Center for Health Decision Science, Harvard School of Public Health, Boston, MA (EW)
Heller School for Social Policy and Management, Brandeis University, Waltham, MA(GAR)
Med Decis Making. 2013 Feb;33(2):235-43. doi: 10.1177/0272989X12464434. Epub 2012 Oct 25.
BACKGROUND/OBJECTIVES: The effects of illness extend beyond the individual to caregivers and family members. This study identified evidence of spillover of illness onto household members' health-related quality of life.
Medical Expenditures Panel Survey (MEPS) data from 2000-2003 were analyzed using multivariable regression to identify spillover of household members' chronic conditions onto individuals' health-related quality of life as measured by the EuroQol-5D (EQ-5D) score (N = 24,188). Spillover was assessed by disease category, timing of occurrence (preexisting or new conditions), and age of the household member (adult or child).
Controlling for an individual's own health conditions and other known predictors of EQ-5D scores, the authors found that the odds of an individual reporting full health (an EQ-5D score of 1.0, relative to <1.0) were lower with the presence of existing mental (odds ratio 0.71; 95% confidence interval, 0.64-0.79), respiratory (0.85; 0.75-0.97), and musculoskeletal (0.83; 0.75-0.93) conditions among adults and with mental (0.72; 0.62-0.82) and respiratory (0.80; 0.81-0.96) conditions among children in the household. The odds of an individual reporting full health were also lower for newly occurring chronic conditions in the household, including adults' mental (0.79; 0.65-0.97), nervous/sensory system (0.76; 0.61-0.96), and musculoskeletal (0.78; 0.65-0.95) conditions and children's mental conditions (0.64; 0.48-0.86). EQ-5D dimensions may be unsuited to fully capture spillover utility among household members, and MEPS lacks condition severity and caregiver status among household members.
Evidence from a US sample suggests that individuals who live with chronically ill household members have lower EQ-5D scores than those who live either alone or with healthy household members. Averting spillover effects may confer substantial additional benefit at the population level for interventions that prevent or alleviate conditions that incur such effects.
背景/目的：疾病的影响不仅限于个人，还会波及照顾者和家庭成员。本研究旨在确定疾病对家庭成员健康相关生活质量产生溢出效应的证据。
利用 2000-2003 年医疗支出面板调查（MEPS）数据，采用多变量回归分析方法，确定家庭成员的慢性疾病是否会对个体的健康相关生活质量（通过 EuroQol-5D [EQ-5D] 评分衡量）产生溢出效应（N=24188）。通过疾病类别、发生时间（预先存在的或新出现的疾病）以及家庭成员的年龄（成人或儿童）来评估溢出效应。
在控制个体自身健康状况和其他已知 EQ-5D 评分预测因素的情况下，作者发现，与存在以下状况的个体相比，报告完全健康（EQ-5D 评分为 1.0，相对评分<1.0）的个体比例较低：存在成人的现有心理健康（比值比 0.71；95%置信区间，0.64-0.79）、呼吸（0.85；0.75-0.97）和肌肉骨骼（0.83；0.75-0.93）疾病，以及儿童的心理健康（0.72；0.62-0.82）和呼吸（0.80；0.81-0.96）疾病。对于新出现的家庭慢性疾病，个体报告完全健康的可能性也较低，包括成人的心理健康（0.79；0.65-0.97）、神经/感觉系统（0.76；0.61-0.96）和肌肉骨骼（0.78；0.65-0.95）疾病，以及儿童的心理健康状况（0.64；0.48-0.86）。EQ-5D 维度可能无法充分捕捉家庭成员之间的溢出效用，而 MEPS 缺乏家庭成员的疾病严重程度和照顾者状况。
来自美国样本的证据表明，与独居或与健康家庭成员生活的个体相比，与患有慢性疾病的家庭成员生活的个体的 EQ-5D 评分较低。对于预防或减轻可能产生此类影响的疾病的干预措施，避免溢出效应可能会在人群层面带来实质性的额外收益。
