Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands; London School of Economics and Political Science, Department of Health Policy, LSE Health, London, United Kingdom.
Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands.
Soc Sci Med. 2023 Jul;328:115996. doi: 10.1016/j.socscimed.2023.115996. Epub 2023 May 25.
Experiencing deteriorating health has implications for your quality of life. The theory of adaptation suggests that with time spend living in a health state individuals can adapt, resulting in observed quality of life levels to revert or stagnate despite persistently decreased health. Adaptation has implications for the use of subjective quality of life indicators when quantifying the impact of health changes or the benefits from new medical technologies. As both the impact from ill health and the benefit from new interventions might be disease- or subgroup-specific adaptation further raises ethical concerns but empirical evidence on its existence, magnitude, and heterogeneity remains inconclusive. This paper uses a general population sample of 9,543 individuals that participate in the UK Understanding Society survey and experience the onset of a long-standing illness or disability to provide evidence on these questions. Using ordered-response fixed effects models we explore longitudinal changes in self-assessed health and life satisfaction around the onset of disability. Our results indicate that disability onset is associated with large decreases in subjective health and well-being. Over time this initial decrease in subjective quality of life indicators attenuates, especially in life satisfaction and to a lesser extent for self-assessed health. While the relative difference in adaptation across these two measures remains persistent, we find that across demographic and severity groups the initial impact of disability onset and adaptation differs considerably in its magnitude. These results have important implications for studies aiming to quantify the impact of health conditions on quality of life outcomes, especially when using observational datasets.
健康状况恶化会影响你的生活质量。适应理论表明，随着时间的推移，人们在某种健康状态下生活，会逐渐适应，从而导致观察到的生活质量水平保持不变或停滞不前，尽管健康状况持续下降。适应会影响到使用主观生活质量指标来量化健康变化的影响或新医疗技术带来的益处。由于健康状况不佳的影响和新干预措施的益处可能是特定于疾病或亚组的，因此进一步引发了伦理问题，但关于其存在、程度和异质性的实证证据仍然没有定论。本文使用了一个由 9543 名参与英国“理解社会”调查的普通人群样本，这些人经历了长期疾病或残疾的发作，为这些问题提供了证据。我们使用有序响应固定效应模型来探讨残疾发作前后自我评估健康和生活满意度的纵向变化。我们的结果表明，残疾发作与主观健康和幸福感的大幅下降有关。随着时间的推移，主观生活质量指标的这种初始下降会减弱，特别是在生活满意度方面，而在自我评估健康方面则稍弱。虽然这两个衡量标准的适应程度的相对差异仍然存在，但我们发现，在人口统计学和严重程度方面，残疾发作和适应的初始影响在程度上有很大的不同。这些结果对旨在量化健康状况对生活质量结果影响的研究具有重要意义，特别是在使用观察性数据集时。
