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Health and Quality of Life Outcomes

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Open Access 01-12-2013 | Research

Quality of life impact of cardiovascular and affective conditions among older residents from urban and rural communities

Authors: Joanne Allen, Kerry J Inder, Melissa L Harris, Terry J Lewin, John R Attia, Brian J Kelly

Published in: Health and Quality of Life Outcomes | Issue 1/2013

Abstract

Background

The demographic, health and contextual factors associated with quality of life impairment are investigated in older persons from New South Wales, Australia. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness.

Methods

Data from persons aged 55 and over were drawn from two community cohorts sampling from across urban to very remote areas. Hierarchical linear regressions were used to assess: 1) the impact of cardiovascular and affective conditions on physical and psychological quality of life impairment; and 2) any influence of remoteness on these effects (N = 4364). Remoteness was geocoded to participants at the postal code level. Secondary data sources were used to examine the social capital and health service accessibility correlates of remoteness.

Results

Physical impairment was consistently associated with increased age, male gender, lower education, being unmarried, retirement, stroke, heart attack/angina, depression/anxiety, diabetes, hypertension, current obesity and low social support. Psychological impairment was consistently associated with lower age, being unmarried, stroke, heart attack/angina, depression/anxiety and low social support. Remoteness tended to be associated with lower psychological impairment, largely reflecting overall urban versus rural differences. The impacts of cardiovascular and affective conditions on quality of life were not influenced by remoteness. Social capital increased and health service accessibility decreased with remoteness, though no differences between outer-regional and remote/very remote areas were observed. Trends suggested that social capital was associated with lower psychological impairment and that the influence of cardiovascular conditions and social capital on psychological impairment was greater for persons with a history of affective conditions. The beneficial impact of social capital in reducing psychological impairment was more marked for those experiencing financial difficulty.

Conclusions

Cardiovascular and affective conditions are key determinants of physical and psychological impairment. Persons affected by physical-psychological comorbidity experience greater psychological impairment. Social capital is associated with community remoteness and may ameliorate the psychological impairment associated with affective disorders and financial difficulties. The use of classifications of remoteness that are sensitive to social and health service accessibility determinants of health may better inform future investigations into the impact of context on quality of life outcomes.

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Sartore GM, Kelly B, Stain H, Albrecht G, Higginbotham N: Control, uncertainty, and expectations for the future: a qualitative study of the impact of drought on a rural Australian community. Rural Remote Health 2008, 8: 950.PubMed

Smith KB, Humphreys JS, Wilson MGA: Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research? Aust J Rural Health 2008, 16: 56–66. 10.1111/j.1440-1584.2008.00953.xPubMedCrossRef

Australian Institute of Health and Welfare: Australia’s health 2008. Cat. no. AUS 99. Canberra: AIHW; 2008:80–87.

Stain HJ, Kelly B, Carr VJ, Lewin TJ, Fitzgerald M, Fragar L: The psychological impact of chronic environmental adversity: responding to prolonged drought. Soc Sci Med 2011, 73: 1593–1599. 10.1016/j.socscimed.2011.09.016PubMedCrossRef

Kutek SM, Turnbull D, Fairweather-Schmidt AK: Rural men’s subjective well-being and the role of social support and sense of community: evidence for the potential benefit of enhancing informal networks. Aust J Rural Health 2011, 19: 20–26. 10.1111/j.1440-1584.2010.01172.xPubMedCrossRef

Romans S, Cohen M, Forte T: Rates of depression and anxiety in urban and rural Canada. Soc Psychiatry Psychiatr Epidemiol 2011, 46: 567–575. 10.1007/s00127-010-0222-2PubMedCrossRef

Onyx J, Bullen P: Measuring social capital in five communities. J Appl Behav Sci 2000, 36: 23–42. 10.1177/0021886300361002CrossRef

Putnam RD: Bowling Alone: The Collapse and Revival of American Community. New York: Simon & Schuster; 2000.CrossRef

Hsieh C-H: A concept analysis of social capital within a health context. Nurs Forum (Auckl) 2008, 43: 151–159. 10.1111/j.1744-6198.2008.00107.xCrossRef

10.

Coleman J: Foundations of Social Theory. United States of America: Belknap Press of Harvard University Press; 1998.

11.

Berkman L, Kawachi I: Social Epidemiology. New York: Oxford University Press; 2000.

12.

Wilkinson R: Unhealthy Societies— the Afflictions of Inequality. London: Routledge; 1996.CrossRef

13.

Bernard P, Charafeddine R, Frohlich KL, Daniel M, Kestens Y, Potvin L: Health inequalities and place: a theoretical conception of neighbourhood. Soc Sci Med 2007, 65: 1839–1852. 10.1016/j.socscimed.2007.05.037PubMedCrossRef

14.

Jackson CH, Richardson S, Best NG: Studying place effects on health by synthesising individual and area-level outcomes. Soc Sci Med 2008, 67: 1995–2006. 10.1016/j.socscimed.2008.09.041PubMedCrossRef

15.

Verhaeghe P-P, Tampubolon G: Individual social capital, neighbourhood deprivation, and self-rated health in England. Soc Sci Med 2012, 75: 349–357. 10.1016/j.socscimed.2012.02.057PubMedCrossRef

16.

Kim D, Kawachi I: U.S. state-level social capital and health-related quality of life: multilevel evidence of main, mediating, and modifying effects. Ann Epidemiol 2007, 17: 258–269. 10.1016/j.annepidem.2006.10.002PubMedCrossRef

17.

Rios R, Aiken L, Zautra A: Neighborhood contexts and the mediating role of neighborhood social cohesion on health and psychological distress among hispanic and non-hispanic residents. Ann Behav Med 2012, 43: 50–61. 10.1007/s12160-011-9306-9PubMedCrossRef

18.

Poortinga W: Social relations or social capital? Individual and community health effects of bonding social capital. Soc Sci Med 2006, 63: 255–270. 10.1016/j.socscimed.2005.11.039PubMedCrossRef

19.

Snelgrove JW, Pikhart H, Stafford M: A multilevel analysis of social capital and self-rated health: evidence from the British household panel survey. Soc Sci Med 2009, 68: 1993–2001. 10.1016/j.socscimed.2009.03.011PubMedCrossRef

20.

Miles A, Proescholdbell R, Puffer E: Explaining rural/non-rural disparities in physical health-related quality of life: a study of United Methodist clergy in North Carolina. Qual Life Res 2011, 20: 807–815. 10.1007/s11136-010-9817-zPubMedCrossRef

21.

Reid-Arndt S, Cox C: Does rurality affect quality of life following treatment for breast cancer? J Rural Health 2010, 26: 402–405. 10.1111/j.1748-0361.2010.00295.xPubMedCentralPubMedCrossRef

22.

Weeks W, Kazis L, Shen Y, Cong Z, Ren X, Miller D, Lee A: Differences in health-related quality of life in rural and urban veterans. Am J Public Health 2004, 94: 1762–1767. 10.2105/AJPH.94.10.1762PubMedCentralPubMedCrossRef

23.

Alonso J, Ferrer M, Gandek B, Ware JE Jr, Aaronson NK, Mosconi P, Rasmussen NK, Bullinger M, Fukuhara S, Kaasa S, et al.: Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project. Qual Life Res 2004, 13: 283–298.PubMedCrossRef

24.

Knox S, Harrison C, Britt H, Henderson J: Estimating prevalence of common chronic morbidities in Australia. Med J Aust 2008, 189: 66–70.PubMed

25.

Centers for Disease Control and Prevention: Trends in aging--United States and worldwide. Morb Mortal Wkly Rep 2003, 52: 101–104.

26.

Teesson M, Mitchell PB, Deady M, Memedovic S, Slade T, Baillie A: Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 national survey of mental health and wellbeing. Aust N Z J Psychiatry 2011, 45: 939–946. 10.3109/00048674.2011.614590PubMedCrossRef

27.

McKnight-Eily L, Elam-Evans L, Strine T, Zack M, Perry G, Presley-Cantrell L, Edwards V, Croft J: Activity limitation, chronic disease, and comorbid serious psychological distress in U.S. adults–BRFSS 2007. Int J Public Health 2009, 54: 111–119. 10.1007/s00038-009-0015-0PubMedCrossRef

28.

Bayliss M, Rendas-Baum R, White M, Maruish M, Bjorner J, Tunis S: Health-related quality of life (HRQL) for individuals with self-reported chronic physical and/or mental health conditions: panel survey of an adult sample in the United States. Health Qual Life Outcomes 2012, 10: 154. 10.1186/1477-7525-10-154PubMedCentralPubMedCrossRef

29.

Scott KM, Von Korff M, Alonso J, Angermeyer MC, Bromet E, Fayyad J, De Girolamo G, Demyttenaere K, Gasquet I, Gureje O, et al.: Mental–physical co-morbidity and its relationship with disability: results from the world mental health surveys. Psychol Med 2009, 39: 33–43. 10.1017/S0033291708003188PubMedCentralPubMedCrossRef

30.

National Mental Health Commission: A Contributing Life, the 2012 National Report Card on Mental Health and Suicide Prevention. Sydney: NMHC; 2012:50–95.

31.

Lawn S: In it together: Physical health and well-being for people with mental illness. Aust N Z J Psychiatry 2012, 46: 14–17. 10.1177/0004867411432079PubMedCrossRef

32.

Watson S, Mackin P: HPA axis function in mood disorders. Psychiatry 2009, 8: 97–101. 10.1016/j.mppsy.2008.11.006CrossRef

33.

Rosmond R, Björntorp P: The hypothalamic–pituitary–adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Intern Med 2000, 247: 188–197. 10.1046/j.1365-2796.2000.00603.xPubMedCrossRef

34.

Hemingway H, Marmot M: Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies. BMJ 1999, 318: 1460–1467. 10.1136/bmj.318.7196.1460PubMedCentralPubMedCrossRef

35.

Poulton R, Caspi A, Milne BJ, Thomson WM, Taylor A, Sears MR, Moffitt TE: Association between children’s experience of socioeconomic disadvantage and adult health: a life-course study. Lancet 2002, 360: 1640–1645. 10.1016/S0140-6736(02)11602-3PubMedCentralPubMedCrossRef

36.

Kessler RC: The effects of stressful life events on depression. Annu Rev Psychol 1997, 48: 191–214. 10.1146/annurev.psych.48.1.191PubMedCrossRef

37.

Orth-Gomér K: Stress and social support in relation to cardiovascular health. In Stress, Coping, and Cardiovascular Disease. Edited by: Mccabe PNS, Field TM, Wellens AR. Mahwah, New Jersey: Mahwah: Lawrence Erlbaum Associates Inc; 2009:229–238.

38.

Inder KJ, Berry H, Kelly BJ: Using cohort studies to investigate rural and remote mental health. Aust J Rural Health 2011, 19: 171–178. 10.1111/j.1440-1584.2011.01208.xPubMedCrossRef

39.

Allen J, Inder K, Lewin T, Attia J, Kelly B: Construct validity of the assessment of quality of life - 6D (AQoL-6D) in community samples. Health Qual Life Outcomes 2013, 11: 61. 10.1186/1477-7525-11-61PubMedCentralPubMedCrossRef

40.

Hayes D, Greenlund K, Denny C, Neyer J, Croft J, Keenan N: Racial/ethnic and socioeconomic disparities in health-related quality of life among people with coronary heart disease, 2007. Prev Chronic Dis 2011, 8: A78. Epub 2011 Jun 2015PubMedCentralPubMed

41.

Jiang Y, Hesser J: Patterns of health-related quality of life and patterns associated with health risks among Rhode Island adults. Health Qual Life Outcomes 2008, 6: 49. 10.1186/1477-7525-6-49PubMedCentralPubMedCrossRef

42.

Katz D, McHorney C, Atkinson R: Impact of obesity on health-related quality of life in patients with chronic illness. J Gen Intern Med 2000, 15: 789–796. 10.1046/j.1525-1497.2000.90906.xPubMedCentralPubMedCrossRef

43.

Huang C, Hsu M, Hsu S, Cheng P, Lin S, Chuang C: Mediating roles of social support on poststroke depression and quality of life in patients with ischemic stroke. J Clin Nurs 2010, 19: 2752–2762. 10.1111/j.1365-2702.2010.03327.xPubMedCrossRef

44.

McEvoy M, Smith W, D’Este C, Duke J, Peel R, Schofield P, Scott R, Byles J, Henry D, Ewald B, et al.: Cohort Profile: the hunter community study. Int J Epidemiol 2010, 39: 1452–1463. 10.1093/ije/dyp343PubMedCrossRef

45.

Kelly BJ, Stain HJ, Coleman C, Perkins D, Fragar L, Fuller J, Lewin TJ, Lyle D, Carr VJ, Wilson JM, Beard JR: Mental health and well-being within rural communities: the Australian rural mental health study. Aust J Rural Health 2010, 18: 16–24. 10.1111/j.1440-1584.2009.01118.xPubMedCrossRef

46.

Richardson J, Peacock S, Hawthorne G, Iezzi A, Elsworth G, Day N: Construction of the descriptive system for the assessment of quality of life AQoL-6D utility instrument. Health Qual Life Outcomes 2012, 10: 38. 10.1186/1477-7525-10-38PubMedCentralPubMedCrossRef

47.

Hayes A, Clarke P, Lung T: Change in bias in self-reported body mass index in Australia between 1995 and 2008 and the evaluation of correction equations. Population Health Metrics 2011, 9: 53. 10.1186/1478-7954-9-53PubMedCentralPubMedCrossRef

48.

Allen J, Inder K, Lewin TJ, Attia J, Kelly B: Social support and age influence distress outcomes differentially across urban, regional and remote Australia: an exploratory study. BMC Publ Health 2012, 12: 928. 10.1186/1471-2458-12-928CrossRef

49.

Brugha TS, Cragg D: The list of threatening experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatr Scand 1990, 82: 77–81. 10.1111/j.1600-0447.1990.tb01360.xPubMedCrossRef

50.

Watson N, Wooden M: The Household, Income and Labour Dynamics in Australia (HILDA) survey: an introduction. In Australian Social Policy 2001–02. Melbourne, Victoria: Department of Families, Community Services (FaCS); 2001:79–99.

51.

Australian Institute of Health and Welfare: Rural, regional and remote health: a guide to remoteness classifications. Canberra: AIHW; 2004.

52.

Perkins DD, Florin P, Rich RC, Wandersman A, Chavis DM: Participation and the social and physical environment of residential blocks: crime and community context. Am J Community Psychol 1990, 18: 83–115. 10.1007/BF00922690CrossRef

53.

Barr M, Baker D, Gorringe M, Fritsche L: Adult Population Health Survey: Description of Methods 2002–2010. NSW Department of Health: NSW Population Health Survey Program. Centre for Epidemiology and Research; 2008.

54.

Graham JW: Missing data analysis: making it work in the real world. Annu Rev Psychol 2009, 60: 549–576. 10.1146/annurev.psych.58.110405.085530PubMedCrossRef

55.

Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT, Walters EE, Zaslecsky AM: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002, 32: 959–976. 10.1017/S0033291702006074PubMedCrossRef

56.

Ziersch AM, Baum F, Darmawan IGN, Kavanagh AM, Bentley RJ: Social capital and health in rural and urban communities in South Australia. Aust N Z J Public Health 2009, 33: 7–16. 10.1111/j.1753-6405.2009.00332.xPubMedCrossRef

57.

Murray G, Judd F, Jackson H, Fraser C, Komiti A, Hodgins G, Pattison P, Humphreys J, Robins G: Rurality and mental health: the role of accessibility. Aust N Z J Psychiatry 2004, 38: 629–634. 10.1080/j.1440-1614.2004.01426.xPubMedCrossRef

58.

Alexander C, Fraser J: General practitioners’ management of patients with mental health conditions: the views of general practitioners working in rural north-western New South Wales. Aust J Rural Health 2008, 16: 363–369. 10.1111/j.1440-1584.2008.01017.xPubMedCrossRef

59.

Collins JE, Winefield H, Ward L, Turnbull D: Understanding help seeking for mental health in rural South Australia: thematic analytical study. Aust J Prim Health 2009, 15: 159–165. 10.1071/PY09019CrossRef

60.

Moorin RE, Holman CDJ, Garfield C, Brameld KJ: Health related migration: evidence of reduced “urban-drift”. Health Place 2006, 12: 131–140. 10.1016/j.healthplace.2004.10.013PubMedCrossRef

61.

Kim J-M, Stewart R, Shin I-S, Yoon J-S, Lee H-Y: Lifetime urban/rural residence, social support and late-life depression in Korea. Int J Geriatr Psychiatry 2004, 19: 843–851. 10.1002/gps.1175PubMedCrossRef

62.

Berry HL, Welsh JA: Social capital and health in Australia: an overview from the household, income and labour dynamics in Australia survey. Soc Sci Med 2010, 70: 588–596. 10.1016/j.socscimed.2009.10.012PubMedCrossRef

63.

Gadalla T: Association of comorbid mood disorders and chronic illness with disability and quality of life in Ontario, Canada. Chronic Dis Can 2008, 28: 148–154.PubMed

Title: Quality of life impact of cardiovascular and affective conditions among older residents from urban and rural communities
Authors: Joanne Allen
Kerry J Inder
Melissa L Harris
Terry J Lewin
John R Attia
Brian J Kelly
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: Health and Quality of Life Outcomes / Issue 1/2013
Electronic ISSN: 1477-7525
DOI: https://doi.org/10.1186/1477-7525-11-140

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Quality of life impact of cardiovascular and affective conditions among older residents from urban and rural communities

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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