University of Minnesota, Minneapolis, MN 55455, USA.
J Med Econ. 2011;14(5):628-38. doi: 10.3111/13696998.2011.604369. Epub 2011 Sep 1.
The aim of this paper is to consider the relationship between the experience of pain, health related quality of life (HRQoL) and healthcare resource utilization in Spain.
The analysis contrasts the contribution of pain severity and frequency of pain reported against respondents reporting no pain in the previous month. Data are from the 2010 National Health and Wellness Survey (NHWS) for Spain. Single equation generalized linear regression models are used to evaluate the association of pain with the physical and mental component scores of the SF-12 questionnaire as well as health utilities generated from the SF-6D. In addition, the role of pain is assessed in its association with self-reported healthcare provider visits, emergency room visits and hospitalizations in the previous 6 months.
The results indicate that the experience of pain, notably severe and frequent pain, is substantial and is significantly associated with the SF-12 physical component scores, health utilities and all aspects of healthcare resource utilization, which far outweighs the role of demographic and socioeconomic variables, health risk factors (in particular body mass index) and the presence of comorbidities. In the case of severe daily pain, the marginal contribution of the SF-12 physical component score is a deficit of -17.86 compared to those reporting no pain (population average score 46.49), while persons who are morbidly obese report a deficit of only -6.63 compared to those who are normal weight. The corresponding association with health utilities is equally dramatic with a severe daily pain deficit of -0.186 compared to those reporting no pain (average population utility 0.71). The impact of pain on healthcare resource utilization is marked. Severe daily pain increases traditional provider visits by 208.8%, emergency room visits by 373.0% and hospitalizations by 348.5%.
As an internet-based survey there is the possibility of bias towards those with internet access, although telephone sampling is used to supplement responses. Respondents are asked to describe their experience of pain; there is no independent check on the accuracy of responses. Finally, while certain acute pain categories are omitted, the study focuses on pain in the last month and not on pain chronicity.
The societal burden of severe and frequent pain in Spain is substantial. Although not reported on before, at a national level, the deficit impact of the experience of pain far outweighs the contribution of more traditional explanations of HRQoL deficits as well as being the primary factor associated with increased provider visits, emergency room visits and hospitalizations.
本文旨在探讨西班牙疼痛体验、健康相关生活质量（HRQoL）与医疗资源利用之间的关系。
本分析通过对比报告上月无疼痛与报告严重疼痛和频繁疼痛患者的差异，来评估疼痛对 SF-12 问卷身体和精神成分评分以及 SF-6D 生成的健康效用的影响。此外，还评估了疼痛在与过去 6 个月内自我报告的医疗服务提供者就诊、急诊就诊和住院治疗之间的关系中的作用。
结果表明，疼痛体验，特别是严重和频繁的疼痛，程度较高，与 SF-12 身体成分评分、健康效用以及所有医疗资源利用方面显著相关，其影响远大于人口统计学和社会经济学变量、健康风险因素（特别是体重指数）和合并症的作用。在每日严重疼痛的情况下，SF-12 身体成分评分的边际贡献为-17.86，与报告无疼痛的患者相比（人群平均评分 46.49），而病态肥胖患者的得分仅比体重正常患者低-6.63。与健康效用的对应关系同样显著，与报告无疼痛的患者相比，每日严重疼痛的健康效用损失为-0.186（人群平均效用为 0.71）。疼痛对医疗资源利用的影响显著。每日严重疼痛使传统医疗服务就诊增加 208.8%，急诊就诊增加 373.0%，住院治疗增加 348.5%。
由于这是一项基于互联网的调查，因此可能存在偏向于互联网使用者的偏差，尽管使用了电话抽样来补充应答者。受访者被要求描述他们的疼痛体验；对回答的准确性没有独立的检查。最后，虽然某些急性疼痛类别被排除在外，但该研究主要关注过去一个月的疼痛，而不是疼痛的慢性程度。
西班牙严重和频繁疼痛的社会负担很大。尽管以前没有在全国范围内报告过，但疼痛体验的影响远远超过了对 HRQoL 缺陷的更传统解释的贡献，并且是与医疗服务提供者就诊、急诊就诊和住院治疗增加相关的主要因素。
