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Burden of Disease Across Chronic Diseases: A Health Survey That Measured Prevalence, Function, and Quality of Life
ESTÍBALIZ LOZA, LYDIA ABÁSOLO, JUAN ANGEL JOVER, LORETO CARMONA, and the EPISER Study Group
ABSTRACT. Methods. A national health survey was conducted during 1999-2000. Participants were randomly selected from city censuses among persons aged over 20 years. All 2192 participants (response rate 73%) completed generic instruments measuring functional ability in activities of daily living [Health Assessment Questionnaire (HAQ)] and HRQOL [Short-Form 12 (SF-12)]. Chronic diseases were defined by self-report and elicited from 2 specific questions: "Have you ever been told you have a chronic disease by a physician?" and "Are you taking any chronic medication?". Only diagnoses present for ≥ 3 months were included as chronic. We estimated mean HAQ and SF-12 scores for the different groups of chronic diseases. We then adjusted the scores for covariates and compared them between diseases by multiple linear regressions. Results. Over half the population had at least one chronic disease [n = 1276 (58.2%)], and 22.6% had any rheumatic disease. Rheumatic diseases have an adverse effect on daily functioning [HAQ ß-coefficient 0.11 (95% CI 0.06–0.15)] and HRQOL [SF-12 physical ß-coefficient –5.78 (95% CI –6.27 to –4.28); SF-12 mental ß-coefficient –2.61 (95% CI –3.79 to –1.41)]. Thus, the influence of the rheumatic diseases is greater when their prevalence is taken into account. Conclusion. When the definition of burden of disease includes a measure of function and HRQOL that is weighted by disease prevalence, rheumatic diseases as a group can be ranked alongside neurological, cardiac, or pulmonary conditions as a major disease. (First Release Oct 15 2007; J Rheumatol 2008; 35:159-65) Key Indexing Terms:
HEALTH RELATED QUALITY OF LIFE
From the Rheumatology Unit, Hospital Clínico San Carlos, and the Research Unit, Spanish Foundation of Rheumatology, Madrid, Spain. Supported by a grant from the Fondo de Investigaciones de la Seguridad Social (FIS 99/0251) and by Merck Sharp and Dohme España. E. Loza, MD; L. Abásolo, MD; J.A. Jover, MD, PhD, Rheumatology Unit, Hospital Clínico San Carlos; L. Carmona, MD, PhD, Research Unit, Spanish Foundation of Rheumatology; and the EPISER Study Group (Appendix). Address reprint requests to Dr. L. Carmona, Research Unit, Spanish Foundation of Rheumatology, Calle Marqués del Duero 5, 1A, 28001 Madrid, Spain. E-mail: lcarmona@ser.es Accepted for publication June 27, 2007. |