRQOL, with lowest educated group being the most disadvantaged in terms of HRQOL. Marital status was found to be significantly associated with lower HRQOL scores. Conclusion: The study highlights sociodemographic inequalities in HRQOL among urban elderly in an Indian setting. The results may help reducing sociodemographic health inequalities among elderly in this region initiating public health actions paying more attention toward more vulnerable sections of populations.
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Affiliation(s)
- Gajendra Kumar Medhi
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, Meghalaya, India
| | - Jogesh Sarma
- Department of Pulmonary Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Himashree Bhattacharyya
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, Meghalaya, India
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, Meghalaya, India
| | - Vizovonuo Visi
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, Meghalaya, India
| | - Parash Jyoti Bora
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, Meghalaya, India
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15
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Dijkland SA, Voormolen DC, Venema E, Roozenbeek B, Polinder S, Haagsma JA, Nieboer D, Chalos V, Yoo AJ, Schreuders J, van der Lugt A, Majoie CBLM, Roos YBWEM, van Zwam WH, van Oostenbrugge RJ, Steyerberg EW, Dippel DWJ, Lingsma HF. Utility-Weighted Modified Rankin Scale as Primary Outcome in Stroke Trials: A Simulation Study. Stroke 2018. [PMID: 29535271 PMCID: PMC5895119 DOI: 10.1161/strokeaha.117.020194] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The utility-weighted modified Rankin Scale (UW-mRS) has been proposed as a new patient-centered primary outcome in stroke trials. We aimed to describe utility weights for the mRS health states and to evaluate the statistical efficiency of the UW-mRS to detect treatment effects in stroke intervention trials. Methods— We used data of the 500 patients enrolled in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Utility values were elicited from the EuroQol Group 5-Dimension Self-Report Questionnaire assessed at 90 days after inclusion, simultaneously with the mRS. Utility weights were determined by averaging the utilities of all patients within each mRS category. We performed simulations to evaluate statistical efficiency. The simulated treatment effect was an odds ratio of 1.65 in favor of the treatment arm, similar for all mRS cutoffs. This treatment effect was analyzed using 3 approaches: linear regression with the UW-mRS as outcome, binary logistic regression with a dichotomized mRS (0–1/2–6, 0–2/3–6, and 0–4/5–6), and proportional odds logistic regression with the ordinal mRS. The statistical power of the 3 approaches was expressed as the proportion of 10 000 simulations that resulted in a statistically significant treatment effect (P≤0.05). Results— The mean utility values (SD) for mRS categories 0 to 6 were: 0.95 (0.08), 0.93 (0.13), 0.83 (0.21), 0.62 (0.27), 0.42 (0.28), 0.11 (0.28), and 0 (0), respectively, but varied substantially between individual patients within each category. The UW-mRS approach was more efficient than the dichotomous approach (power 85% versus 71%) but less efficient than the ordinal approach (power 85% versus 87%). Conclusions— The UW-mRS as primary outcome does not capture individual variation in utility values and may reduce the statistical power of a randomized trial.
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Affiliation(s)
- Simone A Dijkland
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.).
| | - Daphne C Voormolen
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Esmee Venema
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Bob Roozenbeek
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Suzanne Polinder
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Juanita A Haagsma
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Daan Nieboer
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Vicky Chalos
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Albert J Yoo
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Jennifer Schreuders
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Aad van der Lugt
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Charles B L M Majoie
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Yvo B W E M Roos
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Wim H van Zwam
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Robert J van Oostenbrugge
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Ewout W Steyerberg
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Diederik W J Dippel
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Hester F Lingsma
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
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