*Health Outcomes and Behavior, Moffitt Cancer Center and University of South Florida, Tampa, FL †Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC ‡Medical Social Sciences, Northwestern University, Chicago, IL §Health Services, University of California, Los Angeles and RAND, Santa Monica, CA ∥Pharmacy Practice, University of Illinois, Chicago, IL ¶Outcomes Research, Bethesda, MD.
Med Care. 2014 Apr;52(4):307-13. doi: 10.1097/MLR.0000000000000066.
The United States has a culturally and demographically diverse populace, and the aim of this study was to examine differences in health preferences by sex, age, ethnicity, and race.
We assessed preferences for health outcomes defined by the PROMIS-29 survey in a sample of the US population. On the basis of the survey's 540 paired-comparisons trading off lifespan and 7 domains of health-related quality of life (HRQoL), we compared the choices between men and women, adults age 18-54 years and 55 years and older, Hispanics and non-Hispanics, and non-Hispanic blacks and whites. For each subgroup, we estimated the value of 122 HRQoL outcomes on a quality-adjusted life year scale and tested for subgroup differences.
Compared with men, women preferred reduced lifespan over losses in HRQoL, particularly for depression. Compared with the younger adults, older adults preferred reduced lifespan over the symptoms of depression, anxiety, and fatigue. Compared with non-Hispanic whites, Hispanics preferred reduced lifespan over depression and sleep disturbance, but held similar values on losses in physical functioning. Among non-Hispanics, blacks preferred reduced lifespan over losses in ability to climb stairs and to fall asleep compared with whites, but held similar values on mental health outcomes.
With the growing emphasis on patient-centeredness and culturally sensitive treatment, it is important to recognize the diversity in values placed on potential losses in HRQoL, particularly mental health outcomes. Demographic differences in preferences may influence comparative or cost effectiveness of treatments as perceived by one or another subgroup.
美国拥有文化和人口结构多样化的人群，本研究旨在研究不同性别、年龄、族裔和种族的健康偏好差异。
我们评估了美国人群样本中由 PROMIS-29 调查定义的健康结果偏好。基于调查的 540 对权衡寿命和 7 个与健康相关的生活质量 (HRQoL) 领域的比较，我们比较了男性和女性、18-54 岁和 55 岁及以上的成年人、西班牙裔和非西班牙裔以及非西班牙裔黑人和白人之间的选择。对于每个亚组，我们根据质量调整生命年尺度估计了 122 个 HRQoL 结果的价值，并测试了亚组差异。
与男性相比，女性更喜欢减少寿命而不是减少 HRQoL，特别是在抑郁方面。与年轻成年人相比，老年成年人更喜欢减少寿命而不是抑郁、焦虑和疲劳症状。与非西班牙裔白人相比，西班牙裔更喜欢减少寿命而不是抑郁和睡眠障碍，但在身体功能丧失方面的价值相似。在非西班牙裔人群中，与白人相比，黑人更喜欢减少寿命而不是失去爬楼梯和入睡的能力，但在心理健康结果方面的价值相似。
随着对以患者为中心和文化敏感治疗的日益重视，认识到对潜在 HRQoL 丧失的价值的多样性（特别是心理健康结果）非常重要。偏好的人口统计学差异可能会影响一个或另一个亚组对治疗的比较或成本效益。
