Temporal change in health-related quality of life: a longitudinal study in general practice 1999–2004

Abstract

BackgroundIn order to assess and plan for changing healthcare needs, the lack of available information regarding temporal changes in the health-related quality of life of a population must be addressed. AimThis paper aims to describe such changes over 5 years in a general population. Design of studyLongitudinal postal questionnaire study. Setting UK general practice. MethodThis was a longitudinal postal questionnaire study in two general practice populations, using the generic instrument EQ-5D to measure health-related quality of life. Individuals were included if they responded to three postal surveys in 1999, 2001, and 2004 and there were three consecutive values of EQ-5Dindex available between 1999 and 2004. ResultsA total of 2498 subjects were included in the study. After adjustment for potential confounders (including ageing), health-related quality of life declined significantly over the observation period. The change in EQ-5Dindex was from 0.79 to 0.74 and for EQ-5Dvas 76.8 to 73.3 (P for both trends <0.001). ConclusionHealth-related quality of life deteriorated in these populations over 5 years. In an era of improvements in mortality, this has important implications for the use of health-related quality of life data in healthcare planning and resource allocation.Keywords chronic disease; EQ-5D; health related quality of life; temporal trend. INTRODUCTIONTo assess the changing health needs of a population and to evaluate the extent to which patients' healthrelated quality of life (HRQoL) benefits from health care, it is generally agreed that a systematic structured approach is needed.1 For this purpose, generic HRQoL measures such as EQ-5D have been developed. 2In contrast to disease-specific instruments, these can compare quality of life in populations, regardless of disease.EQ-5D has been used in cross-sectional studies in both general populations 3-5 and those with specific morbidities.6-9 So far, however, there has been no report of any long-term longitudinal study in the UK, although two British population surveys described follow-up of 1 year.1,10 A recent study from Sweden reported a deterioration over 4 years in HRQoL of women of all ages, and in younger men. 11 METHODThe aim of this study was to compare the temporal changes in health-related quality of life in three postal surveys. This study formed part of a larger long-term epidemiological study looking at a

How do common chronic conditions affect health-related quality of life?

“…The small differences could mean that older, less educated, and anxious or depressed patients are slightly less well represented within the study data, causing a small overestimate of the HRQoL values, since all these groups were shown to be more likely to have a lower HRQoL, both here and in previous studies. 27,28 The corroboration of previously reported correlations regarding age, 25,27 sex, [29][30][31][32] smoking status, 28,29 and higher education 33 are important not only to back up previous research, but also to validate the ability of the present results to represent the general population sample. However, although the differences are significant, the effect sizes are small and must be viewed within the context of the minimal important differences for EQ-5Dindex and EQ-5Dvas, which are as yet not fully determined.…”

Quality of life: what does it mean for general practice?

“…16 QoL instruments are also needed as outcome indicators to calculate qualityadjusted life years and cost-effectiveness of therapy and care-delivery interventions. The study by Hazell et al showed 17 an autonomous decrease in QoL over a 5-year period, indicating the difficulty of taking a point of reference. Questions arise around the validity of health-related QoL measures; for example, which cultural and economic influences interfere with health related QoL?…”

“…16,17 Both studies are based on postal surveys carried out in the registered population of two general practices. The surveys included the EQ-5D: a generic QoL instrument covering the five dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, from which an index score is calculated.…”

“…In the first study 16 a cross-sectional analysis showed how comorbidity affects the EQ-5D index. In the second study 17 the changes in the EQ-5D scores were calculated for patients who had three consecutive measurements over a 5-year period. The researchers found that QoL decreases with increasing numbers of chronic conditions, and that in a cohort of about 2500 participants the quality of life declined significantly over 5 years after adjusting for age, education level and duration, sex, and smoking behaviour.…”

Determinants of health-related quality of life in older primary care patients: results of the longitudinal observational AgeCoDe Study

“…Available longitudinal studies are based only on small numbers, [5][6][7][8][9][10][11] have short follow-up periods of 6-18 months, 5,6,8,9,11,12 and/or did not investigate the development of factors influencing HRQoL, but included the factors only at one fixed point in time. 13,14 As a result, there are insufficient data to derive practical considerations for GPs on which changes in influencing factors might support patients in maintaining or improving their HRQoL. In light of this, factors affecting the course of patients' HRQoL over 4.5 years were investigated in a representative cohort of 1968 older (aged ≥78 years) primary care patients.…”