Abstract
Previous studies about the association of multimorbidity and the health-related quality of life (HRQOL) in primary-care patients are limited because of their reliance on simple counts of diseases from a limited list of diseases and their failure to assess the severity of disease. We evaluated the association while taking into account the severity of the medical conditions based on the Cumulative Illness Rating Scale (CIRS) score, and controlling for potential confounders (age, sex, household income, education, self-perception of economic status, number of people living in the same dwelling, and perceived social support). We randomly selected 238 patients to construct quintiles of increasing multimorbidity (CIRS). Patients completed the 36-item Medical Outcomes study questionnaire (SF-36) to evaluate their HRQOL. Applying bivariate and multivariate linear regression analyses, we used the CIRS as either a continuous or a categorical (quintiles) variable. Use of the CIRS revealed a stronger association of HRQOL with multimorbidity than using a simple count of chronic conditions. Physical more than mental health deteriorated with increasing multimorbidity. Perceived social support and self-perception of economic status were significantly related to all scales of the SF-36 (p < 0.05). Increased multimorbidity adversely affected HRQOL in primary-care adult patients, even when confounding variables were controlled for.
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Abbreviations
- BP:
-
Bodily pain
- CIRS:
-
Cumulative Illness Rating Scale
- GH:
-
General health
- HRQOL:
-
Quality of life
- HT:
-
Health transition
- MCS:
-
Mental component summary
- MH:
-
Mental health
- PCS:
-
Physical component summary
- PF:
-
Physical functioning
- RE:
-
Role emotional
- RP:
-
Role physical
- SF:
-
Social functioning
- SF-36:
-
36-item Medical Outcomes Study questionnaire
- VT:
-
Vitality scale
References
C Hoffman D Rice HY Sung (1996) ArticleTitlePersons with chronic conditions. Their prevalence and costs JAMA 276 1473–1479 Occurrence Handle10.1001/jama.276.18.1473 Occurrence Handle1:STN:280:ByiD28%2Fit1c%3D Occurrence Handle8903258
JF Metsemakers P Hoppener JA Knottnerus RJ Kocken CB Limonard (1992) ArticleTitleComputerized health information in The Netherlands: a registration network of family practices Br J Gen Pract 42 102–106 Occurrence Handle1:STN:280:ByyC2M3isVI%3D Occurrence Handle1493025
M Akker Particlevan den F Buntinx JF Metsemakers S Roos JA Knottnerus (1998) ArticleTitleMultimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases J Clin Epidemiol 51 367–375 Occurrence Handle9619963
M Fortin G Bravo C Hudon A Vanasse L Lapointe (2005) ArticleTitlePrevalence of multimorbidity among adults seen in family practice Ann Fam Med 3 223–228 Occurrence Handle10.1370/afm.272 Occurrence Handle15928225
I McDowell C Newell (1996) Measuring Health. A Guide to Rating Scales and Questionnaires Oxford University Press New York 380–492
VS Fan JR Curtis S Tu MB McDonell SD Fihn (2002) ArticleTitleUsing quality of life to predict hospitalization and mortality in patients with obstructive lung diseases Chest 122 429–436 Occurrence Handle10.1378/chest.122.2.429 Occurrence Handle12171813
CJ Howes MC Reid C Brandt B Ruo MW Yerkey B Prasad C Lin P Peduzzi MD Ezekowitz (2001) ArticleTitleExercise tolerance and quality of life in elderly patients with chronic atrial fibrillation J Cardiovasc Pharmacol Ther 6 23–29 Occurrence Handle1:STN:280:DC%2BD3MzpvVWjtQ%3D%3D Occurrence Handle11452333
AJ Schaeffer JR Landis JS Knauss KJ Propert RB Alexander MS Litwin JC Nickel MP O’Leary RB Nadler MA Pontari DA Shoskes SI Zeitlin JE Fowler SuffixJr CA Mazurick L Kishel JW Kusek LM Nyberg (2002) ArticleTitleChronic Prostatitis Collaborative Research Network G. Demographic and clinical characteristics of men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study J Urol 168 593–598 Occurrence Handle12131316
J Xuan LJ Kirchdoerfer JG Boyer GJ Norwood (1999) ArticleTitleEffects of comorbidity on health-related quality-of-life scores: an analysis of clinical trial data Clin Ther 21 383–403 Occurrence Handle10.1016/S0149-2918(00)88295-8 Occurrence Handle1:STN:280:DyaK1M3is1GhsA%3D%3D Occurrence Handle10211540
M Fortin L Lapointe C Hudon AL Ntetu D Maltais A Vanasse (2004) ArticleTitleMultimorbidity and quality of life in primary care: a systematic review Health and Quality of life Outcomes 2 51 Occurrence Handle10.1186/1477-7525-2-51 Occurrence Handle15380021
L Cheng S Cumber C Dumas R Winter KM Nguyen LZ Nieman (2003) ArticleTitleHealth related quality of life in pregeriatric patients with chronic diseases at urban, public supported clinics Health and Quality of Life Outcomes 1 63 Occurrence Handle10.1186/1477-7525-1-63 Occurrence Handle14613559
M Wensing E Vingerhoets R Grol (2001) ArticleTitleFunctional status, health problems, age and comorbidity in primary care patients Qual Life Res 10 141–148 Occurrence Handle10.1023/A:1016705615207 Occurrence Handle1:STN:280:DC%2BD3MrmtF2ltw%3D%3D Occurrence Handle11642684
H Michelson C Bolund Y Brandberg (2000) ArticleTitleMultiple chronic health problems are negatively associated with health related quality of life (HRQoL) irrespective of age Qual Life Res 9 1093–1104 Occurrence Handle10.1023/A:1016654621784 Occurrence Handle1:STN:280:DC%2BD3Mzjtlemtw%3D%3D Occurrence Handle11401042
P Cuijpers P Lammeren Particlevan B Duzijn (1999) ArticleTitleRelation between quality of life and chronic illnesses in elderly living in residential homes: a prospective study Int Psychogeriatr 11 445–454 Occurrence Handle10.1017/S1041610299006067 Occurrence Handle1:STN:280:DC%2BD3c%2FpslWltw%3D%3D Occurrence Handle10631590
A Grimby A Svanborg (1997) ArticleTitleMorbidity and health-related quality of life among ambulant elderly citizens Aging Clin Exp Res 9 356–364 Occurrence Handle1:STN:280:DyaK1c7itVKitQ%3D%3D
DG Fryback EJ Dasbach R Klein BE Klein N Dorn K Peterson PA Martin (1993) ArticleTitleThe beaver dam health outcomes study: initial catalog of health-state quality factors Med Decis Making 13 89–102 Occurrence Handle1:STN:280:ByyB2cjkslE%3D Occurrence Handle8483408
GI Kempen M Jelicic J Ormel (1997) ArticleTitlePersonality, chronic medical morbidity, and health-related quality of life among older persons Health Psychol 16 539–546 Occurrence Handle10.1037/0278-6133.16.6.539 Occurrence Handle1:STN:280:DyaK1c%2FkvVansg%3D%3D Occurrence Handle9386999
V Groot Particlede H Beckerman GJ Lankhorst LM Bouter (2003) ArticleTitleHow to measure comorbidity. a critical review of available methods J Clin Epidemiol 56 221–229 Occurrence Handle12725876
J Ormel M VonKorff B Ustun S Pini A Korten T Oldehinkel (1994) ArticleTitleCommon mental disorders and disability across cultures: results from the WHO collaborative study on psychological problems in general health care JAMA 272 1741–1748 Occurrence Handle10.1001/jama.272.22.1741 Occurrence Handle1:STN:280:ByqD2MnjvFY%3D Occurrence Handle7966922
World Health Organization. Innovative Care for Chronic Conditions. Building blocks for action. Geneva, Switzerland: World Health Organization; 2002 [cited 2004 Dec 28] Available from: http://www.who.int/chronic_conditions/en/icccglobalreport.pdf
BS Linn MW Linn L Gurel (1968) ArticleTitleCumulative illness rating scale J Am Geriatr Soc 16 622–626 Occurrence Handle1:STN:280:CCeB3c7kvFA%3D Occurrence Handle5646906
Miller EA, Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G).: University of Pittsburgh, 1991.
M Harboun J Ankri (2001) ArticleTitle[Comorbidity indexes: review of the literature and application to studies of elderly population][French] Rev Epidemiol Sante Publique 49 287–298 Occurrence Handle1:STN:280:DC%2BD3MvislyltQ%3D%3D Occurrence Handle11427831
C Hudon M Fortin A Vanasse (2005) ArticleTitle Cumulative Illness Rating Scale was a reliable and valid index in a family practice context J Clin Epidemiol 58 603–608 Occurrence Handle10.1016/j.jclinepi.2004.10.017 Occurrence Handle1:STN:280:DC%2BD2M3ktFChsQ%3D%3D Occurrence Handle15878474
JE Ware CD Sherbourne (1992) ArticleTitleThe MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection Med Care 30 473–483 Occurrence Handle1593914
Ware JE, Jr. SF-36® Health Survey Update [cited 2004 Dec 28]. Available from: http://www.sf-36.org/tools/sf36.shtml.
SW Dauphinee L Gauthier B Gandek L Magnan U Pierre (1997) ArticleTitleReadying a US measure of health status, the SF-36, for use in Canada Clin Invest Med 20 224–238 Occurrence Handle1:STN:280:ByiH3czitVw%3D Occurrence Handle9258577
CA Cutrona DW Russel (1987) ArticleTitleThe provisions of social support and adaptation to stress Adv Pers Relationships 1 37–67
J Caron (1996) ArticleTitle[The scale of social provisions: their validation in Quebec][French] Santé Mentale au Québec 21 158–180 Occurrence Handle1:STN:280:ByiB3cvns1Q%3D Occurrence Handle9052268
WM Hopman T Towheed T Anastassiades A Tenenhouse S Poliquin C Berger L Joseph JP Brown TM Murray JD Adachi DA Hanley E Papadimitropoulos (2000) ArticleTitleCanadian normative data for the SF-36 health survey Can Mult Osteoporosis Study Res Group. CMAJ 163 265–271 Occurrence Handle1:STN:280:DC%2BD3cvhvVyhsA%3D%3D
JG Walker HJ Jackson GO Littlejohn (2004) ArticleTitleModels of adjustment to chronic illness: using the example of rheumatoid arthritis Clin Psychol Rev 24 461–488 Occurrence Handle15245831
JN Katz MG Larson CB Phillips AH Fossel MH Liang (1992) ArticleTitleComparative measurement sensitivity of short and longer health status instruments Med Care 30 917–925 Occurrence Handle1:STN:280:ByyD383ptlY%3D Occurrence Handle1405797
D Allaire (1988) Questionnaires: mesure verbale du comportament M Robert (Eds) Fondements et étapes de la recherche scientifique en psychologie EditionNumber3 St-Hyacinthe Québec, Edisem 229–275
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Fortin, M., Bravo, G., Hudon, C. et al. Relationship Between Multimorbidity and Health-Related Quality of Life of Patients in Primary Care. Qual Life Res 15, 83–91 (2006). https://doi.org/10.1007/s11136-005-8661-z
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DOI: https://doi.org/10.1007/s11136-005-8661-z