Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Quality of Life Research
Published in: Quality of Life Research 4/2015

Open Access 01-04-2015

Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey

Authors: R. E. Mujica-Mota, M. Roberts, G. Abel, M. Elliott, G. Lyratzopoulos, M. Roland, J. Campbell

Published in: Quality of Life Research | Issue 4/2015

Login to get access

Abstract

Background

There is limited evidence about the impact of specific patterns of multi-morbidity on health-related quality of life (HRQoL) from large samples of adult subjects.

Methods

We used data from the English General Practice Patient Survey 2011–2012. We defined multi-morbidity as the presence of two or more of 12 self-reported conditions or another (unspecified) long-term health problem. We investigated differences in HRQoL (EQ-5D scores) associated with combinations of these conditions after adjusting for age, gender, ethnicity, socio-economic deprivation and the presence of a recent illness or injury. Analyses were based on 831,537 responses from patients aged 18 years or older in 8,254 primary care practices in England.

Results

Of respondents, 23 % reported two or more chronic conditions (ranging from 7 % of those under 45 years of age to 51 % of those 65 years or older). Multi-morbidity was more common among women, White individuals and respondents from socio-economically deprived areas. Neurological problems, mental health problems, arthritis and long-term back problem were associated with the greatest HRQoL deficits. The presence of three or more conditions was commonly associated with greater reduction in quality of life than that implied by the sum of the differences associated with the individual conditions. The decline in quality of life associated with an additional condition in people with two and three physical conditions was less for older people than for younger people. Multi-morbidity was associated with a substantially worse HRQoL in diabetes than in other long-term conditions. With the exception of neurological conditions, the presence of a comorbid mental health problem had a more adverse effect on HRQoL than any single comorbid physical condition.

Conclusion

Patients with multi-morbid diabetes, arthritis, neurological, or long-term mental health problems have significantly lower quality of life than other people. People with long-term health conditions require integrated mental and physical healthcare services.
Appendix
Available only for authorised users
Literature
1.
Saarni, S. I., Harkanen, T., Sintonen, H., Suvisaari, J., Koskinen, S., Aromaa, A., et al. (2006). The impact of 29 chronic conditions on health-related quality of life: A general population survey in Finland using 15D and EQ-5D. Quality of Life Research, 15(8), 1403–1414.CrossRefPubMed
2.
Brettschneider, C., Leicht, H., Bickel, H., Dahlhaus, A., Fuchs, A., Gensichen, J., et al. (2013). (MultiCare Study Group). Relative impact of multimorbid chronic conditions on health-related quality of life–results from the MultiCare Cohort Study. PLoS One, 8(6), e66742.CrossRefPubMedCentralPubMed
3.
Whiteford, H., Degenhardt, L., Rehm, J., Baxter, A., Farrari, A., Erskine, H., et al. (2013). Global burden of disease attributable to mental and substance misuse disorders: Findings from the Global Burden of Disease Study 2010. Lancet, 382, 1575–1586.CrossRefPubMed
4.
Alonso, J., Ferrer, M., Gandek, B., Ware, J. E, Jr, Aaronson, N. K., Mosconi, P., et al. (2004). Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project. Quality of Life Research, 13(2), 283–298.CrossRefPubMed
5.
Bhattarai, N., Charlton, J., Rudisill, C., & Gulliford, M. C. (2013). Prevalence of depression and utilization of health care in single and multiple morbidity: A population-based cohort study. Psychological Medicine, 43(7), 1423–1431.CrossRefPubMed
6.
Onubogu, U. D. (2014). Pain and depression in older adults with arthritis. Orthopaedic Nursing, 33(2), 102–108.CrossRefPubMed
7.
Rast, P., Rush, J., Piccinin, A., & Hofer, S. M. (2014). The identification of regions of significance in the effect of multimorbidity on depressive symptoms using longitudinal data: An application of the Johnson-Neyman technique. Gerontology, 60(3), 274–281.CrossRefPubMedCentralPubMed
8.
Fortin, M., Lapointe, L., Hudon, C., Vanasse, A., Ntetu, A. L., & Maltais, D. (2004). Multimorbidity and quality of life in primary care: a systematic review. Health and Quality of Life Outcomes, 20(2), 51.CrossRef
9.
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research and medical education: a cross-sectional study. The Lancet, 380(9836), 37–43.CrossRef
10.
Lawson, K. D., Mercer, S. W., Wyke, S., Grieve, E., Guthrie, B., Watt, G. C., et al. (2013). Double trouble: The impact of multimorbidity and deprivation on preference-weighted health-related quality of life a cross sectional analysis of the Scottish Health Survey. International Journal for Equity in Health, 12(1), 67. doi:10.​1186/​1475-9276-12-67.CrossRefPubMedCentralPubMed
11.
12.
Fried, L. P., Bandeen-Roche, K., Kasper, J. D., et al. (1999). Association of comorbidity with disability in older women: the Women’s Health and Aging Study. Journal of Clinical Epidemiology, 52, 27–37.CrossRefPubMed
13.
Fultz, N. H., Ofstedal, M. B., Herzog, A. R., & Wallace, R. B. (2003). Additive and interactive effects of comorbid physical and mental conditions on functional health. Journal of Aging and Health, 15, 465–481.CrossRefPubMed
14.
Hodek, J. M., Ruhe, A. K., & Greiner, W. (2010). Relationship between health-related quality of life and multimorbidity. Gesundheitswesen, 72(8–9), 455–465.CrossRefPubMed
15.
Fortin, M., Dubois, M.-F., Hudon, C., Soubhi, H., & Almirall, J. (2007). Multimorbidity and quality of life: A closer look. Health and Quality of Life Outcomes, 5, 52.CrossRefPubMedCentralPubMed
16.
Hunger, M., Thorand, B., Schunk, M., Doring, A., Menn, P., Peters, A., et al. (2011). Multimorbidity and health-related quality of life in the older population: Results from the German KORA-age study. Health and Quality of Life Outcomes, 9, 53.CrossRefPubMedCentralPubMed
17.
McDaid, O., Hanly, M.J., Richardson K., Kee F., Kenny R.A., Savva G.M. et al. (2013). The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: A comparison of two nationally representative cross-sectional surveys. BMJ Open , 3(6), e002571. doi:10.​1136/​bmjopen-2013-002571.
18.
Sullivan, P. W., Ghushchyan, V. H., & Bayliss, E. A. (2012). The impact of co-morbidity burden on preference-based health-related quality of life in the United States. Pharmacoeconomics, 30(5), 431–442.CrossRefPubMed
19.
Agborsangaya, C. B., Lahtinen, M., Cooke, T., & Johnson, J. A. (2014). Comparing the EQ-5D 3L and 5L: Measurement properties and association with chronic conditions and multimorbidity in the general population. Health and Quality of Life Outcomes, 12, 74.CrossRefPubMedCentralPubMed
20.
Campbell, J., Smith, P., Nissen, S., Bower, P., Elliott, M., & Roland, M. (2009). The GP Patient Survey for use in primary care in the National Health Service in the UK—Development and psychometric characteristics. BMC Family Practice, 10, 57.CrossRefPubMedCentralPubMed
21.
22.
Euroqol Group. (1990). EuroQoL—A new facility for the measurement of health-related quality of life. Health Policy, 16, 199–208.CrossRef
23.
Dolan, P., Gudex, C., Kind, P., & Williams, A. (1996). Valuing health states: A comparison of methods. Journal of Health Economics, 15(2), 209–231.CrossRefPubMed
24.
Clemens, J. Q., Elliott, M. N., Suttorp, M., & Berry, S. (2012). Temporal ordering of interstitial cystitis/bladder pain syndrome (IC/BPS) and non-bladder conditions. Urology, 80(6), 1231–1232.CrossRef
25.
Fan, J., & Gijbels, I. (1992). Variable bandwidth and local linear regression smoothers. Annals of Statistics, 20(4), 2008–2036.CrossRef
26.
27.
Walters, S. J., & Brazier, J. E. (2005 ). Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Quality of Life Research, 14(6), 1523–1532.CrossRefPubMed
28.
Kaplan, R. M. (2005). The minimally clinically important difference in generic utility-based measures. COPD, 2, 91–97.CrossRefPubMed
29.
Bloom, D. E., & Killingsworth, M. R. (1985). Correcting for truncation bias caused by a latent truncation variable. Journal of Econometrics, 27, 131–135.CrossRef
30.
Heckman, J. J. (1978). Dummy endogenous variables in a simultaneous equation system. Econometrica, 46, 931–959.CrossRef
31.
32.
White, H. (1980). A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica, 48, 817–838.CrossRef
33.
Mousavi, S., Chatterji, S., Verdes, E., Tandon, A., & Patel VikramUstun, B. (2007). Depression, chronic diseases, and decrements in health.: results from the World Health Survey. The Lancet, 370, 851–858.CrossRef
34.
Hays, R., Reeve, B. R., Smith, A. W., & Clauser, S. B. (2014). Associations of cancer and other chronic medical conditions with SF-6D preference based scores in Medicare beneficiaries. Quality of Life Research, 23(2), 385–391.CrossRefPubMedCentralPubMed
35.
Sullivan, P. W., Lawrence, W. F., & Ghushchyan, V. (2005). A national catalog of preference-based scores for chronic conditions in the United States. Medical Care, 43, 736–740.CrossRefPubMed
36.
37.
Luo, N., Wang, P., Fu, A., Johnson, J., & Coons, S. J. (2012). Preference-based SF-6D scores derived from the SF-36 and SF-12 have different discriminative power in a population health survey. Medical Care, 50(7), 627–632.CrossRefPubMed
38.
Holland, R., Smith, R. D., Harvey, I., Swift, L., & Lenaghan, E. (2004). Assessing quality of life in the elderly: A direct comparison of the EQ-5D and AQoL. Health Economics, 13, 793–805.CrossRefPubMed
39.
Brazier, J., Ratcliffe, J., Salomon, J. A., & Tsuchiya, A. (2007). Measuring and valuing health benefits for economic evaluation. Oxford: Oxford University Press.
40.
Berkanovic, E., & Telesky, C. (1985). Mexican-American, black-American and white-American differences in reporting illnesses, disability and physician visits for illnesses. Social Science and Medicine, 20, 567–577.CrossRefPubMed
41.
Johnson, T.P., O’Rourke, D., Chavez, N., Sudman, S. (1996). Cultural variations in the interpretation of health survey questions. In: Warnecke RB (ed), Health Survey Research Methods. National Center for Health Statistics (. pp. 57–62). Hyattsville: MD.
42.
Stewart, A. L., & Napoles-Springer, A. (2000). Health-related quality-of-life assessments in diverse population groups in the United States. Medical Care, 38(9 Suppl), II102–II124.PubMed
43.
Cassano, P., & Fava, M. (2002). Depression and public health: And overview. Journal of Psychosomatic Research, 53, 849–857.CrossRefPubMed
44.
Groves, R. M. (2006). Nonresponse rates and nonresponse bias in household surveys. Public Opinion Quarterly, 70(5), 646–675.
45.
Klein, D. J., Elliott, M. N., Haviland, A. M., Saliba, D., Burkhart, Q., Edwards, C., et al. (2011). Understanding nonresponse to the 2007 Medicare CAHPS survey. The Gerontologist, 51(6), 843–855.CrossRefPubMed
46.
Paddison, C., Elliott, M., Parker, R., Staestsky, L., Lyratzopoulos, G., Campbell, J. L., et al. (2012). Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey. BMJ Quality & Safety, 21(8), 634–640.CrossRef
47.
Gonzalez, J. S., Peyrot, M., McCarl, L. A., Collins, E. M., Serpa, L., Mimaga, M. J., et al. (2008). Depression and diabetes treatment nonadherence: A meta-analysis. Diabetes Care, 31(12), 2398–2403.CrossRefPubMedCentralPubMed
48.
Lustman, P. J., Anderson, R. J., Freedland, K. E., De Groot, M., Carney, R. M., & Clouse, R. E. (2000). Depression and poor glycemic control: A meta-analytic review of the literature. Diabetes Care, 23(7), 934–942.CrossRefPubMed
49.
De Groot, M., Anderson, R., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). Association of depression and diabetes complications: A meta-analysis. Psychosomatic Medicine, 63(4), 619–630.CrossRefPubMed
50.
Salisbury, C., Johnson, L., Purdy, S., Valderas, J. M., & Montgomery, A. A. (2011). Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. British Journal of General Practice, 61(582), e12–e21.CrossRefPubMedCentralPubMed
Metadata
Title
Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey
Authors
R. E. Mujica-Mota
M. Roberts
G. Abel
M. Elliott
G. Lyratzopoulos
M. Roland
J. Campbell
Publication date
01-04-2015
Publisher
Springer International Publishing
Published in
Quality of Life Research / Issue 4/2015
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-014-0820-7

Other articles of this Issue 4/2015

Quality of Life Research 4/2015 Go to the issue

OriginalPaper

Measuring changes in health over time using the EQ-5D 3L and 5L: a head-to-head comparison of measurement properties and sensitivity to change in a German inpatient rehabilitation sample

OriginalPaper

Influence of different prosthodontic rehabilitation options on oral health-related quality of life, orofacial esthetics and chewing function based on patient-reported outcomes

OriginalPaper

Joint modeling of longitudinal health-related quality of life data and survival

OriginalPaper

Living with orofacial conditions: psychological distress and quality of life in adults affected with Treacher Collins syndrome, cherubism, or oligodontia/ectodermal dysplasia—a comparative study

OriginalPaper

Comparison of EQ-5D and SF-6D utilities in Pompe disease

Brief Communication

Reliability and validity of a Chinese version of the Oral Health Impact Profile for edentulous subjects