Elsevier

Primary Care Diabetes

Volume 3, Issue 1, February 2009, Pages 37-42
Primary Care Diabetes

Are health-related quality-of-life and self-rated health associated with mortality? Insights from Translating Research Into Action for Diabetes (TRIAD)

https://doi.org/10.1016/j.pcd.2009.01.001Get rights and content

Abstract

Aims

To determine if health-related quality-of-life and self-rated health are associated with mortality in persons with diabetes.

Methods

Survey and medical record data were obtained from 7892 patients with diabetes in Translating Research Into Action for Diabetes (TRIAD), a multicenter prospective observational study of diabetes care in managed care. Vital status at follow-up was determined from the National Death Index. Multivariable proportional hazard models were used to determine if a generic measure of health-related quality-of-life (EQ-5D) and self-rated health measured at baseline were associated with 4-year all-cause, cardiovascular, and noncardiovascular mortality.

Results

At baseline, the mean EQ-5D score for decedents was 0.73 (S.D. = 0.20) and for survivors was 0.81 (S.D. = 0.18) (p < 0.0001). Fifty-five percent of decedents and 36% of survivors (p < 0.0001) rated their health as fair or poor. Lower EQ-5D scores and fair or poor self-rated health were associated with higher rates of mortality after adjusting for the demographic, socioeconomic, and clinical risk factors for mortality.

Conclusions

Health-related quality-of-life and self-rated health predict mortality in persons with diabetes. Health-related quality-of-life and self-rated health may provide additional information on patient risk independent of demographic, socioeconomic, and clinical risk factors for mortality.

Introduction

Persons with diabetes and those with diabetic complications have an increased risk of mortality [1]. Measures of health-related quality-of-life (HRQoL) and self-rated health provide a subjective weighting of health problems that may not be captured with objective physical health assessments and may predict mortality in persons with diabetes [2]. Such measures can capture physical limitations which may impact mental functioning, which in turn can impact health by altering health behaviors, adherence with treatment plans, or the function of the immune, endocrine, and cardiovascular systems [2]. Self-rated health may also predict mortality because it provides a dynamic evaluation that reflects not only the current level of health but the trajectory of health, or the presence or absence of resources that can attenuate a decline in health [3]. Davis et al. suggested that the psychosocial impact of having diabetes might predict mortality, but their study, conducted 20 years ago, was limited by small sample size and their inability to adjust for demographic and socioeconomic risk factors for death such as race, education, or income [4]. Another study by Dasbach et al. showed that self-rated health predicted mortality in persons with diabetes after adjustment for physical health [5]. However, the authors did not examine cause-specific mortality and the study population was composed primarily of non-Hispanic white persons [5].

The purpose of this study was to reexamine the associations between HRQoL, self-rated health, and mortality, and to expand upon the previous research by assessing different measures of quality-of-life (the EQ-5D and self-rated health), by studying a racially and ethnically diverse population, and by examining both cardiovascular and noncardiovascular mortality. Our primary aim was to determine if HRQoL and self-rated health are associated with mortality in patients with diabetes after controlling for demographic, socioeconomic, and clinical risk factors for mortality and whether their assessment might identify persons at increased risk for death.

Section snippets

Study setting and population

Translating Research Into Action for Diabetes (TRIAD) has been described in detail elsewhere [6]. In brief, six centers collaborate with 10 managed care health plans and 68 provider groups that serve approximately 180,000 Americans with diabetes. Patients  18 years of age with diabetes were sampled. Institutional Review Boards at each participating site and the Centers for Disease Control and Prevention approved the study. All participants provided informed consent.

A baseline survey was

Results

Of the 7892 persons included in our analyses, 749 (9%) died before January 1, 2005. The average length of follow-up was 3.7 years. The median age at death was 71 years and 54% of decedents were men. Fourteen percent of decedents were Hispanic, 18% black, 51% white, 9% Asian/Pacific Islander, and 8% of other races/ethnicities (Table 1). Of the 749 patients who died, 320 (43%) had a cardiovascular cause and 429 (57%) had a noncardiovascular cause listed as the underlying cause of death.

Compared

Discussion

Research has highlighted the importance of HRQoL and self-rated health in predicting health outcomes [3], [14], [15], [16], [17], [18], [19], [20]. We have shown a consistent relationship between the EQ-5D score and mortality after adjusting for demographic, socioeconomic, and clinical risk factors for death. While the mechanism for this relationship is unknown, we hypothesize that the long-term complications of diabetes may contribute to lower HRQoL that in turn affect self-care and survival.

Conflict of interest statement

The authors have no conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

Acknowledgements

This study was jointly funded by Program Announcement number 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding organizations. Significant contributions to this study were made by members of the TRIAD Study Group. A complete listing of the TRIAD

References (21)

There are more references available in the full text version of this article.

Cited by (73)

  • Predictive value of a novel sub-item mortality risk score derived from the Norfolk Quality of Life in Diabetic Neuropathy questionnaire in Romanian participants with diabetes mellitus

    2022, Primary Care Diabetes
    Citation Excerpt :

    Landman et al. [24] found that in 1353 participants with type 2 diabetes followed for a mean of 9.6 years, baseline health-related QOL scores measured using the RAND-36 were inversely associated with mortality; having an additional ten points on the PCS decreased the risk of mortality by 11 %. Results of the TRIAD (Translating Research Into Action for Diabetes) study, obtained from 7,892 participants, show that those who survived at the end of a 4-year follow-up period had significantly lower (better) baseline EQ-5D health-related QOL scores compared to those who died (0.73 [SD = 0.20] vs. 0.81 [SD = 0.18], p < 0.0001) [12]. Despite this body of evidence highlighting the relationship between low QOL and a higher risk of mortality, we could not identify any mortality scores derived from questionnaires assessing QOL in the literature.

  • The associations between objective and subjective health among older adults with type 2 diabetes: The moderating role of personality

    2019, Journal of Psychosomatic Research
    Citation Excerpt :

    The highest prevalence of T2D is among older adults (60–79 years of age) [34], who are particularly vulnerable to suffer from T2D complications, including physical and cognitive decline [35]. Studies among individuals with T2D suggest that subjective health predicts mortality and provides additional information on mortality risk, independently of demographic, socioeconomic, and clinical risk factors (e.g., glycemic control, BMI, and blood pressure) [36,37]. In addition, better subjective health among T2D patients has been cross-sectionally linked with various factors, including younger age [38], better glycemic control [15], lower BMI [38], as well as less smoking [38], depression [39], and disability [39].

View all citing articles on Scopus
View full text