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Associations Between Mortality, Asthma, and Health-Related Quality of Life in an Elderly Cohort of Swedes
Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala.ORCID iD: 0000-0002-3944-8633
Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala.
Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala.
Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
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2010 (English)In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 47, no 6, 627-632 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Asthma is a common chronic health condition among the elderly and an important cause of morbidity and mortality. Some studies show that subjective assessments of health-related quality of life (HRQL) are important predictors of mortality and survival. The primary aim of this study was to investigate whether low HRQL was a predictor of mortality in elderly subjects and whether such an association differed between subjects with and without asthma.

METHODS:

In 1990, a cohort in middle Sweden was investigated using a respiratory questionnaire. To assess HRQL, the generic instrument Gothenburg Quality of Life (GQL) was used. The participants were also investigated by spirometry and allergy testing. The present study was limited to the subjects in the oldest age group, aged 60-69 years in 1990, and included 222 subjects with clinically verified asthma, 148 subjects with respiratory symptoms but no asthma or other lung diseases, and 102 subjects with no respiratory symptoms. Mortality in the cohort was followed during 1990-2008.

RESULTS:

Altogether, 166 of the 472 subjects in the original cohort had died during the follow-up period of 1990-2008. Mortality was significantly higher in men, in older subjects, in smokers, and subjects with a low forced expiratory volume in one second (FEV(1)). There was, however, no difference in mortality between the asthmatic and the nonasthmatic groups. A higher symptoms score for GQL was significantly related to increased mortality. No association between HRQL and mortality was found when limiting the analysis to the asthmatic group, although the asthmatics had a lower symptom score for GQL compared to the other groups.

CONCLUSION:

A higher symptom score in the GQL instrument was significantly related to increased mortality, but this association was not found when analyzing the asthmatic group alone. The negative prognostic implications of a low HRQL in the whole group and the fact that the asthmatic group had a lower HRQL than the other group supports the use of HRQL instruments in clinical health assessments.

Place, publisher, year, edition, pages
Informa Healthcare, 2010. Vol. 47, no 6, 627-632 p.
Keyword [en]
asthma, generic instrument, GQL, mortality, quality of life
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:rkh:diva-529DOI: 10.3109/02770901003617402PubMedID: 20626313OAI: oai:DiVA.org:rkh-529DiVA: diva2:607747
Available from: 2013-02-25 Created: 2013-02-25 Last updated: 2017-05-17Bibliographically approved
In thesis
1. Health-related quality of life in asthma
Open this publication in new window or tab >>Health-related quality of life in asthma
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Health-related quality of life (HRQL) has become an important outcome in asthma, since traditional outcomes, such as respiratory symptoms and pulmonary function, might not entirely express the patient’s perception of the limitations caused by the disease. The aim of this thesis was to study HRQL in asthma and to analyse if HRQL was related to asthma onset and prognosis. Other aims were to identify determinants of low HRQL in clinically-verified asthmatics, and to study whether low HRQL was a predictor of mortality.

In 1990, a self-administered questionnaire was completed by 12,560 individuals from three age groups (16, 30-39, and 60-69 years) in two counties of Sweden. In a second phase, all subjects who reported a history of obstructive respiratory symptoms (n = 1,851) and 600 randomly-selected controls were invited to a clinical investigation including spirometry, allergy testing, and assessment of HRQL with the Gothenburg Quality of Life instrument. In 2003, the eligible subjects in the cohort (n=11,282) were sent a new questionnaire. Mortality data in the cohort was followed up during 1990–2008 using data from the National Board of Health and Welfare Mortality Database.

The 616 subjects with clinically-verified asthma 1990 had significantly lower HRQL than subjects without asthma. In the 2003 follow-up, the 305 subjects with persistent asthma had a lower HRQL than the 155 subjects who showed improvement in asthma during the follow-up. Subjects who had developed asthma by the follow-up had a significantly lower HRQL at baseline than those who did not develop asthma. Significant determinants of quality of life in asthma were female sex, smoking habits, higher airway responsiveness to irritants, respiratory symptom severity, positive skin prick test, and absenteeism from work or school. Low HRQL was related to increased mortality, but this association was not found when analyzing the asthmatic group alone.

In conclusion, measurements of HRQL are of value for evaluating both the impact and progression of asthma.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 71 p.
Keyword
asthma, adult, quality of life, cohort studies, longitudinal study, questionnaires, epidemiology, prognosis, Gothenburg quality of life instrument
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-532 (URN)978-91-554-7864-3 (ISBN)
Public defence
2010-10-02, Hörsalen, Akademiska sjukhuset, Dag Hammarskjölds väg 17, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Note

medicine doktorsexamen

Available from: 2014-07-08 Created: 2013-02-25 Last updated: 2017-05-17Bibliographically approved

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