Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Dept of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
PLoS One. 2018 Aug 23;13(8):e0202624. doi: 10.1371/journal.pone.0202624. eCollection 2018.
The aim was to evaluate the impact of asthma on patients' Health-Related Quality of Life (HRQoL) by comparing asthmatic women and men with reference norms, to examine the factors which contributed to an impaired HRQoL, and to identify groups at higher risk.
Cross-sectional evaluation of 222 primary care patients with persistent asthma (18-40 years old). HRQoL impact was estimated with the EuroQol-5 Dimensions (EQ-5D), which allows calculating Quality-Adjusted Life-Years (QALYs) by applying society preferences. Participants self-completed the EQ-5D questionnaire online. Telephonic interviews collected information on medication and adherence, and administered the Asthma Control Questionnaire. Severity markers included asthma-related comorbidity, previous oral corticosteroids course prescription, and inhaled corticosteroids daily dose. After bivariate analyses, multiple linear regression models were constructed to examine the relations between HRQoL asthma impact and socio-demographic and clinical variables, using as dependent variable the deviation from general population-based EQ-5D reference norms.
Deviation from the EQ-5D index norms was moderate in most age/gender groups (-0.1, which corresponds to 0.6 standard deviations), while it was large in women aged 18-24 years (-0.18, corresponding to 1.1 standard deviations). In regression models, a poor asthma control was the only factor independently associated to HRQoL impact in both women and men: β -0.18 (p<0.001) and -0.15 (p = 0.01) respectively. Translating these β coefficients to QALYs, they are interpretable as 66 fewer days of full health per year in women with uncontrolled asthma and 55 for men, compared with those with controlled asthma.
Persistent asthma has a moderately negative HRQoL impact on patients of both genders, and the youngest women have been identified as a high risk group which merits further research. We identified asthma control as the major contributor to impaired HRQoL in patients, regardless of their gender, suggesting that asthma HRQoL impact could be alleviated by achieving a good control of symptoms.
本研究旨在通过与参考标准比较，评估哮喘对女性和男性患者健康相关生活质量（HRQoL）的影响，探讨导致 HRQoL 受损的因素，并确定高危人群。
对 222 名年龄在 18-40 岁的持续性哮喘初级保健患者进行横断面评估。使用欧洲五维健康量表（EQ-5D）评估 HRQoL 影响，该量表通过应用社会偏好来计算质量调整生命年（QALYs）。参与者在线自我完成 EQ-5D 问卷。电话访谈收集药物和依从性信息，并进行哮喘控制问卷评估。严重程度标志物包括哮喘相关合并症、既往口服皮质类固醇疗程处方和每日吸入皮质类固醇剂量。进行双变量分析后，使用多元线性回归模型，根据依赖变量与一般人群 EQ-5D 参考标准的偏差，研究 HRQoL 哮喘影响与社会人口统计学和临床变量之间的关系。
在大多数年龄/性别组中，与 EQ-5D 指数标准的偏差处于中等水平（-0.1，对应 0.6 个标准差），而在 18-24 岁的女性中，偏差较大（-0.18，对应 1.1 个标准差）。在回归模型中，哮喘控制不良是女性和男性 HRQoL 影响的唯一独立相关因素：β分别为-0.18（p<0.001）和-0.15（p=0.01）。将这些β系数转换为 QALYs，可解释为患有未控制哮喘的女性每年有 66 天的完全健康天数减少，而男性则减少 55 天，与控制良好的哮喘患者相比。
持续性哮喘对两性患者的 HRQoL 均有中度负面影响，年龄最小的女性被确定为一个高危群体，需要进一步研究。我们发现，无论性别如何，哮喘控制是导致患者 HRQoL 受损的主要因素，这表明通过实现症状的良好控制，哮喘 HRQoL 影响可以得到缓解。
