Health-Related Quality-of-Life Outcomes of Very Preterm or Very Low Birth Weight Adults: Evidence From an Individual Participant Data Meta-Analysis

Abstract

Background and Objective Assessment of health-related quality of life for individuals born very preterm and/or low birthweight (VP/VLBW) offers valuable complementary information alongside biomedical assessments. However, the impact of VP/VLBW status on health-related quality of life in adulthood is inconclusive. The objective of this study was to examine associations between VP/VLBW status and preference-based health-related quality-of-life outcomes in early adulthood. Methods Individual participant data were obtained from five prospective cohorts of individuals born VP/VLBW and controls contributing to the 'Research on European Children and Adults Born Preterm' Consortium. The combined dataset included over 2100 adult VP/VLBW survivors with an age range of 18-29 years. The main exposure was defined as birth before 32 weeks' gestation (VP) and/or birth weight below 1500 g (VLBW). Outcome measures included multi-attribute utility scores generated by the Health Utilities Index Mark 3 and the Short Form 6D. Data were analysed using generalised linear mixed models in a one-step approach using fixed-effects and random-effects models. Results VP/VLBW status was associated with a significant difference in the Health Utilities Index Mark 3 multi-attribute utility score of − 0.06 (95% confidence interval − 0.08, − 0.04) in comparison to birth at term or at normal birthweight; this was not replicated for the Short Form 6D. Impacted functional domains included vision, ambulation, dexterity and cognition. VP/VLBW status was not associated with poorer emotional or social functioning, or increased pain. Conclusions VP/VLBW status is associated with lower overall health-related quality of life in early adulthood, particularly in terms of physical and cognitive functioning. Further studies that estimate the effects of VP/VLBW status on health-related quality-of-life outcomes in mid and late adulthood are needed.

Comparative evaluation of the health utilities index mark 3 and the short form 6D: evidence from an individual participant data meta-analysis of very preterm and very low birthweight adults

“…We utilized random effects models and reported results in Online Appendix B. Further evidence on the association between VP/VLBW status and HRQoL in adulthood using HUI3 and SF-6D can be found in a recent study [ 63 ].…”

Health-related quality of life in children and adolescents born very preterm and its correlates: a cross-sectional study

“…There were also not many fullterm born children with chronic health conditions in the FLiP sample, which would have allowed us to further explore the associations between very preterm birth, chronic health conditions and HRQOL. Like other studies of very preterm born children, our sample may have had selection bias or selective drop-out [8, 10]. We cannot exclude the possibility that some participants in the Ciao Corona sample were very preterm born as well, as this information was not assessed (1% [23] in a general population).…”

“…It is possible that the siblings used here as controls are not representative of the general population. Some recent studies have examined the health utility index (HUI) to evaluate HRQOL [8], but our study did not collect the data required to assess HUI. We did not have information on other potentially important variables, for example, on participants' mental health status (e.g.…”

“…While much research on school-age children born very preterm has focused on neurodevelopment [4,5], as these children grow into adulthood, outcomes such as mental health and health-related quality of life (HRQOL) increase likewise in importance. It has been suggested that very preterm born children have lower HRQOL than their fullterm counterparts throughout childhood [6][7][8], but that these differences do not necessarily persist through adolescence or adulthood [6,9,10]. Some research has specifically focused on HRQOL in preterm children with chronic health conditions, where HRQOL was even found to be similar or only slightly lower than that of their fullterm counterparts [11,12].…”

“…Some research has specifically focused on HRQOL in preterm children with chronic health conditions, where HRQOL was even found to be similar or only slightly lower than that of their fullterm counterparts [11,12]. Yet, the many systematic reviews [6][7][8][10][11][12] on HRQOL in the premature born often cannot account for important potentially modifiable factors, and are likely to suffer from inadequate comparison groups or selection bias, including but not limited to selective dropout.…”