Prior James A, Jordan Kelvin P, Kadam Umesh T
Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
Health Services Research Unit, Keele University, Keele, UK.
Health Qual Life Outcomes. 2015 May 30;13:71. doi: 10.1186/s12955-015-0265-x.
Population-based assessments of physical health are important to evaluate healthcare resource allocation. Normative data on the level of physical impairments attributable to specific diseases and severity levels within these diseases is critical to interpreting such data. Our objective, by means of a systematic review and meta-analysis, was to test the hypothesis that specific diseases which form cardiovascular and musculoskeletal disease spectra are associated with gradients of physical impairments. We examined a cardiovascular disease spectrum which consisted of hypertension, ischaemic heart disease and heart failure, and a musculoskeletal disease spectrum of lower back pain, osteoarthritis and rheumatoid arthritis. Using Medline, EMBASE and CINAHL databases, articles which had examined these morbidities and used either the SF-12 or SF-36 in general or primary care populations were selected; data was extracted independently by three reviewers. Study characteristics were described and the mean physical component summary scores of the SF-12 or SF-36 was analysed by disease, using random-effects meta-analysis. The association between disease and physical health (mean physical component summary scores) was assessed using multilevel meta-regression analysis, adjusting for age, health setting, country, disease definition and SF-12 or 36 format. From this search, 26 articles were identified, yielding 70 separate estimates of mean physical component summary scores across the morbidities from 14 different countries. For the selected conditions, pooled unadjusted mean physical component summary scores were: 44.4 for hypertension, 38.9 for ischaemic heart disease, 35.9 for heart failure, 39.5 for lower back pain, 36.0 for osteoarthritis and 36.5 for rheumatoid arthritis. The adjusted meta-regression showed mean physical component summary score difference for ischaemic heart disease of -4.6 (95 % confidence interval -6.0 to -3.2) and heart failure -7.5 (-9.1 to -5.9) compared to the hypertension category. For osteoarthritis -4.2 (-5.3 to -3.0) and rheumatoid arthritis -3.9 (-9.5 to 1.6) compared to the lower back pain category. Our findings provide the benchmark norms for the differences in physical health within and between disease spectra. Improved characterisation of the relative impact of individual conditions on physical health will facilitate public health assessments of chronic diseases as well as assessments of interventions using functional patient-reported outcomes.
基于人群的身体健康评估对于评估医疗资源分配很重要。关于特定疾病所致身体损伤水平以及这些疾病严重程度的标准数据对于解读此类数据至关重要。我们的目标是通过系统评价和荟萃分析来检验这样一个假设，即构成心血管和肌肉骨骼疾病谱的特定疾病与身体损伤梯度相关。我们研究了一个心血管疾病谱，包括高血压、缺血性心脏病和心力衰竭，以及一个肌肉骨骼疾病谱，包括下背痛、骨关节炎和类风湿关节炎。利用Medline、EMBASE和CINAHL数据库，选择了那些在普通人群或初级保健人群中研究过这些疾病并使用了SF - 12或SF - 36的文章；数据由三位审阅者独立提取。描述了研究特征，并使用随机效应荟萃分析按疾病分析了SF - 12或SF - 36的平均身体成分汇总得分。使用多水平荟萃回归分析评估疾病与身体健康（平均身体成分汇总得分）之间的关联，并对年龄、健康环境、国家、疾病定义以及SF - 12或36格式进行了调整。通过此次检索，确定了26篇文章，得出了来自14个不同国家的70个关于各疾病平均身体成分汇总得分的单独估计值。对于所选疾病，汇总的未调整平均身体成分汇总得分分别为：高血压44.4、缺血性心脏病38.9、心力衰竭35.9、下背痛39.5、骨关节炎36.0、类风湿关节炎36.5。经调整的荟萃回归显示，与高血压类别相比，缺血性心脏病的平均身体成分汇总得分差异为 - 4.6（95%置信区间 - 6.0至 - 3.2），心力衰竭为 - 7.5（- 9.1至 - 5.9）。与下背痛类别相比，骨关节炎为 - 4.2（- 5.3至 - 3.0），类风湿关节炎为 - 3.9（- 9.5至1.6）。我们的研究结果为疾病谱内和疾病谱之间身体健康差异提供了基准规范。更好地描述个体疾病对身体健康的相对影响将有助于对慢性病进行公共卫生评估，以及使用患者报告的功能结局对干预措施进行评估。
