BMC Public Health 2006, 6:268 http://www.biomedcentral.com/1471-2458/6/268 Table 4: Differences in domain scores associated with determinants of HRQOL (negative numbers mean reduction of HRQOL, positive numbers an improvement in comparison to the references group, adjusted for all other variables in the table, presented is mean difference and its 95% confidence interval, all included interactions were significant at the level of p < 0.05 in multivariate evaluation) Physical health Psychological Social relationships Environment Effect modification by diabetes Diabetes patients Male Female Controls Male Female Diabetes patients Age below 50 50 or more Controls Age below 50 50 or more Diabetes patients 5 or less depending persons 6 or more Controls 5 or less depending persons 6 or more Other variables Younger refugees (age below 50) Income below 200 Income above 200 Older refugees (age of 50 or more) Income below 200 Income above 200 Younger refugees (age below 50) 5 or less depending persons 6 or more Older refugees (age of 50 or more) 5 or less depending persons 6 or more Marital status Other Married -36.1 (-47.0; -25.3) -45.2 (-53.4; -37.0) -0.5 (-5.7; 4.7) Reference -26.4 (-37.2; -15.6) -45.2 (-53.4; -37.0) -2.2 (-9.5; 5.1) Reference -53.8 (-64.8; -42.8) -45.2 (-53.4; -37.0) 4.8 (-1.5; 11.1) Reference -21.5 (-30.2; -12.8) -2.2 (-9.5; 5.1) -10.4 (-15.3; -5.5) Reference 9.7 (-0.5; 19.9) -2.2 (-9.5; 5.1) 4.8 (-1.5; 11.1) Reference -4.0 (-8.8; 0.8) Reference -31.8 (-42.7; -20.9) -45.4 (-53.7; -37.2) -2.0 (-7.2; 3.2) Reference -24.9 (-35.8; -14.1) -45.4 (-53.7; -37.2) -3.5 (-10.9; 3.8) Reference -51.4 (-62.4; -40.3) -45.4 (-53.7; -37.2) 6.7 (0.4; 13.0) Reference -23.4 (-32.1; -14.7) -3.5 (-10.9; 3.8) -8.9 (-13.8; -4.0) Reference 4.8 (-5.5; 15.0) -3.5 (-10.9; 3.8) 6.7 (0.4; 13.0) Reference -6.4 (-11.2; -1.7) Reference -14.2 (-24.9; -3.5) -19.5 (-27.6; -11.5) -1.6 (-12.7; -3.4) Reference -8.7 (-19.4; 1.9) -19.5 (-27.6; -11.5) -5.3 (-12.5; 1.9) Reference -28.9 (-39.7; -18.1) -19.5 (-27.6; -11.5) 4.0 (-2.2; 10.2) Reference -15.7 (-24.3; -7.2) -5.3 (-12.5; 1.9) -5.5 (-10.3; -0.7) Reference 7.7 (-2.3; 17.7) -5.3 (-12.5; 1.9) 4.0 (-2.2; 10.2) Reference -8.0 (-12.7; -3.4) Reference -1.7 (-11.3; 7.9) -12.3 (-19.6; -5.1) -1.4 (-6.0; 3.2) Reference -6.8 (-16.4; 2.7) -12.3 (-19.6; -5.1) 3.1 (-3.3; 9.6) Reference -23.3 (-33.1; -13.6) -12.3 (-19.6; -5.1) 11.7 (6.1; 17.2) Reference -16.1 (-23.7; -8.4) 3.1 (-3.3; 9.6) -9.2 (-13.5; -4.9) Reference 7.0 (-2.0; 16.0) 3.1 (-3.3; 9.6) 11.7 (6.1; 17.2) Reference -2.9 (-7.1; 1.3) Reference lation. The most striking difference between diabetic patients and controls was their level of education. The most likely explanation is that this reflects the lower will- ingness of controls with lower education to participate in the study. However, the number of eligible controls who refused participation was not appropriately recorded to provide evidence for this assumption. Given the practical limitations, the sampling technique for controls appeared most appropriate and was successfully implemented in other studies [24]. In a Danish validation study of the WHOQOL-BREF the mean scores were considerably higher for all the domains in diabetic patients (between 70 and 76 points) as com- pared to our sample (23 to 52), but only slightly higher for controls (74 to 89 versus 70 to 76) with the exception of the environment domain, where the score in our sam- ple was much lower (80 vs. 36) [23]. In the Iranian study the scores for the diabetic patients were lower than in the Danish study (55 to 65) but still considerably higher than in our sample [13]. Still the largest difference between our data and other studies was for the environment domain. Conclusion Diabetic patients living in the Gaza strip camps have a poor HRQOL compared to non-diabetic controls living under the same conditions and diabetic patients surveyed in other studies. Higher age further reduces the HRQOL in diabetic patients without having an impact on controls. Diabetes has a greater impact on the HRQOL of females than on the HRQOL of males. Under the living conditions encountered in this study, poverty strongly reduced HRQOL, especially in younger participants and this effect did not differ for diabetic patients and controls. Page 6 of 7 (page number not for citation purposes)