Skip to main content
Top
Published in: Respiratory Research 1/2016

Open Access 01-12-2016 | Research

Relative impact of COPD and comorbidities on generic health-related quality of life: a pooled analysis of the COSYCONET patient cohort and control subjects from the KORA and SHIP studies

Authors: Margarethe E. Wacker, Rudolf A. Jörres, Annika Karch, Armin Koch, Joachim Heinrich, Stefan Karrasch, Holger Schulz, Annette Peters, Sven Gläser, Ralf Ewert, Sebastian E. Baumeister, Claus Vogelmeier, Reiner Leidl, Rolf Holle, for the COSYCONET study group

Published in: Respiratory Research | Issue 1/2016

Login to get access

Abstract

Background

Health-related quality of life (HRQL) is an important patient-reported outcome measure used to describe the burden of chronic obstructive pulmonary disease (COPD) which is often accompanied by comorbid conditions.

Methods

Data from 2275 participants in the COPD cohort COSYCONET and from 4505 lung-healthy control subjects from the population-based KORA and SHIP studies were pooled. Main outcomes were the five dimensions of the generic EQ-5D-3 L questionnaire and two EQ-5D index scores using a tariff based on valuations from the general population and an experience-based tariff.
The association of COPD in GOLD grades 1–4 and of several comorbid conditions with the EQ-5D index scores was quantified by multiple linear regression models while adjusting for age, sex, education, body mass index (BMI), and smoking status.

Results

For all dimensions of the EQ-5D, the proportion of participants reporting problems was higher in the COPD group than in control subjects. COPD was associated with significant reductions in the EQ-5D index scores (-0.05 points for COPD grades 1/2, -0.09 for COPD grade 3, -0.18 for COPD grade 4 according to the preference-based utility tariff, all p < 0.0001). Adjusted mean index scores were 0.89 in control subjects and 0.85, 0.84, 0.81, and 0.72 in COPD grades 1-4 according to the preference-based utility tariff and 0.76, 0.71, 0.68, 0.64, and 0.58 for control subjects and COPD grades 1-4 for the experience-based tariff respectively. Comorbidities had additive negative effects on the index scores; the effect sizes for comorbidities were comparable to or smaller than the effects of COPD grade 3. No statistically significant interactions between COPD and comorbidities were observed. Score differences between COPD patients and control subjects were most pronounced in younger age groups.

Conclusions

Compared with control subjects, the considerable reduction of HRQL in patients with COPD was mainly due to respiratory limitations, but observed comorbidities added linearly to this effect. Younger COPD patients showed a greater loss of HRQL and may therefore be in specific need of comprehensive disease management.

Trial registration

Literature
2.
go back to reference Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (Update 2015). http://www.goldcopd.org/. Accessed 17 Mar 2016. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (Update 2015). http://​www.​goldcopd.​org/​. Accessed 17 Mar 2016.
3.
go back to reference Justine M, Tahirah F, Mohan V. Health-related quality of life, lung function and dyspnea rating in COPD patients. Monaldi Arch Chest Dis. 2013;79:116–20.CrossRefPubMed Justine M, Tahirah F, Mohan V. Health-related quality of life, lung function and dyspnea rating in COPD patients. Monaldi Arch Chest Dis. 2013;79:116–20.CrossRefPubMed
4.
go back to reference Rubinsztajn R, Przybylowski T, Maskey-Warzechowska M, Karwat K, Chazan R. Exacerbations of Chronic Obstructive Pulmonary Disease and Quality of Life of Patients. Adv Exp Med Biol. 2016;884:69–74.CrossRefPubMed Rubinsztajn R, Przybylowski T, Maskey-Warzechowska M, Karwat K, Chazan R. Exacerbations of Chronic Obstructive Pulmonary Disease and Quality of Life of Patients. Adv Exp Med Biol. 2016;884:69–74.CrossRefPubMed
5.
go back to reference Menn P, Weber N, Holle R. Health-related quality of life in patients with severe COPD hospitalized for exacerbations - comparing EQ-5D, SF-12 and SGRQ. Health Qual Life Outcomes. 2010;8:39.CrossRefPubMedPubMedCentral Menn P, Weber N, Holle R. Health-related quality of life in patients with severe COPD hospitalized for exacerbations - comparing EQ-5D, SF-12 and SGRQ. Health Qual Life Outcomes. 2010;8:39.CrossRefPubMedPubMedCentral
6.
go back to reference Miravitlles M, Huerta A, Valle M, Garcia-Sidro P, Forne C, Crespo C, Lopez-Campos JL. Clinical variables impacting on the estimation of utilities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015;10:367–77.CrossRefPubMedPubMedCentral Miravitlles M, Huerta A, Valle M, Garcia-Sidro P, Forne C, Crespo C, Lopez-Campos JL. Clinical variables impacting on the estimation of utilities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015;10:367–77.CrossRefPubMedPubMedCentral
7.
go back to reference Miravitlles M, Ferrer M, Pont A, Zalacain R, Alvarez-Sala JL, Masa F, Verea H, Murio C, Ros F, Vidal R. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study. Thorax. 2004;59:387–95.CrossRefPubMedPubMedCentral Miravitlles M, Ferrer M, Pont A, Zalacain R, Alvarez-Sala JL, Masa F, Verea H, Murio C, Ros F, Vidal R. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study. Thorax. 2004;59:387–95.CrossRefPubMedPubMedCentral
8.
go back to reference Huber MB, Wacker ME, Vogelmeier CF, Leidl R. Comorbid Influences on Generic Health-Related Quality of Life in COPD: A Systematic Review. PLoS ONE. 2015;10:e0132670.CrossRefPubMedPubMedCentral Huber MB, Wacker ME, Vogelmeier CF, Leidl R. Comorbid Influences on Generic Health-Related Quality of Life in COPD: A Systematic Review. PLoS ONE. 2015;10:e0132670.CrossRefPubMedPubMedCentral
9.
go back to reference Koskela J, Kilpelainen M, Kupiainen H, Mazur W, Sintonen H, Boezen M, Lindqvist A, Postma D, Laitinen T. Co-morbidities are the key nominators of the health related quality of life in mild and moderate COPD. BMC Pulm Med. 2014;14:102.CrossRefPubMedPubMedCentral Koskela J, Kilpelainen M, Kupiainen H, Mazur W, Sintonen H, Boezen M, Lindqvist A, Postma D, Laitinen T. Co-morbidities are the key nominators of the health related quality of life in mild and moderate COPD. BMC Pulm Med. 2014;14:102.CrossRefPubMedPubMedCentral
10.
11.
go back to reference Decramer M, Rennard S, Troosters T, Mapel DW, Giardino N, Mannino D, Wouters E, Sethi S, Cooper CB. COPD as a lung disease with systemic consequences--clinical impact, mechanisms, and potential for early intervention. COPD. 2008;5:235–56.CrossRefPubMed Decramer M, Rennard S, Troosters T, Mapel DW, Giardino N, Mannino D, Wouters E, Sethi S, Cooper CB. COPD as a lung disease with systemic consequences--clinical impact, mechanisms, and potential for early intervention. COPD. 2008;5:235–56.CrossRefPubMed
12.
go back to reference Rutten-van Molken MP, Oostenbrink JB, Tashkin DP, Burkhart D, Monz BU. Does quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages? Chest. 2006;130:1117–28.CrossRefPubMed Rutten-van Molken MP, Oostenbrink JB, Tashkin DP, Burkhart D, Monz BU. Does quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages? Chest. 2006;130:1117–28.CrossRefPubMed
14.
go back to reference Hong JY, Kim SY, Chung KS, Kim EY, Jung JY, Park MS, Kang YA, Kim SK, Chang J, Kim YS. Factors associated with the quality of life of Korean COPD patients as measured by the EQ-5D. Qual Life Res. 2015;24:2549–58.CrossRefPubMed Hong JY, Kim SY, Chung KS, Kim EY, Jung JY, Park MS, Kang YA, Kim SK, Chang J, Kim YS. Factors associated with the quality of life of Korean COPD patients as measured by the EQ-5D. Qual Life Res. 2015;24:2549–58.CrossRefPubMed
15.
go back to reference Jones PW. Health status measurement. In: Kolb M, Vogelmeier CF, editors. Outcomes in Clinical Trials. Lausanne: European Respiratory Society; 2013. p. 96–104.CrossRef Jones PW. Health status measurement. In: Kolb M, Vogelmeier CF, editors. Outcomes in Clinical Trials. Lausanne: European Respiratory Society; 2013. p. 96–104.CrossRef
16.
go back to reference Knies S, Evers SM, Candel MJ, Severens JL, Ament AJ. Utilities of the EQ-5D: transferable or not? Pharmacoeconomics. 2009;27:767–79.CrossRefPubMed Knies S, Evers SM, Candel MJ, Severens JL, Ament AJ. Utilities of the EQ-5D: transferable or not? Pharmacoeconomics. 2009;27:767–79.CrossRefPubMed
17.
go back to reference Karch A, Vogelmeier C, Welte T, Bals R, Kauczor HU, Biederer J, Heinrich J, Schulz H, Gläser S, Holle R, et al. The German COPD cohort COSYCONET: Aims, methods and descriptive analysis of the study population at baseline. Respir Med. 2016;114:27–37.CrossRefPubMed Karch A, Vogelmeier C, Welte T, Bals R, Kauczor HU, Biederer J, Heinrich J, Schulz H, Gläser S, Holle R, et al. The German COPD cohort COSYCONET: Aims, methods and descriptive analysis of the study population at baseline. Respir Med. 2016;114:27–37.CrossRefPubMed
18.
go back to reference Jorres RA, Welte T, Bals R, Koch A, Schnoor M, Vogelmeier C. Systemic manifestations and comorbidities in patients with chronic obstructive pulmonary disease (COPD) and their effect on clinical state and course of the disease--an overview of the cohort study COSYCONET. Dtsch Med Wochenschr. 2010;135:446–9.CrossRefPubMed Jorres RA, Welte T, Bals R, Koch A, Schnoor M, Vogelmeier C. Systemic manifestations and comorbidities in patients with chronic obstructive pulmonary disease (COPD) and their effect on clinical state and course of the disease--an overview of the cohort study COSYCONET. Dtsch Med Wochenschr. 2010;135:446–9.CrossRefPubMed
19.
go back to reference Holle R, Happich M, Lowel H, Wichmann HE. KORA--a research platform for population based health research. Gesundheitswesen. 2005;67 Suppl 1:S19–25.CrossRefPubMed Holle R, Happich M, Lowel H, Wichmann HE. KORA--a research platform for population based health research. Gesundheitswesen. 2005;67 Suppl 1:S19–25.CrossRefPubMed
20.
go back to reference Peters A, Doring A, Ladwig KH, Meisinger C, Linkohr B, Autenrieth C, Baumeister SE, Behr J, Bergner A, Bickel H, et al. Multimorbidity and successful aging: the population-based KORA-Age study. Z Gerontol Geriatr. 2011;44 Suppl 2:41–54.CrossRefPubMed Peters A, Doring A, Ladwig KH, Meisinger C, Linkohr B, Autenrieth C, Baumeister SE, Behr J, Bergner A, Bickel H, et al. Multimorbidity and successful aging: the population-based KORA-Age study. Z Gerontol Geriatr. 2011;44 Suppl 2:41–54.CrossRefPubMed
21.
go back to reference Volzke H, Alte D, Schmidt CO, Radke D, Lorbeer R, Friedrich N, Aumann N, Lau K, Piontek M, Born G, et al. Cohort profile: the study of health in Pomerania. Int J Epidemiol. 2011;40:294–307.CrossRefPubMed Volzke H, Alte D, Schmidt CO, Radke D, Lorbeer R, Friedrich N, Aumann N, Lau K, Piontek M, Born G, et al. Cohort profile: the study of health in Pomerania. Int J Epidemiol. 2011;40:294–307.CrossRefPubMed
22.
go back to reference Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, Enright PL, Hankinson JL, Ip MSM, Zheng J, et al. Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324–43.CrossRefPubMedPubMedCentral Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, Enright PL, Hankinson JL, Ip MSM, Zheng J, et al. Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324–43.CrossRefPubMedPubMedCentral
23.
go back to reference Dolan P. Output measures and valuation of health. In: Drummond M, Alistair M, editors. Economic evaluations in health care. Oxford: Oxford University Press; 2010. p. 46–67. Dolan P. Output measures and valuation of health. In: Drummond M, Alistair M, editors. Economic evaluations in health care. Oxford: Oxford University Press; 2010. p. 46–67.
24.
go back to reference Greiner W, Claes C, Busschbach JJ, von der Schulenburg JM. Validating the EQ-5D with time trade off for the German population. Eur J Health Econ. 2005;6:124–30.CrossRefPubMed Greiner W, Claes C, Busschbach JJ, von der Schulenburg JM. Validating the EQ-5D with time trade off for the German population. Eur J Health Econ. 2005;6:124–30.CrossRefPubMed
25.
go back to reference Leidl R, Reitmeir P. A value set for the EQ-5D based on experienced health states: development and testing for the German population. Pharmacoeconomics. 2011;29:521–34.CrossRefPubMed Leidl R, Reitmeir P. A value set for the EQ-5D based on experienced health states: development and testing for the German population. Pharmacoeconomics. 2011;29:521–34.CrossRefPubMed
26.
go back to reference Vogl M, Wenig CM, Leidl R, Pokhrel S. Smoking and health-related quality of life in English general population: implications for economic evaluations. BMC Public Health. 2012;12:203.CrossRefPubMedPubMedCentral Vogl M, Wenig CM, Leidl R, Pokhrel S. Smoking and health-related quality of life in English general population: implications for economic evaluations. BMC Public Health. 2012;12:203.CrossRefPubMedPubMedCentral
27.
go back to reference Soltoft F, Hammer M, Kragh N. The association of body mass index and health-related quality of life in the general population: data from the 2003 Health Survey of England. Qual Life Res. 2009;18:1293–9.CrossRefPubMedPubMedCentral Soltoft F, Hammer M, Kragh N. The association of body mass index and health-related quality of life in the general population: data from the 2003 Health Survey of England. Qual Life Res. 2009;18:1293–9.CrossRefPubMedPubMedCentral
28.
go back to reference Hunger M, Baumert J, Holle R. Analysis of SF-6D index data: is beta regression appropriate? Value Health. 2011;14:759–67.CrossRefPubMed Hunger M, Baumert J, Holle R. Analysis of SF-6D index data: is beta regression appropriate? Value Health. 2011;14:759–67.CrossRefPubMed
29.
go back to reference Martinez CH, Diaz AA, Parulekar AD, Rennard SI, Kanner RE, Hansel NN, Couper D, Holm KE, Hoth KF, Curtis JL, et al. Age-Related Differences in Health-Related Quality of Life in COPD: An Analysis of the COPDGene and SPIROMICS Cohorts. Chest. 2016;149(4):927–35.CrossRefPubMed Martinez CH, Diaz AA, Parulekar AD, Rennard SI, Kanner RE, Hansel NN, Couper D, Holm KE, Hoth KF, Curtis JL, et al. Age-Related Differences in Health-Related Quality of Life in COPD: An Analysis of the COPDGene and SPIROMICS Cohorts. Chest. 2016;149(4):927–35.CrossRefPubMed
30.
go back to reference Nici L, ZuWallack R. An official American Thoracic Society workshop report: the Integrated Care of The COPD Patient. Proc Am Thorac Soc. 2012;9:9–18.CrossRefPubMed Nici L, ZuWallack R. An official American Thoracic Society workshop report: the Integrated Care of The COPD Patient. Proc Am Thorac Soc. 2012;9:9–18.CrossRefPubMed
31.
go back to reference Szende A, Oppe M, Devlin N. EQ-5D Value Sets: Inventory, Comparative Review and User Guide, vol. 2. Dordrecht: Springer Netherlands; 2007.CrossRef Szende A, Oppe M, Devlin N. EQ-5D Value Sets: Inventory, Comparative Review and User Guide, vol. 2. Dordrecht: Springer Netherlands; 2007.CrossRef
32.
go back to reference Weldam SWM, Schuurmans MJ, Liu R, Lammers J-WJ. Evaluation of Quality of Life instruments for use in COPD care and research: A systematic review. Int J Nurs Stud. 2013;50:688–707.CrossRefPubMed Weldam SWM, Schuurmans MJ, Liu R, Lammers J-WJ. Evaluation of Quality of Life instruments for use in COPD care and research: A systematic review. Int J Nurs Stud. 2013;50:688–707.CrossRefPubMed
33.
go back to reference Petrillo J, van Nooten F, Jones P, Rutten-van MM. Utility estimation in chronic obstructive pulmonary disease: a preference for change? Pharmacoeconomics. 2011;29:917–32.CrossRefPubMed Petrillo J, van Nooten F, Jones P, Rutten-van MM. Utility estimation in chronic obstructive pulmonary disease: a preference for change? Pharmacoeconomics. 2011;29:917–32.CrossRefPubMed
34.
go back to reference Wacker ME, Jörres RA, Karch A, Wilke S, Heinrich J, Karrasch S, Koch A, Schulz H, Watz H, Leidl R, Vogelmeier C, Holle R, COSYCONET-Consortium. Assessing health-related quality of life in COPD: comparing generic and disease-specific instruments with focus on comorbidities. BMC Pulm Med. 2016;16(1):70.CrossRefPubMedPubMedCentral Wacker ME, Jörres RA, Karch A, Wilke S, Heinrich J, Karrasch S, Koch A, Schulz H, Watz H, Leidl R, Vogelmeier C, Holle R, COSYCONET-Consortium. Assessing health-related quality of life in COPD: comparing generic and disease-specific instruments with focus on comorbidities. BMC Pulm Med. 2016;16(1):70.CrossRefPubMedPubMedCentral
35.
go back to reference Luo N, Johnson J, Coons SJ. Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Med Care. 2010;48:365–71.CrossRefPubMed Luo N, Johnson J, Coons SJ. Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Med Care. 2010;48:365–71.CrossRefPubMed
36.
go back to reference Walters SJ, Brazier JE. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005;14:1523–32.CrossRefPubMed Walters SJ, Brazier JE. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005;14:1523–32.CrossRefPubMed
37.
go back to reference Stahl E, Lindberg A, Jansson S-A, Ronmark E, Svensson K, Andersson F, Lofdahl C-G, Lundback B. Health-related quality of life is related to COPD disease severity. Health Qual Life Outcomes. 2005;3:56.CrossRefPubMedPubMedCentral Stahl E, Lindberg A, Jansson S-A, Ronmark E, Svensson K, Andersson F, Lofdahl C-G, Lundback B. Health-related quality of life is related to COPD disease severity. Health Qual Life Outcomes. 2005;3:56.CrossRefPubMedPubMedCentral
38.
go back to reference Jones PW, Brusselle G, Dal Negro RW, Ferrer M, Kardos P, Levy ML, Perez T, Soler-Cataluna JJ, van der Molen T, Adamek L, Banik N. Health-related quality of life in patients by COPD severity within primary care in Europe. Respir Med. 2011;105:57–66.CrossRefPubMed Jones PW, Brusselle G, Dal Negro RW, Ferrer M, Kardos P, Levy ML, Perez T, Soler-Cataluna JJ, van der Molen T, Adamek L, Banik N. Health-related quality of life in patients by COPD severity within primary care in Europe. Respir Med. 2011;105:57–66.CrossRefPubMed
39.
go back to reference Miravitlles M, Huerta A, Fernandez-Villar JA, Alcazar B, Villa G, Forne C, Cuesta M, Crespo C, Garcia-Rio F. Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems. Health Qual Life Outcomes. 2014;12:120.CrossRefPubMedPubMedCentral Miravitlles M, Huerta A, Fernandez-Villar JA, Alcazar B, Villa G, Forne C, Cuesta M, Crespo C, Garcia-Rio F. Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems. Health Qual Life Outcomes. 2014;12:120.CrossRefPubMedPubMedCentral
40.
go back to reference Pickard AS, Wilke C, Jung E, Patel S, Stavem K, Lee TA. Use of a preference-based measure of health (EQ-5D) in COPD and asthma. Respir Med. 2008;102:519–36.CrossRefPubMed Pickard AS, Wilke C, Jung E, Patel S, Stavem K, Lee TA. Use of a preference-based measure of health (EQ-5D) in COPD and asthma. Respir Med. 2008;102:519–36.CrossRefPubMed
41.
go back to reference Einarson TR, Bereza BG, Nielsen TA, Hemels ME. Utilities for asthma and COPD according to category of severity: a comprehensive literature review. J Med Econ. 2015;18:550–63.CrossRefPubMed Einarson TR, Bereza BG, Nielsen TA, Hemels ME. Utilities for asthma and COPD according to category of severity: a comprehensive literature review. J Med Econ. 2015;18:550–63.CrossRefPubMed
42.
go back to reference Leidl R, Schweikert B, Hahmann H, Steinacker JM, Reitmeir P. Assessing quality of life in a clinical study on heart rehabilitation: how well do value sets based on given or experienced health states reflect patients’ valuations? Health Qual Life Outcomes. 2016;48:1. Leidl R, Schweikert B, Hahmann H, Steinacker JM, Reitmeir P. Assessing quality of life in a clinical study on heart rehabilitation: how well do value sets based on given or experienced health states reflect patients’ valuations? Health Qual Life Outcomes. 2016;48:1.
Metadata
Title
Relative impact of COPD and comorbidities on generic health-related quality of life: a pooled analysis of the COSYCONET patient cohort and control subjects from the KORA and SHIP studies
Authors
Margarethe E. Wacker
Rudolf A. Jörres
Annika Karch
Armin Koch
Joachim Heinrich
Stefan Karrasch
Holger Schulz
Annette Peters
Sven Gläser
Ralf Ewert
Sebastian E. Baumeister
Claus Vogelmeier
Reiner Leidl
Rolf Holle
for the COSYCONET study group
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2016
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-016-0401-0

Other articles of this Issue 1/2016

Respiratory Research 1/2016 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.