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Socioeconomic inequality in health-related quality of life among Korean adults with chronic disease: an analysis of the Korean Community Health Survey
Thi Huyen Trang Nguyen, Thi Tra Bui, Jinhee Lee, Kui Son Choi, Hyunsoon Cho, Jin-Kyoung Oh
Epidemiol Health. 2024;46:e2024018.   Published online January 8, 2024
DOI: https://doi.org/10.4178/epih.e2024018
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Health-related quality of life is crucial for people dealing with chronic illness. This study investigated the quality of life in individuals with 5 common chronic conditions in Korea. We also analyzed socioeconomic factors such as education, income, occupation, and urbanization to identify determinants of inequality.
METHODS
Using 2016 Korea Community Health Survey data, we examined individuals aged 30 or older with chronic diseases (diabetes, hypertension, cardiovascular disease, hyperlipidemia, arthritis) using the EuroQol 5-Dimension 3 Level tool. We analyzed the associations between socioeconomic factors (education, income, occupation, urbanization) and quality of life using descriptive statistics and regression analysis. Inequality indices (relative inequality index, absolute inequality index) were used to measure inequality in quality of life.
RESULTS
Individuals with higher income levels showed a 1.95-fold higher likelihood of a better quality of life than those with the lowest income. The lowest income group had higher odds of mobility (adjusted odds ratio [aOR], 2.2), self-care (aOR, 2.1), activity limitations (aOR, 2.4), pain/discomfort (aOR, 1.8), and anxiety/depression (aOR, 2.3). Educational disparities included a 3-fold increase in mobility and daily activity problems for those with elementary or lower education. Well-educated participants had a 1.94 times higher quality of life, with smaller differences in anxiety/depression and self-management. The income gap accounted for 14.1% of variance in quality-of-life disparities.
CONCLUSIONS
Addressing socioeconomic disparities in the quality of life for individuals with chronic diseases necessitates tailored interventions and targeted health policies. This research informs policymakers in developing focused initiatives to alleviate health inequities. It emphasizes the importance of mental health support and ensuring affordable, accessible healthcare services.
Summary
Korean summary
- 지역사회건강조사 자료를 통해 확인한 한국인에게 호발하는 만성질환자(당뇨, 고혈압, 심혈관질환, 고지혈증, 관절염)에서 삶의 질 점수(EQ-5D)는 평균 0.7점으로, 남성에서 높고, 연령이 높을수록 낮다. - 소득이 낮거나 교육수준이 낮은 군에서 삶의 질이 상대적으로 낮으며, 특히 운동능력, 자기관리, 통증/불편, 불안/우울 각각에서 두배 가량 어려움을 겪는 것으로 나타났다. - 만성질환자에서 삶의 질은 사회경제적 여건에 따라 격차가 존재하므로, 취약한 계층 발굴과 지원이 필요하다.
Key Message
- Quality of life score (EQ-5D) in patients with chronic diseases (i.e., diabetes, hypertension, cardiovascular disease, hyperlipidemia, and arthritis) that are prevalent in Koreans identified through data from community health surveys averaged 0.7, lower in women than in men, and decreased by age. - Low-income or low-educated patients have relatively low quality of life, and they have more than twice as much problem in mobility, self-care, pain/discomfort, and anxiety/depression. - Disparities in quality of life in patients with chronic diseases according to socioeconomic conditions have been found, and support for the vulnerable is needed.
Multimorbidity patterns by health-related quality of life status in older adults: an association rules and network analysis utilizing the Korea National Health and Nutrition Examination Survey
Thi-Ngoc Tran, Sanghee Lee, Chang-Mo Oh, Hyunsoon Cho
Epidemiol Health. 2022;44:e2022113.   Published online November 29, 2022
DOI: https://doi.org/10.4178/epih.e2022113
  • 6,180 View
  • 192 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Improved life expectancy has increased the prevalence of older adults living with multimorbidity which likely deteriorates their health-related quality of life (HRQoL). However, relatively little is known about patterns and the relationships of multimorbidity by HRQoL status in older adults.
METHODS
Individuals aged 65 or older from the Korea National Health and Nutrition Examination Survey V-VII (2010-2018) were analyzed. HRQoL was assessed by the EuroQoL-5 dimensions questionnaire and categorized as poor, normal, or good. The impact of multimorbidity on HRQoL was evaluated using logistic regression. The patterns and inter-relationships between multimorbidity, stratified by HRQoL groups, were analyzed using the association rules and network analysis approach.
RESULTS
Multimorbidity was significantly associated with poor HRQoL (3 or more diseases vs. none; adjusted odds ratio, 2.70; 95% confidence interval, 2.10 to 3.46). Hypertension, arthritis, hyperlipidemia, and diabetes were the most prevalent diseases across all HRQoL groups. Complex interrelationships of morbidities, higher prevalence, and node strengths in all diseases were observed in the poor HRQoL group, particularly for arthritis, depression, and stroke, compared to other groups (1.5-3.0 times higher, p<0.05 for all). Apart from hypertension, arthritis and hyperlipidemia had a higher prevalence and stronger connections with other diseases in females, whereas this was the case for diabetes and stroke in males with poor HRQoL.
CONCLUSIONS
Multimorbidity patterns formed complicatedly inter-correlated disease networks in the poor HRQoL group with differences according to sex. These findings enhance the understanding of multimorbidity connections and provide information on the healthcare needs of older adults, especially those with poor HRQoL.
Summary
Korean summary
기대 수명의 증가에 따라 고령인구에서 건강관련 삶의 질을 저하시킬 수 있는 복합질환의 유병률도 함께 증가하고 있다. 본 연구에서는 국민건강영양조사 자료를 이용하여 65세 이상 우리나라 고령인구에서 건강관련 삶의 질 (HRQoL)에 따른 복합만성질환 패턴을 분석하였다. 복합만성질환은 건강관련 삶의 질 저하와 통계적으로 유의하게 연관되어 있으며, 연관성 및 네크워크 분석 결과 건강관련 삶의 질이 낮을수록 복합질환의 패턴이 복잡한 것으로 나타났다. 전체적으로 고혈압, 관절염, 고지혈증, 당뇨병이 가장 높은 발생률을 보였다. 건강관련 삶의 질이 낮은 그룹에서는 관절염, 우울증, 뇌졸중 등의 질병이 높은 발생률과 상호관련성을 보였으며, 이는 성별에 따라 차이가 있었다. 연구 결과는 고령자, 특히 건강관련 삶의 질이 낮은 노인의 의료 서비스 요구에 대해 정보를 제공해 줄 수 있을 것이다,
Key Message
Network analysis of older adults (65 or older) in Korea showed that hypertension, arthritis, hyperlipidemia, and diabetes were the most common multimorbidity regardless of HRQoL status. However, as HRQoL deteriorated, multimorbidity patterns formed complicatedly inter-correlated disease networks; the prevalence and the node strength of arthritis, depression, and stroke increased considerably and be diversified by sex.

Citations

Citations to this article as recorded by  
  • Chronic Disease Patterns and Their Relationship With Health-Related Quality of Life in South Korean Older Adults With the 2021 Korean National Health and Nutrition Examination Survey: Latent Class Analysis
    Mi-Sun Lee, Hooyeon Lee
    JMIR Public Health and Surveillance.2024; 10: e49433.     CrossRef
  • Health-promoting behavior to enhance perceived meaning and control of life in chronic disease patients with role limitations and depressive symptoms: a network approach
    Je-Yeon Yun, Young Ho Yun
    Scientific Reports.2023;[Epub]     CrossRef
The medium-term consequences of a COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary disease, cardiovascular disease, musculoskeletal disease, depression, and cancer
Irene Rodríguez-Gómez, Coral Sánchez-Martín, Francisco J. García-García, Esther García-Esquinas, Marta Miret, Germán Vicente-Rodriguez, Narcís Gusi, Asier Mañas, José A. Carnicero, Marcela Gonzalez-Gross, José L. Ayuso-Mateos, Fernando Rodríguez-Artalejo, Leocadio Rodríguez-Mañas, Ignacio Ara
Epidemiol Health. 2022;44:e2022026.   Published online February 21, 2022
DOI: https://doi.org/10.4178/epih.e2022026
  • 10,446 View
  • 364 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the associations of chronic diseases with changes in lifestyle and health behaviours in older people following the coronavirus disease 2019 (COVID-19) lockdown in Spain and compared the differences in changes over time.
METHODS
1,092 participants (80.3±5.6 years; 66.5% female) from 2 Spanish cohorts were included. Telephone-based questionnaires were conducted to evaluate lifestyle and health risk behaviours at the end of lockdown and 7 months post-lockdown. Participants were classified as having physician-diagnosed chronic diseases based on self-reported data. Cox proportional models adjusted for major confounders were used.
RESULTS
Compared to those without the corresponding chronic diseases, older people with hypertension were less likely to report increased alcohol consumption (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55 to 0.99). Pulmonary diseases were associated with lower risks of increased sedentary time (HR, 0.58; 95% CI, 0.39 to 0.86) and worsened sleep quality (HR, 0.56; 95% CI, 0.36 to 0.87), while cardiovascular diseases were associated with a lower risk of decreased sedentary time (HR, 0.58; 95% CI, 0.38 to 0.88). Depression was linked to a higher likelihood of improved diet quality (HR, 1.53; 95% CI, 1.00 to 2.36). Cancer pacients were less likely to have worsened sleep quality (HR, 0.44; 95% CI, 0.22 to 0.89) but more likely to have reduced their frequency of social contact (HR, 2.05; 95% CI, 1.05 to 3.99).
CONCLUSIONS
Older people with chronic diseases showed beneficial changes in lifestyle and health risk behaviours after the COVID-19 lockdown. In particular, older people with hypertension, pulmonary disease, and cancer tended to make beneficial lifestyle and health behaviour changes. However, older people with cardiovascular disease and depression engaged in more health risk behaviours.
Summary
Key Message
Although the majority of older people with chronic diseases showed beneficial changes in lifestyle and health risk behaviors after the COVID-19 lockdown, public health interventions should be developed to prevent the dangerous long-term effects that COVID-19 pandemic-type situations may have on the health of older people, with a particular focus on older people with CVD and depression that seem to have experienced more health risk behaviors during the COVID-19 pandemic than older people with other chronic diseases.

Citations

Citations to this article as recorded by  
  • Global burden of sleep disturbances among older adults and the disparities by geographical regions and pandemic periods
    Min Du, Min Liu, Yaping Wang, Chenyuan Qin, Jue Liu
    SSM - Population Health.2024; 25: 101588.     CrossRef
  • Nut Consumption and Depression: Cross-Sectional and Longitudinal Analyses in Two Cohorts of Older Adults
    R. Fernández-Rodríguez, R. Ortolá, Vicente Martínez-Vizcaíno, B. Bizzozero-Peroni, F. Rodríguez-Artalejo, E. García-Esquinas, E. López-García, A.E. Mesas
    The Journal of nutrition, health and aging.2023; 27(6): 448.     CrossRef
Factors associated with health-related quality of life in a working population in Singapore
Dhiya Mahirah, Charlotte Sauter, Thuan-Quoc Thach, Gerard Dunleavy, Nuraini Nazeha, George I. Christopoulos, Chee Kiong Soh, Josip Car
Epidemiol Health. 2020;42:e2020048.   Published online June 30, 2020
DOI: https://doi.org/10.4178/epih.e2020048
  • 14,083 View
  • 238 Download
  • 6 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to evaluate the determinants of health-related quality of life (HRQoL) among workers in Singapore.
METHODS
We analysed data from a cross-sectional study of 464 participants from 4 companies in Singapore. Physical and mental components of HRQoL were assessed using the Short-Form 36 version 2.0 survey. A generalized linear model was used to determine factors associated with the physical component summary (PCS) and mental component summary (MCS) scores of HRQoL.
RESULTS
The overall mean PCS and MCS scores were mean±standard deviation 51.6±6.7 and 50.2±7.7, respectively. The scores for subscales ranged from 62.7±14.7 for vitality to 83.5±20.0 for role limitation due to emotional problems. Ethnicity, overweight/obesity, and years working at the company were significantly associated with physical HRQoL, and age and stress at work were significantly associated with mental HRQoL. Moreover, sleep quality was significantly associated with both physical and mental HRQoL.
CONCLUSIONS
These findings could help workplaces in planning strategies and initiatives for employees to maintain a worklife balance that encompasses their physical, emotional, and social well-being.
Summary

Citations

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  • Дослідження показників якості життя, пов’язаної зі здоров’ям, у розрізі трудової діяльності та безробіття (міжнародний досвід)
    Svitlana Indyka, Nataliia Bielikova
    Physical education, sport and health culture in modern society.2023; (3(63)): 12.     CrossRef
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    Kok Hian Tan, Boon Leng Lim, Zann Foo, Joo Ying Tang, Mabel Sim, Phong Teck Lee, Kok Yong Fong
    Annals of the Academy of Medicine, Singapore.2022; 51(7): 409.     CrossRef
  • Factors Associated with Health-Related Quality of Life among Government Employees in Putrajaya, Malaysia
    Muhamad Hasrol Mohd Ashri, Hazizi Abu Saad, Siti Nur’Asyura Adznam
    International Journal of Environmental Research and Public Health.2021; 18(5): 2626.     CrossRef
  • Health-related quality of life in a general population sample in Kazakhstan and its sociodemographic and occupational determinants
    Denis Vinnikov, Aizhan Raushanova, Zhanna Romanova, Zhangir Tulekov
    Health and Quality of Life Outcomes.2021;[Epub]     CrossRef
  • Association of Subjective Quality and Quantity of Sleep with Quality of Life among a General Population
    Kentaro Matsui, Takuya Yoshiike, Kentaro Nagao, Tomohiro Utsumi, Ayumi Tsuru, Rei Otsuki, Naoko Ayabe, Megumi Hazumi, Masahiro Suzuki, Kaori Saitoh, Sayaka Aritake-Okada, Yuichi Inoue, Kenichi Kuriyama
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Review
Meta-analysis of the prevalence of depression among breast cancer survivors in Iran: an urgent need for community supportive care programs
Hassan Ahmadi Gharaei, Mostafa Dianatinasab, Seyyed Mostafa Kouhestani, Mohammad Fararouei, Hossein Moameri, Reza Pakzad, Reza Ghaiasvand
Epidemiol Health. 2019;41:e2019030.   Published online July 4, 2019
DOI: https://doi.org/10.4178/epih.e2019030
  • 14,175 View
  • 299 Download
  • 15 Web of Science
  • 18 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Depression, which is the most common comorbidity in breast cancer (BC) patients, has adverse effects on patients’ quality of life, disease progress, and survival.
METHODS
The protocol of this study was registered in PROSPERO (registration No. CRD42019121494). We electronically searched published studies through January 2019 with the aim of finding articles that investigated the prevalence of depression among BC survivors. Web of Science, Scopus, PubMed/MEDLINE, Science Direct, and Google Scholar were searched to obtain relevant published studies. This review included 14 cross-sectional and 4 cohort studies published from 2000 to 2018. We used a random-effects model to conduct the meta-analysis and generated a summary estimate for the pooled prevalence with 95% confidence intervals (CIs). A subgroup analysis was also conducted based on the depression assessment tool used and the study design.
RESULTS
The total sample size of the studies contained 2,799 women with BC, including 1,228 women who were diagnosed with depression. The pooled prevalence of depression among Iranian women with BC was 46.83% (95% CI, 33.77 to 59.88) with significant heterogeneity (I2 =98.5%; p<0.001). The prevalence of depression ranged from 14.00% (95% CI, 4.91 to 23.09) to 95.90% (95% CI, 91.97 to 99.83). The results of the subgroup analyses suggested that the depression assessment tool, year of publication, and study design were sources of heterogeneity.
CONCLUSIONS
Our findings indicate a high prevalence of depression among BC patients, underscoring the urgent need for clinicians and health authorities to provide well-defined social and psychological supportive care programs for these patients.
Summary

Citations

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  • The prevalence of anxiety and depression in cancer around the world: An overview of systematic reviews evaluating 128 meta-analyses
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Original Articles
Ambient air quality and subjective stress level using Community Health Survey data in Korea
Myung-Jae Hwang, Hae-Kwan Cheong, Jong-Hun Kim, Youn Seo Koo, Hui-Young Yun
Epidemiol Health. 2018;40:e2018028.   Published online June 28, 2018
DOI: https://doi.org/10.4178/epih.e2018028
  • 13,228 View
  • 209 Download
  • 8 Web of Science
  • 9 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Air pollution causes various disease in exposed populations, and can lead to premorbid health effects manifested as both physical and psychological functional impairment. The present study investigated the subjective stress level in daily life in relation to the level of air pollution.
METHODS
Data from the Community Health Survey (2013), comprising 99,162 men, and 121,273 women residing in 253 healthcare administrative districts, were combined with air pollutant concentration modelling data from the Korean Air Quality Forecasting System, and were stratified by subjective stress levels into five strata for multiple logistic regression. Levels of exposure were divided into five quintiles according to the annual concentration of nitrogen dioxide (NO2), and were analyzed using a single-pollutant model using NO2 concentration only, and a multi-pollutant model adjusted for the concentration of particulate matter <10 μm in diameter.
RESULTS
Analysis of men and women in various age groups showed the highest odds ratio (OR) for subjective stress level at the highest NO2 concentration quintile in men and women aged 30–64 years (men: 2.91; 95% confidence interval [CI], 2.12 to 4.01; women: 1.82; 95% CI, 1.32 to 2.51). As the NO2 concentration quintile increased, the OR increased. Men showed higher ORs than women in all strata.
CONCLUSIONS
In the present study, annual NO2 concentrations were found to be associated with subjective stress levels. This association was especially clear among socioeconomically active men and women aged 30-64 years.
Summary
Korean summary
2013년 지역사회건강조사를 이용하여 253개 보건행정지역단위로 Korean Air Quality Forecasting System (KAQFS) 대기물질농도 모델링자료를 결합하여 주관적 스트레스 정도에 따라 5분위로 범주화하여 다항로지스틱회귀을 하였다. 본 연구에서는 연평균 NO2농도와 주관적 스트레스 정도가 관련이 있는 것으로 나타났다. 특히, 사회 경제적 활동이 활발한30세 이상 65세 미만의 남성과 여성에서 관련성이 뚜렷하게 나타났다.

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    Anne Boudier, Iana Markevych, Bénédicte Jacquemin, Michael J. Abramson, Simone Accordini, Bertil Forsberg, Elaine Fuertes, Judith Garcia-Aymerich, Joachim Heinrich, Ane Johannessen, Bénédicte Leynaert, Isabelle Pin, Valérie Siroux
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    Xiuleng Yang, Juan Pablo Orjuela, Emma McCoy, Guillem Vich, Esther Anaya-Boig, Ione Avila-Palencia, Christian Brand, Glòria Carrasco-Turigas, Evi Dons, Regine Gerike, Thomas Götschi, Mark Nieuwenhuijsen, Luc Int Panis, Arnout Standaert, Audrey de Nazelle
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Determinants of health-related quality of life in Iranian adults: evidence from a cross-sectional study
Satar Rezaei, Mohammad Hajizadeh, Ali Kazemi, Masoud Khosravipour, Farid Khosravi, Shahab Rezaeian
Epidemiol Health. 2017;39:e2017038.   Published online August 15, 2017
DOI: https://doi.org/10.4178/epih.e2017038
  • 14,313 View
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  • 12 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
This study aimed to measure the level and determinants of health-related quality of life (HRQoL) in adults in Kermanshah, a city in the western region of Iran.
METHODS
Convenience sampling was employed to obtain a sample of 998 adults aged 18 years and older (646 males and 352 females) in the city of Kermanshah. A 2-part self-administered questionnaire was used to collect data over the period between March 1 and May 30, 2017. The first part was designed to collect information on socio-demographic characteristics, socioeconomic status, and lifestyle factors (10 items). The second part consisted of the EuroQoL 5-dimensions (EQ-5D) EuroQoL-3-level and the EuroQoL visual analog scale (EQ-VAS) questions. A multiple linear regression model was used to determine the factors associated with the EQ-5D index and EQ-VAS score among study participants.
RESULTS
The mean values for the EQ-5D index and the EQ-VAS score were 0.74 (standard deviation [SD], 0.19) and 80.9 (SD, 16.5), respectively. The highest percentage of self-reported problems (‘some’ and ‘severe’ problems) across the 5 dimensions of the EQ-5D index were associated with the dimensions of anxiety/depression (35.3%) and pain/discomfort (32.9%). The percentage of self-reported problems for the dimensions of usual activities, mobility, and self-care were 19.0, 12.8, and 8.9%, respectively. Our regression analyses indicated that there were statistically significant positive associations between being physically active, monthly household income per capita, and post-secondary education and the EQ-5D index and EQ-VAS score. In contrast, negative associations were found between older age, being married, having a chronic disease, and smoking and the EQ-5D index and EQ-VAS score. A negative association was also found between being uninsured and the EQ-5D index.
CONCLUSIONS
Our findings suggest that interventions aiming to improve physical activity, to prevent chronic diseases, and to reduce the smoking rate among adults living in the city of Kermanshah may improve their HRQoL.
Summary

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The impact of disease characteristics on multiple sclerosis patients’ quality of life
Aziz Rezapour, Abdollah Almasian Kia, Sahar Goodarzi, Mojtaba Hasoumi, Soraya Nouraei Motlagh, Sajad Vahedi
Epidemiol Health. 2017;39:e2017008.   Published online February 19, 2017
DOI: https://doi.org/10.4178/epih.e2017008
  • 16,602 View
  • 396 Download
  • 44 Web of Science
  • 42 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
The aim of this study was to assess the quality of life (QoL) of patients with multiple sclerosis (MS), and to investigate the effects of characteristics of MS such as disease course, severity, and relapses on patients’ QoL.
METHODS
This was a cross-sectional study, in which 171 patients were enrolled. Health-related QoL was assessed using the Persian version of the Multiple Sclerosis Quality of Life-54 questionnaire. To measure patients’ disability status, we used the Expanded Disability Status Scale. Other variables included in the study were disease course and relapses of the disease.
RESULTS
The average scores for patients’ physical and mental QoL were 60.9±22.3 and 59.5±21.4, respectively. In a bivariate analysis, disease course, severity of the disease, and relapses were significantly associated with the physical and mental health composite scores. In a hierarchal regression analysis, disease course, severity of the disease, and relapses were responsible for 38 and 16% of the variance in physical and mental QoL, respectively. It was also observed that relapses were a strong predictor of both physical and mental QoL.
CONCLUSIONS
Our results showed that disease characteristics significantly affected both dimensions of QoL. It is therefore suggested that health care providers should be aware of these characteristics of MS to more successfully improve MS patients’ QoL.
Summary

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Associations between a health-promoting lifestyle and quality of life among adults with beta-thalassemia major
Aghbabak Maheri, Roya Sadeghi, Davoud Shojaeizadeh, Azar Tol, Mehdi Yaseri, Mojtaba Ebrahimi
Epidemiol Health. 2016;38:e2016050.   Published online November 15, 2016
DOI: https://doi.org/10.4178/epih.e2016050
  • 16,681 View
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AbstractAbstract PDF
Abstract
OBJECTIVES
A health-promoting lifestyle (HPL) is a factor that affects the quality of life (QoL) in patients with beta-thalassemia (β-thalassemia). Due to the lack of studies of this issue, this study aimed to determine the association between HPL and QoL among adults with β-thalassemia.
METHODS
This cross-sectional (descriptive-analytic) study was conducted among 389 adult patients with β-thalassemia in Tehran, Iran. The research instrument included a questionnaire consisting of three parts: demographic items, the Short-Form Health Survey and the Health-Promoting Lifestyle Profile. The data were analyzed using SPSS version 23.0. The results were considered significant at the conventional p<0.05 level.
RESULTS
The mean age of the participants was 30.2±8.3 years. The mean score of the HPL dimensions was 127.28±21.53, and the mean score of the QoL domains was 61.44±23.38. The highest and the lowest mean scores of the HPL dimensions were found for spiritual growth (23.96±5.74) and physical activity (11.32±3.95), respectively. The QoL scores in all three domains (total, physical component summary score, and mental component summary score) were moderate. Health responsibility, physical activity, spiritual growth, and interpersonal relations were significant predictive factors of QoL in adults with β-thalassemia; these four dimensions explained 37.9% of the variance in QoL.
CONCLUSIONS
QoL and HPL were not at acceptable levels among patients with thalassemia. Therefore, educational interventions emphasizing spiritual growth, physical activity, and interpersonal relations are necessary for patients with thalassemia.
Summary

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Self-reported health-related quality of life (HRQoL) and factors affecting HRQoL among individuals with health insurance in Iran
Ali Kazemi Karyani, Arash Rashidian, Sarar Emamgholipour Sefiddashti, Ali Akbari Sari
Epidemiol Health. 2016;38:e2016046.   Published online October 26, 2016
DOI: https://doi.org/10.4178/epih.e2016046
  • 14,708 View
  • 235 Download
  • 26 Web of Science
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The aim of this study was to measure the health-related quality of life (HRQoL) and to evaluate the factors affecting HRQoL in individuals with health insurance in Tehran, Iran.
METHODS
A cross-sectional analytical study was conducted using the 3-level EuroQol 5-dimensions (EQ-5D) questionnaire. In order to estimate the determinants of HRQoL, information about participants’ demographic, socioeconomic, and health status was gathered. The cluster sampling technique was used to collect data from May to June, 2016. The chi-square test and weighted least squares method were employed for data analysis. Data were analyzed using Stata version 11.0.
RESULTS
A total of 600 Iranians with insurance completed the study, of whom 327 (54.5%) were male and 273 (45.5%) were female. The mean age of the participants was 41.48 years (standard deviation [SD], 14.60 years). Meanwhile, the mean duration of education was 12.36 years (SD, 4.68 years). The mean EQ-5D score was 0.74 (SD, 0.16). The most common health problems in the participants were anxiety/depression (42.3%), followed by pain/discomfort (39.2%). Sex, age, years of schooling, income, chronic disease, and body mass index had a significant effect on HRQoL (p<0.05). Healthy insured individuals, on average, had a HRQoL score 0.119 higher than that of people with a chronic disease, all else being equal (p<0.001).
CONCLUSIONS
Among all determinants of HRQoL, chronic disease was found to be the highest priority for interventions to improve the health status of Iranians with insurance. This finding can help policymakers and health insurance organizations improve their planning to promote the HRQoL of individuals with insurance and society as a whole in Iran.
Summary
Korean summary
본 연구는 만 19세 이상의 한국 성인 동성애자와 양성애자를 대상으로 이들의 건강상태에 대한 설문조사를 시행하고, 수집한 자료를 분석하여 동성애자•양성애자의 건강불평등 실태를 파악하고자 하였다. 본 연구의 목적은 자가평가건강, 정신건강(우울, 자살생각 및 자살시도), 신체적 건강(근골격계 통증) 및 건강관련행동(흡연율, 위험음주율)을 포함하여 다양한 측면에서 한국 성인 동성애자•양성애자와 일반인구집단의 건강수준을 비교하는 것이다.

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  • What Explains Socioeconomic Inequality in Health-related Quality of Life in Iran? A Blinder-Oaxaca Decomposition
    Satar Rezaei, Mohammad Hajizadeh, Yahya Salimi, Ghobad Moradi, Bijan Nouri
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    Shahab Rezaeian
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    Satar Rezaei, Mohammad Hajizadeh, Ali Kazemi, Masoud Khosravipour, Farid Khosravi, Shahab Rezaeian
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Application of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) to patients with cataract
Ali Gholami, Mahmood Tavakoli Araghi, Fatemeh Shamsabadi, Mahdiye Bayat, Fatemeh Dabirkhani, Farhad Moradpour, Kamyar Mansori, Yousef Moradi, Abdolhalim Rajabi
Epidemiol Health. 2016;38:e2016005.   Published online February 4, 2016
DOI: https://doi.org/10.4178/epih.e2016005
  • 20,284 View
  • 350 Download
  • 15 Web of Science
  • 13 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Cataract is a prevalent disease in the elderly, and negatively influences patients’ quality of life. This study was conducted to study the application of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) to patients with cataract.
METHODS
In this cross-sectional study, 300 patients with cataract were studied in Neyshabur, Iran from July to October 2014. The Iranian version of the WHOQOL-BREF questionnaire was used to measure their quality of life. Cronbach’s alpha coefficient, Pearson’s correlation coefficient, the paired t-test, the independent t-test, and a linear regression model were used to analyze the data in SPSS version 16.0 (SPSS Inc., Chicago, IL, USA).
RESULTS
The mean age of the participants was 68.11±11.98 years, and most were female (53%). The overall observed Cronbach’s alpha coefficient for the WHOQOL-BREF was 0.889, ranging from 0.714 to 0.810 in its four domains. The total mean score of the respondents on the WHOQOL-BREF was 13.19. The highest and lowest mean scores were observed in the social relationship domain (14.11) and the physical health domain (12.29), respectively. A backward multiple linear regression model found that duration of disease and marital status were associated with total WHOQOL scores, while age, duration of disease, marital status, and income level were associated with domains one through four, respectively (p<0.05).
CONCLUSIONS
The reliability analysis conducted in this study indicated that the WHOQOL-BREF scale exhibited an acceptable degree of internal consistency in the measurement of the quality of life of patients with cataract. It was also found that the patients with cataract who were surveyed reported a relatively moderate quality of life.
Summary

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Epidemiological evaluation quality of life in patients suffering from early rheumatoid arthritis: a pragmatic, prospective, randomized, blind allocation controlled of a modular program group intervention
Hadi Yousefi, Arvind Chopra, Rez Farrokhseresht, Sanjeev Sarmukaddam, Fariba Asadi Noghabi, Nilima Bedekar, Abdolhosain Madani
Epidemiol Health. 2015;37:e2015048.   Published online November 5, 2015
DOI: https://doi.org/10.4178/epih/e2015048
  • 15,654 View
  • 195 Download
  • 3 Web of Science
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AbstractAbstract PDF
Abstract
OBJECTIVES
Epidemiology has taken on new roles in the management of health care services. In this study, we developed a non-pharmacological self-management modular program group intervention and evaluated its efficacy as an adjunct therapy in patients suffering from early rheumatoid arthritis (RA). METHODS: Patients were randomized to either participate in a non-equivalent intervention group along with the standard of care or only receive standard-of-care treatment at a community rheumatology center. The outcomes measured were a pain visual analog scale (VAS), patient general health (GH) on a VAS, and the Short Form-36 Version 2 (SF-36v2) scale measuring quality of life. These parameters were evaluated in the first week to obtain baseline values, and at 20, 32, 48, and 60 weeks to evaluate the efficacy of the intervention group. RESULTS: The patients were randomized, with 100 patients in the intervention group and 106 in the control group. The intervention and control groups were similar with regard to the percentage of women (86% vs. 89.6%), tobacco usage (25% vs. 19.8%), mean age (42.6±13.2 years vs. 46.6±10.9 years), and disease duration (15.3±6.7 months vs. 14.5±6.6 months). The mean outcomes were significantly different between the two groups, and post-hoc pairwise analysis demonstrated significant deterioration in the control group in contrast to improvement in the intervention group at the second, third, fourth, and fifth evaluations. Improvements were often seen as early as the 12-week and 24-week follow-up visits. CONCLUSIONS: Epidemiology contributes to the evaluation of how well specific therapies or other health interventions prevent or control health problems. The modular program group intervention implemented in this study appears to be a suitable and feasible method to facilitate much more comprehensive management of early RA in socioeconomically challenged communities.
Summary

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  • The Effects of Patient Education on Psychological Status and Clinical Outcomes in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis
    Zugui Wu, Yue Zhu, Yi Wang, Rui Zhou, Xiangling Ye, Zehua Chen, Congcong Li, Junyi Li, Zixuan Ye, Zhenbang Wang, Wengang Liu, Xuemeng Xu
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Methods
Value-based medicine: concepts and application
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015014.   Published online March 4, 2015
DOI: https://doi.org/10.4178/epih/e2015014
  • 23,531 View
  • 371 Download
  • 21 Web of Science
  • 53 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.
Summary
Korean summary
21세기 의학은 근거기반, 환자중심, 비용효과적인 의료를 지향하고 있다. 근거기반의학은 의사결정에 있어 최선의 의학적 근거를 기반으로 하려는 패러다임이다. 이런 근거기반의학에 더하여 환자의 가치를 치료 결정에 적극 반영하기 위하여 가치기반의학이 제기되었다. 가치기반의학은 최선의 근거에 따라 진료를 하면서도 의료자원을 효율적으로 사용하도록 만들어서, 궁극적으로 한 나라의 보건의료의 질적 향상을 도모하게 한다. 본 논문의 목적은 가치기반의학의 개념을 소개하고 관련 연구의 활성화를 위한 전략적 제언을 하는 것이다.

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Original Article
Burden of Disease of Multiple Sclerosis in Korea
Soo-Eun Chung, Hae-Kwan Cheong, Jae-Hyun Park, Ho Jin Kim
Epidemiol Health. 2012;34:e2012008.   Published online November 30, 2012
DOI: https://doi.org/10.4178/epih/e2012008
  • 20,591 View
  • 151 Download
  • 19 Crossref
AbstractAbstract PDF
Abstract
<sec><title>OBJECTIVES</title><p>Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. There are few reports on the burden of disease of MS, worldwide. The authors aim to estimate burden of disease and estimate the epidemiologic indexes of MS in Korea using available epidemiologic data.</p></sec><sec><title>METHODS</title><p>Epidemiologic indexes were computed using DISMOD II software based on prevalence from nationwide survey, incidence estimated from extrapolation, mortality from National Statistics Office, and duration of disease from literature as input indexes. We calculated disability-adjusted life year (DALY) as a measure of premature mortality and disability, equivalent to years of healthy life lost due to a given condition.</p></sec><sec><title>RESULTS</title><p>The incidence of MS in Korea was 0.1 per 100,000, higher in female than in male. The highest incidence was estimated in the age group between 35 and 44 years in male and age group between 25 and 29 years in female. Total burden of disease of MS was 1,394 DALY, comprised of 292 (21%) years of life lost and 1,101 (79%) years lived with disability. The mean age at onset of MS was 33 years old in men and 32 years old in female. Estimated duration of disease was 35 years in men and 40 years in female. Most of the DALY of MS occurred in the adult population between 25 and 54 years of age.</p></sec><sec><title>CONCLUSION</title><p>Although MS is a rare disease in Korea, most of the DALY arises from young people, which results in a major financial burden on the patient, family, health system and society.</p></sec>
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