Maxwell Colleen J, Kang Jian, Walker Jennifer D, Zhang Jenny X, Hogan David B, Feeny David H, Wodchis Walter P
Department of Community Health Sciences and Centre for Health & Policy Studies, University of Calgary, Calgary, Alberta, Canada.
Health Qual Life Outcomes. 2009 Sep 2;7:80. doi: 10.1186/1477-7525-7-80.
The heterogeneity evident among home care clients highlights the need for greater understanding of the clinical and social determinants of multi-dimensional health-related quality of life (HRQL) indices and of potential sex-differences in these determinants. We examined the relative contribution of social and clinical factors to HRQL among older home care clients and explored whether any of the observed associations varied by sex.
The Canadian-US sample included 514 clients. Self-reported HRQL was measured during in-home interviews (2002-04) using the Health Utilities Index Mark 2 (HUI2). Data on clients' sociodemographic, health and clinical characteristics were obtained with the Minimum Data Set for Home Care. The relative associations between clients' characteristics and HUI2 scores were examined using multivariable linear regression models.
Women had a significantly lower mean HUI2 score than men (0.48, 95%CI 0.46-0.50 vs. 0.52, 0.49-0.55). Clients with distressed caregivers and poor self-rated health exhibited significantly lower HRQL scores after adjustment for a comprehensive list of clinical conditions. Several other factors remained statistically significant (arthritis, psychiatric illness, bladder incontinence, urinary tract infection) or clinically important (reported loneliness, congestive heart failure, pressure ulcers) correlates of lower HUI2 scores in adjusted analyses. These associations generally did not vary significantly by sex.
For females and males, HRQL scores were negatively associated with conditions predictive or indicative of disability and with markers of psychosocial stress. Despite sex differences in the prevalence of social and clinical factors likely to affect HRQL, few varied significantly by sex in their relative impact on HUI2 scores. Further exploration of differences in the relative importance of clinical and psychosocial well-being (e.g., loneliness) to HRQL among female and male clients may help guide the development of sex-specific strategies for risk screening and care management.
家庭护理客户中明显存在的异质性凸显了更深入了解多维健康相关生活质量（HRQL）指标的临床和社会决定因素以及这些决定因素中潜在性别差异的必要性。我们研究了社会和临床因素对老年家庭护理客户HRQL的相对贡献，并探讨了所观察到的任何关联是否因性别而异。
加拿大-美国样本包括514名客户。在家庭访谈（2002 - 2004年）期间，使用健康效用指数Mark 2（HUI2）测量自我报告的HRQL。通过家庭护理最小数据集获取客户的社会人口统计学、健康和临床特征数据。使用多变量线性回归模型检查客户特征与HUI2分数之间的相对关联。
女性的平均HUI2分数显著低于男性（0.48，95%CI 0.46 - 0.50对比0.52，0.49 - 0.55）。在对一系列综合临床状况进行调整后，照顾者苦恼且自我健康评分差的客户表现出显著更低的HRQL分数。在调整分析中，其他几个因素仍然是HUI2分数较低的统计学显著（关节炎、精神疾病、膀胱失禁、尿路感染）或临床重要（报告的孤独感、充血性心力衰竭、压疮）相关因素。这些关联通常在性别上没有显著差异。
对于女性和男性，HRQL分数与预测或表明残疾的状况以及心理社会压力指标呈负相关。尽管在可能影响HRQL的社会和临床因素患病率方面存在性别差异，但它们对HUI2分数的相对影响在性别上很少有显著差异。进一步探索临床和心理社会幸福感（如孤独感）对女性和男性客户HRQL相对重要性的差异，可能有助于指导制定针对性别的风险筛查和护理管理策略。
