Associations Between Health-Related Quality of Life and Mortality in Older Adults
This study measures the use and relative importance of different measures of health-related quality of life (HRQOL) as predictors of mortality in a large sample of older US adults. We used Cox proportional hazards models to analyze the association between general self-reported health and three “healthy days” (HDs) measures of HRQOL and mortality at short-term (90-day) and long-term (2.5 years) follow-up. The data were from Cohorts 6 through 8 of the Medicare Health Outcomes Survey, a national sample of older adults who completed baseline surveys in 2003–2005. At the long term, reduced HRQOL in general health and all categories of the HDs were separately and significantly associated with greater mortality (P < 0.001). In multivariate analysis of long-term mortality, at least one HD category remained significant for each measure, but the associations between mental health and mortality were inconsistent. For short-term mortality, the physical health measures had larger hazard ratios, but fewer categories were significant. Hazard ratios decreased over time for all measures of HRQOL except mental health. In conclusion, HRQOL measures were shown to be significant predictors of short- and long-term mortality, further supporting their value in health surveillance and as markers of risk for targeted prevention efforts. Although all four measures of HRQOL significantly predicted mortality, general self-rated health and age were more important predictors than the HDs.
KeywordsMortality Survival analysis Quality of life Medicare
- Bowling, A. (1991). Measuring health: A review of quality of life measurement scales. Bristol, PA: Open University Press.Google Scholar
- CDC (Centers for Disease Control and Prevention). (2000). Measuring healthy days. Atlanta, GA: CDC.Google Scholar
- Corti, M.-C., Guralnik, J. M., Ferrucci, L., Izmirlian, G., Leveille, S. G., Pahor, M., et al. (1999). Evidence for a black-white crossover in all-cause and coronary heart disease mortality in an older population: The North Carolina EPESE. American Journal of Public Health, 89, 308–314.PubMedCentralCrossRefPubMedGoogle Scholar
- Cox, D. R. (1972). Regression models and life-tables. Journal of the Royal Statistical Society, Series B, 34, 187–220.Google Scholar
- Ellis, B. H., Bannister, W. M., Cox, J. K., Fowler, B. M., Shannon, E. D., Drachman, D., et al. (2003). Utilization of the propensity score method: An exploratory comparison of proxy-completed to self-reported responses in the Medicare Health Outcomes Survey. Health and Quality of Life Outcomes, 1, 47. doi: 10.1186/1477-7525-1-47.PubMedCentralCrossRefPubMedGoogle Scholar
- Gold, M., Phelps, D., Jacobson, G., & Neuman, T. (2010). Medicare Advantage 2010 data spotlight. Plan enrollment patterns and trends. Kaiser Family Foundation Medicare Policy Project, publication 8080. Retrieved from http://www.kff.org/medicare/upload/8080.pdf.
- Korten, A. E., Jorm, A. F., Jiao, Z., Letenneur, L., Jacomb, P. A., Henderson, A. S., et al. (1999). Health, cognitive, and psychosocial factors as predictors of mortality in an elderly community sample. Journal of Epidemiology and Community Health, 53, 83–88.PubMedCentralCrossRefPubMedGoogle Scholar
- Moriarty, D.G., Kobau, R., Zack, M.M., & Zahran, H.S. (2005). Tracking Healthy Days—A window on the health of older adults. Preventing Chronic Disease, 2, 1–8. Retrieved from http://www.cdc.gov/pcd/issues/2005/jul/05_0023.htm.
- Moriarty, D. G., Zack, M. M., & Kobau, R. (2003). The Centers for Disease Control and Prevention’s Healthy Days measures—Population tracking of perceived physical and mental health over time. Health and Quality of Life Outcomes, 1, 37. doi: 10.1186/1477-7525-1-37.PubMedCentralCrossRefPubMedGoogle Scholar
- Sargent-Cox, K. A., Anstey, K. J., & Luszcz, M. A. (2010). The choice of self-rated health measures matter when predicting mortality: Evidence from 10 years follow-up of the Australian longitudinal study of ageing. BMC Geriatrics, 10, 18. doi: 10.1186/1471-2318-10-18.PubMedCentralCrossRefPubMedGoogle Scholar
- Spilker, B. (Ed.). (1995). Quality of life and pharmacoeconomics in clinical trials (2nd ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins.Google Scholar