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Published in: Health and Quality of Life Outcomes 1/2009

Open Access 01-12-2009 | Research

Health-related quality of life of Southern Chinese with chronic hepatitis B infection

Authors: Elegance TP Lam, Cindy LK Lam, CL Lai, MF Yuen, Daniel YT Fong, Thomas MK So

Published in: Health and Quality of Life Outcomes | Issue 1/2009

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Abstract

Background

Few studies have evaluated the health-related quality of life (HRQOL) of Southern Chinese with chronic hepatitis B (CHB) infection.

Aim

To evaluate the HRQOL of Chinese patients at different stages of CHB infection and to find out factors associated with HRQOL.

Methods

520 Chinese adult CHB patients of whom 156 were uncomplicated, 102 had impaired liver function, 139 had cirrhosis and 123 had hepatocellular carcinoma (HCC) were interviewed with a structured questionnaire, the SF-36 Health Survey version 2 (SF-36v2), and the Chronic Liver Disease Questionnaire (CLDQ). The differences in SF-6D health preference values and SF-36v2 scores between each CHB group and Hong Kong population norms were assessed by t-test. ANOVA was used to compare the mean SF-6D health preference, SF-36v2 scores, and CLDQ scores among CHB groups. Multiple linear regressions were performed to identify determinants of HRQOL.

Results

CHB patients had significantly lower SF-36v2 scores than the population norm. The SF-6D values of CHB patients with uncomplicated disease, impaired liver function, HCC and cirrhosis were 0.755, 0.745, 0.720 and 0.701, respectively, all significantly lower than the population norm of 0.787. Advanced stage of CHB illness, anti-viral treatment, bilirubin level, psychological co-morbidity, younger age and female were associated with poorer HRQOL.

Conclusion

CHB infection had a negative impact on HRQOL. There was a progressive decrease in health preference values with CHB disease progression. The results can be used for the estimation of quality adjusted life years (QALYs) for CHB patients in cost effectiveness or cost utility studies.

Trial Registration

Literature
1.
go back to reference Liu J, Fan D: Hepatitis B in China. Lancet 2007, 369: 1582–1583. 10.1016/S0140-6736(07)60723-5CrossRef Liu J, Fan D: Hepatitis B in China. Lancet 2007, 369: 1582–1583. 10.1016/S0140-6736(07)60723-5CrossRef
2.
go back to reference Lok AS, McMahon BJ: Chronic hepatitis B. Hepatology 2007, 45: 507–539. 10.1002/hep.21513CrossRef Lok AS, McMahon BJ: Chronic hepatitis B. Hepatology 2007, 45: 507–539. 10.1002/hep.21513CrossRef
3.
go back to reference Chen CJ, Wang LY, Yu MW: Epidemiology of hepatitis B virus infection in the Asia-Pacific region. J Gastroenterol Hepatol 2000,15(Suppl):E3–6. 10.1046/j.1440-1746.2000.02124.xCrossRef Chen CJ, Wang LY, Yu MW: Epidemiology of hepatitis B virus infection in the Asia-Pacific region. J Gastroenterol Hepatol 2000,15(Suppl):E3–6. 10.1046/j.1440-1746.2000.02124.xCrossRef
4.
go back to reference Lai CL, Ratziu V, Yuen MF, Poynard T: Viral hepatitis B. Lancet 2003, 362: 2089–2094. 10.1016/S0140-6736(03)15108-2CrossRef Lai CL, Ratziu V, Yuen MF, Poynard T: Viral hepatitis B. Lancet 2003, 362: 2089–2094. 10.1016/S0140-6736(03)15108-2CrossRef
5.
go back to reference Foster GR, Goldin RD, Thomas HC: Chronic hepatitis C virus infection causes a significant reduction in quality of life in the absence of cirrhosis. Hepatology 1998, 27: 209–212. 10.1002/hep.510270132CrossRef Foster GR, Goldin RD, Thomas HC: Chronic hepatitis C virus infection causes a significant reduction in quality of life in the absence of cirrhosis. Hepatology 1998, 27: 209–212. 10.1002/hep.510270132CrossRef
6.
go back to reference Hussain KB, Fontana RJ, Moyer CA, Su GL, Sneed-Pee N, Lok AS: Comorbid illness is an important determinant of health-related quality of life in patients with chronic hepatitis C. Am J Gastroenterol 2001, 96: 2737–2744. 10.1111/j.1572-0241.2001.04133.xCrossRef Hussain KB, Fontana RJ, Moyer CA, Su GL, Sneed-Pee N, Lok AS: Comorbid illness is an important determinant of health-related quality of life in patients with chronic hepatitis C. Am J Gastroenterol 2001, 96: 2737–2744. 10.1111/j.1572-0241.2001.04133.xCrossRef
7.
go back to reference Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, Loguercio C, Apolone G, Niero M, Abbiati R, Italian Study Group for Quality of Life in Cirrhosis: Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology 2001, 120: 170–178. 10.1053/gast.2001.21193CrossRef Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, Loguercio C, Apolone G, Niero M, Abbiati R, Italian Study Group for Quality of Life in Cirrhosis: Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology 2001, 120: 170–178. 10.1053/gast.2001.21193CrossRef
8.
go back to reference van der Plas SM, Hansen BE, de Boer JB, Stijnen T, Passchier J, de Man RA, Schalm SW: Generic and disease-specific health related quality of life in non-cirrhotic, cirrhotic and transplanted liver patients: a cross-sectional study. BMC Gastroenterol 2003, 3: 33. 10.1186/1471-230X-3-33CrossRef van der Plas SM, Hansen BE, de Boer JB, Stijnen T, Passchier J, de Man RA, Schalm SW: Generic and disease-specific health related quality of life in non-cirrhotic, cirrhotic and transplanted liver patients: a cross-sectional study. BMC Gastroenterol 2003, 3: 33. 10.1186/1471-230X-3-33CrossRef
9.
go back to reference Younossi ZM, Kiwi ML, Boparai N, Price LL, Guyatt G: Cholestatic liver diseases and health-related quality of life. Am J Gastroenterol 2000, 95: 497–502. 10.1111/j.1572-0241.2000.01774.xCrossRef Younossi ZM, Kiwi ML, Boparai N, Price LL, Guyatt G: Cholestatic liver diseases and health-related quality of life. Am J Gastroenterol 2000, 95: 497–502. 10.1111/j.1572-0241.2000.01774.xCrossRef
10.
go back to reference Kondo Y, Yoshida H, Tateishi R, Shiina S, Mine N, Yamashiki N, Sato S, Kato N, Kanai F, Yanase M, Yoshida H, Akamatsu M, Teratani T, Kawabe T, Omata M: Health-related quality of life of chronic liver disease patients with and without hepatocellular carcinoma. J Gastroenterol Hepatol 2007, 22: 197–203. 10.1111/j.1440-1746.2006.04456.xCrossRef Kondo Y, Yoshida H, Tateishi R, Shiina S, Mine N, Yamashiki N, Sato S, Kato N, Kanai F, Yanase M, Yoshida H, Akamatsu M, Teratani T, Kawabe T, Omata M: Health-related quality of life of chronic liver disease patients with and without hepatocellular carcinoma. J Gastroenterol Hepatol 2007, 22: 197–203. 10.1111/j.1440-1746.2006.04456.xCrossRef
11.
go back to reference Younossi ZM, Boparai N, Price LL, Kiwi ML, McCormick M, Guyatt G: Health-related quality of life in chronic liver disease: the impact of type and severity of disease. Am J Gastroenterol 2001, 96: 2199–2205. 10.1111/j.1572-0241.2001.03956.xCrossRef Younossi ZM, Boparai N, Price LL, Kiwi ML, McCormick M, Guyatt G: Health-related quality of life in chronic liver disease: the impact of type and severity of disease. Am J Gastroenterol 2001, 96: 2199–2205. 10.1111/j.1572-0241.2001.03956.xCrossRef
12.
go back to reference Sobhonslidsuk A, Silpakit C, Kongsakon R, Satitpornkul P, Sripetch C, Khanthavit A: Factors influencing health-related quality of life in chronic liver disease. World J Gastroenterol 2006, 12: 7786–7791. Sobhonslidsuk A, Silpakit C, Kongsakon R, Satitpornkul P, Sripetch C, Khanthavit A: Factors influencing health-related quality of life in chronic liver disease. World J Gastroenterol 2006, 12: 7786–7791.
13.
go back to reference Dan AA, Kallman JB, Srivastava R, Younoszai Z, Kim A, Younossi ZM: Impact of chronic liver disease and cirrhosis on health utilities using SF-6D and the health utility index. Liver Transpl 2008, 14: 321–326. 10.1002/lt.21376CrossRef Dan AA, Kallman JB, Srivastava R, Younoszai Z, Kim A, Younossi ZM: Impact of chronic liver disease and cirrhosis on health utilities using SF-6D and the health utility index. Liver Transpl 2008, 14: 321–326. 10.1002/lt.21376CrossRef
14.
go back to reference Bondini S, Kallman J, Dan A, Younoszai Z, Ramsey L, Nader F, Younossi ZM: Health-related quality of life in patients with chronic hepatitis B. Liver Int 2007, 27: 1119–1125. 10.1111/j.1478-3231.2007.01558.xCrossRef Bondini S, Kallman J, Dan A, Younoszai Z, Ramsey L, Nader F, Younossi ZM: Health-related quality of life in patients with chronic hepatitis B. Liver Int 2007, 27: 1119–1125. 10.1111/j.1478-3231.2007.01558.xCrossRef
15.
go back to reference Ong SC, Mak B, Aung MO, Li SC, Lim SG: Health-related quality of life in chronic hepatitis B patients. Hepatology 2008, 47: 1108–1117. 10.1002/hep.22138CrossRef Ong SC, Mak B, Aung MO, Li SC, Lim SG: Health-related quality of life in chronic hepatitis B patients. Hepatology 2008, 47: 1108–1117. 10.1002/hep.22138CrossRef
16.
go back to reference Gutteling JJ, de Man RA, van der Plas SM, Schalm SW, Busschbach JJ, Darlington AS: Determinants of quality of life in chronic liver patients. Aliment Pharmacol Ther 2006, 23: 1629–1635. 10.1111/j.1365-2036.2006.02934.xCrossRef Gutteling JJ, de Man RA, van der Plas SM, Schalm SW, Busschbach JJ, Darlington AS: Determinants of quality of life in chronic liver patients. Aliment Pharmacol Ther 2006, 23: 1629–1635. 10.1111/j.1365-2036.2006.02934.xCrossRef
17.
go back to reference Bennett WG, Inoue Y, Beck JR, Wong JB, Pauker SG, Davis GL: Estimates of the cost-effectiveness of a single course of interferon-alpha 2b in patients with histologically mild chronic hepatitis C. Ann Intern Med 1997, 127: 855–865.CrossRef Bennett WG, Inoue Y, Beck JR, Wong JB, Pauker SG, Davis GL: Estimates of the cost-effectiveness of a single course of interferon-alpha 2b in patients with histologically mild chronic hepatitis C. Ann Intern Med 1997, 127: 855–865.CrossRef
18.
go back to reference Kim WR, Poterucha JJ, Hermans JE, Therneau TM, Dickson ER, Evans RW, Gross JB Jr: Cost-effectiveness of 6 and 12 months of interferon-alpha therapy for chronic hepatitis C. Ann Intern Med 1997, 127: 866–874.CrossRef Kim WR, Poterucha JJ, Hermans JE, Therneau TM, Dickson ER, Evans RW, Gross JB Jr: Cost-effectiveness of 6 and 12 months of interferon-alpha therapy for chronic hepatitis C. Ann Intern Med 1997, 127: 866–874.CrossRef
20.
go back to reference Lam ETP, Lam CLK, Lo YYC, Grandek B: Psychometrics and population norm of the Chinese (HK) SF-36 Health Survey version 2. HK Pract 2008, 30: 185–198. Lam ETP, Lam CLK, Lo YYC, Grandek B: Psychometrics and population norm of the Chinese (HK) SF-36 Health Survey version 2. HK Pract 2008, 30: 185–198.
21.
go back to reference Lam CLK, Tse EY, Gandek B, Fong DYT: The SF-36 summary scales were valid, reliable, and equivalent in a Chinese population. J Clin Epidemiol 2005, 58: 815–822. 10.1016/j.jclinepi.2004.12.008CrossRef Lam CLK, Tse EY, Gandek B, Fong DYT: The SF-36 summary scales were valid, reliable, and equivalent in a Chinese population. J Clin Epidemiol 2005, 58: 815–822. 10.1016/j.jclinepi.2004.12.008CrossRef
22.
go back to reference Ware JE Jr: SF-36 health survey update. Spine 2000, 25: 3130–3139. 10.1097/00007632-200012150-00008CrossRef Ware JE Jr: SF-36 health survey update. Spine 2000, 25: 3130–3139. 10.1097/00007632-200012150-00008CrossRef
23.
go back to reference Ware JE, Kosinski MA, Dewey JE: How to Score Version 2 of the SF-36 Health Survey. Lincoln: Quality Metric Inc; 2000. Ware JE, Kosinski MA, Dewey JE: How to Score Version 2 of the SF-36 Health Survey. Lincoln: Quality Metric Inc; 2000.
24.
go back to reference Brazier J, Roberts J, Deverill M: The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002, 21: 271–292. 10.1016/S0167-6296(01)00130-8CrossRef Brazier J, Roberts J, Deverill M: The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002, 21: 271–292. 10.1016/S0167-6296(01)00130-8CrossRef
25.
go back to reference McGhee SM, Brazier J, Lam CLK, Wong LC, Chau J, Cheung A, Ho A: Quality adjusted life years (QALYS) – population specific measurement of the quality component – Final Report. Health and Health Services Research Fund; 2006. McGhee SM, Brazier J, Lam CLK, Wong LC, Chau J, Cheung A, Ho A: Quality adjusted life years (QALYS) – population specific measurement of the quality component – Final Report. Health and Health Services Research Fund; 2006.
26.
go back to reference Lam CLK, Brazier J, McGhee SM: Valuation of the SF-6D health states is feasible, acceptable, reliable, and valid in a Chinese population. Value Health 2008, 11: 295–303. 10.1111/j.1524-4733.2007.00233.xCrossRef Lam CLK, Brazier J, McGhee SM: Valuation of the SF-6D health states is feasible, acceptable, reliable, and valid in a Chinese population. Value Health 2008, 11: 295–303. 10.1111/j.1524-4733.2007.00233.xCrossRef
27.
go back to reference Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D: Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut 1999, 45: 295–300.CrossRef Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D: Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut 1999, 45: 295–300.CrossRef
28.
go back to reference Lam ETP, Lam CLK, Lai CL, Yuen MF, Fong DYT: Psychometrics of Chronic Liver Disease Questionnaire for Southern Chinese patients with hepatitis B virus infection. World J Gastroenterol 2009, in press. Lam ETP, Lam CLK, Lai CL, Yuen MF, Fong DYT: Psychometrics of Chronic Liver Disease Questionnaire for Southern Chinese patients with hepatitis B virus infection. World J Gastroenterol 2009, in press.
29.
go back to reference Census and Statistics Department: 2006 Population By-Census: Main Tables. Hong Kong: Government Printing Department; 2007. Census and Statistics Department: 2006 Population By-Census: Main Tables. Hong Kong: Government Printing Department; 2007.
30.
go back to reference Census and Statistics Department: Thematic Household Survey Report No. 30 – Health status of Hong Kong residents, doctor consultation, hospitalization, dental consultation, provision of medical benefits by employers/companies and coverage of medical insurance purchased by individuals and health status of institutional residents and their utilization of medical services. Hong Kong: Government Printing Department; 2007. Census and Statistics Department: Thematic Household Survey Report No. 30 – Health status of Hong Kong residents, doctor consultation, hospitalization, dental consultation, provision of medical benefits by employers/companies and coverage of medical insurance purchased by individuals and health status of institutional residents and their utilization of medical services. Hong Kong: Government Printing Department; 2007.
31.
go back to reference Yuen MF, Yuan HJ, Wong DK, Yuen JC, Wong WM, Chan AO, Wong BC, Lai KC, Lai CL: Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications. Gut 2005, 54: 1610–1614. 10.1136/gut.2005.065136CrossRef Yuen MF, Yuan HJ, Wong DK, Yuen JC, Wong WM, Chan AO, Wong BC, Lai KC, Lai CL: Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications. Gut 2005, 54: 1610–1614. 10.1136/gut.2005.065136CrossRef
32.
go back to reference Kazis LE, Anderson JJ, Meenan RF: Effect sizes for interpreting changes in health status. Med Care. 1989,27(3 Suppl ):S178-S189. 10.1097/00005650-198903001-00015CrossRef Kazis LE, Anderson JJ, Meenan RF: Effect sizes for interpreting changes in health status. Med Care. 1989,27(3 Suppl ):S178-S189. 10.1097/00005650-198903001-00015CrossRef
33.
go back to reference Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD: Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Med Care 1999, 37: 469–478. 10.1097/00005650-199905000-00006CrossRef Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD: Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Med Care 1999, 37: 469–478. 10.1097/00005650-199905000-00006CrossRef
34.
go back to reference Poon RT, Fan ST, Yu WC, Lam BK, Chan FY, Wong J: A prospective longitudinal study of quality of life after resection of hepatocellular carcinoma. Arch Surg 2001, 136: 693–699. 10.1001/archsurg.136.6.693CrossRef Poon RT, Fan ST, Yu WC, Lam BK, Chan FY, Wong J: A prospective longitudinal study of quality of life after resection of hepatocellular carcinoma. Arch Surg 2001, 136: 693–699. 10.1001/archsurg.136.6.693CrossRef
35.
go back to reference Martin RC, Eid S, Scoggins CR, McMasters KM: Health-related quality of life: return to baseline after major and minor liver resection. Surgery 2007, 142: 676–684. 10.1016/j.surg.2007.04.026CrossRef Martin RC, Eid S, Scoggins CR, McMasters KM: Health-related quality of life: return to baseline after major and minor liver resection. Surgery 2007, 142: 676–684. 10.1016/j.surg.2007.04.026CrossRef
36.
go back to reference Brucker PS, Yost K, Cashy J, Webster K, Cella D: General population and cancer patient norms for the Functional Assessment of Cancer Therapy-General (FACT-G). Eval Health Prof 2005, 28: 192–211. 10.1177/0163278705275341CrossRef Brucker PS, Yost K, Cashy J, Webster K, Cella D: General population and cancer patient norms for the Functional Assessment of Cancer Therapy-General (FACT-G). Eval Health Prof 2005, 28: 192–211. 10.1177/0163278705275341CrossRef
37.
go back to reference Walters SJ, Brazier JE: What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health Qual Life Outcomes 2003, 1: 4. 10.1186/1477-7525-1-4CrossRef Walters SJ, Brazier JE: What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health Qual Life Outcomes 2003, 1: 4. 10.1186/1477-7525-1-4CrossRef
38.
go back to reference Levy AR, Kowdley KV, Iloeje U, Tafesse E, Mukherjee J, Gish R, Bzowej N, Briggs AH: The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value Health 2008, 11: 527–538. 10.1111/j.1524-4733.2007.00297.xCrossRef Levy AR, Kowdley KV, Iloeje U, Tafesse E, Mukherjee J, Gish R, Bzowej N, Briggs AH: The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value Health 2008, 11: 527–538. 10.1111/j.1524-4733.2007.00297.xCrossRef
39.
go back to reference Foster GR: Hepatitis C virus infection: quality of life and side effects of treatment. J Hepatol 1999,31(Suppl 1):250–254. 10.1016/S0168-8278(99)80411-5CrossRef Foster GR: Hepatitis C virus infection: quality of life and side effects of treatment. J Hepatol 1999,31(Suppl 1):250–254. 10.1016/S0168-8278(99)80411-5CrossRef
40.
go back to reference Ware JE Jr, Bayliss MS, Mannocchia M, Davis GL: Health-related quality of life in chronic hepatitis C: impact of disease and treatment response. The Interventional Therapy Group. Hepatology 1999, 30: 550–555. 10.1002/hep.510300203CrossRef Ware JE Jr, Bayliss MS, Mannocchia M, Davis GL: Health-related quality of life in chronic hepatitis C: impact of disease and treatment response. The Interventional Therapy Group. Hepatology 1999, 30: 550–555. 10.1002/hep.510300203CrossRef
41.
go back to reference Kang SC, Hwang SJ, Lee SH, Chang FY, Lee SD: Health-related quality of life and impact of antiviral treatment in Chinese patients with chronic hepatitis C in Taiwan. World J Gastroenterol 2005, 11: 7494–7498. Kang SC, Hwang SJ, Lee SH, Chang FY, Lee SD: Health-related quality of life and impact of antiviral treatment in Chinese patients with chronic hepatitis C in Taiwan. World J Gastroenterol 2005, 11: 7494–7498.
42.
go back to reference Lam CLK, Lauder IJ, Lam TP, Gandek B: Population based norming of the Chinese (HK) version of the SF-36 health survey. HK Pract 1999, 21: 460–470. Lam CLK, Lauder IJ, Lam TP, Gandek B: Population based norming of the Chinese (HK) version of the SF-36 health survey. HK Pract 1999, 21: 460–470.
Metadata
Title
Health-related quality of life of Southern Chinese with chronic hepatitis B infection
Authors
Elegance TP Lam
Cindy LK Lam
CL Lai
MF Yuen
Daniel YT Fong
Thomas MK So
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2009
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/1477-7525-7-52

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