School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa.
College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
Health Qual Life Outcomes. 2020 Mar 24;18(1):80. doi: 10.1186/s12955-020-01330-2.
Longitudinal quality of life (QoL) is an important outcome in many chronic illness studies aiming to evaluate the efficiency of care both at the patient and health system level. Although many QoL studies involve multiple correlated hierarchical outcome measures, very few of them use multivariate modeling. In this work, we modeled the long-term dynamics of QoL scores accounting for the correlation between the QoL scores in a multilevel multivariate framework and to compare the effects of covariates across the outcomes.
The data is from an ongoing prospective cohort study conducted amongst adult women who were HIV-infected and on the treatment in Kwazulu-Natal, South Africa. Independent and related QoL outcome multivariate multilevel models were presented and compared.
The analysis showed that related outcome multivariate multilevel models fit better for our data used. Our analyses also revealed that higher educational levels, middle age, stable sex partners and higher weights had a significant effect on better improvements in the rate of change of QoL scores of HIV infected patients. Similarly, patients without TB co-infection, without thrombocytopenia, with lower viral load, with higher CD4 cell count levels, with higher electrolytes component score, with higher red blood cell (RBC) component score and with lower liver abnormality component score, were associated with significantly improved the rate of change of QoL, amongst HIV infected patients.
It is hoped that the article will help applied researchers to familiarize themselves with the models and including interpretation of results. Furthermore, three issues are highlighted: model building of multivariate multilevel outcomes, how this model can be used to assess multivariate assumptions, involving fixed effects (for example, to examine the size of the covariate effect varying across QoL domain scores) and random effects (for example, to examine the rate of change in one response variable associated to changes in the other).
在许多旨在评估患者和医疗体系层面护理效率的慢性病研究中，纵向生活质量（QoL）是一个重要的结果。尽管许多 QoL 研究涉及多个相关的分层结果测量，但很少有研究使用多元建模。在这项工作中，我们在多层次多元框架中对 QoL 评分的长期动态进行建模，以考虑 QoL 评分之间的相关性，并在多个结果中比较协变量的影响。
数据来自南非夸祖鲁-纳塔尔省正在进行的一项前瞻性队列研究，涉及接受 HIV 感染和治疗的成年女性。提出并比较了独立和相关的 QoL 结果多元多层次模型。
分析表明，使用相关结果多元多层次模型对我们的数据拟合得更好。我们的分析还表明，较高的教育水平、中年、稳定的性伴侣和较高的体重对改善 HIV 感染患者 QoL 评分变化率有显著影响。同样，没有合并结核感染、没有血小板减少症、病毒载量较低、CD4 细胞计数水平较高、电解质成分评分较高、红细胞（RBC）成分评分较高且肝脏异常成分评分较低的患者，与 HIV 感染患者 QoL 评分变化率显著改善相关。
希望本文能帮助应用研究人员熟悉这些模型，并包括对结果的解释。此外，还强调了三个问题：多元多层次结果的模型构建、如何使用该模型评估多元假设，包括固定效应（例如，检查协变量效应在 QoL 域评分之间的变化大小）和随机效应（例如，检查一个响应变量的变化率与其他响应变量的变化相关联）。
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