Socioeconomic and Medical Characteristics Associated with Health-Related Quality of Life in North Carolina's Adults with Diabetes Mellitus
Creators: name: Wubben, Deborah Patrick, MD
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2003

description: Background: In addition to the substantial mortality, medical morbidity, and disability among people in North Carolina and the US with diabetes mellitus, poor health-related quality of life is increasingly being documented among people with diabetes. As we consider interventions to improve health-related quality of life among people with diabetes, information about which subgroups have a poor quality of life may help target our resources and interventions more effectively. Objective: To determine which groups of people with diabetes in North Carolina have lower healthrelated quality of life. Methods: A Centers for Disease Control and Prevention (CDC) collaboration resulted in the creation ofthe Healthy Days measures, a set of four questions to assess general wellbeing that have been included in the core questions of the Behavior Risk Factor Surveillance System (BRFSS) in every state since 1993. The BRFSS, sponsored by the CDC, is a state-based, random-digit dialed telephone survey of civilian, noninstitutionalized adults 2: 18 years old. We used the North Carolina BRFSS from 1998- 2001 to explore associations between HRQOL and sociodemographic and medical characteristics among adults with diabetes using the Healthy Days questions as outcomes. We hypothesized that age, sex, race, income, education, employment, insurance status, obesity, duration of diabetes, and insulin use would be associated with health-related quality of life among people with diabetes. We dichotomized the non-linear outcomes of physically unhealthy days, mentally unhealthy days, and functionally limited days into seven days or less and more than seven days since one week of unhealthy days is a clinically and socially significant outcome. Statistical Analyses: All analyses were conducted using Stata version 7.0. Descriptive analyses were conducted using tests of proportions and means with standard deviations. Relationships between sociodemographic and medical characteristics with the dichotomized Healthy Days measures were done using Pearson's Chi-square. Results were considered statistically significant if the p-value was less than 0.05. Results: The majority of adults with diabetes in North Carolina were female, younger than 65 years, White, had a household income of greater than $20,000 per year, had a college education or greater, were not employed, had insurance, did not use insulin, were diagnosed less than 10 years ago, and were not disabled. An equal number of adults in North Carolina with diabetes rated their health as excellent, very good, or good (49%) compared to fair or poor (51%). The overall mean for physically unhealthy days was 9.3 per month, for mentally unhealthy days was 4.5 per month, and for functionally limited days was 5.7 per month. People with diabetes in North Carolina were more likely to have a poor quality oflife on all or most of the Healthy Days measures ifthey had a high school education or less, lower household income, were unemployed, had no health insurance, had a longer duration of diabetes, and were using insulin. Race was the only sociodemographic characteristic with no relation to quality of life. Female sex was only related to more mentally unhealthy days. Younger age was associated with more mentally unhealthy days and older age was associated with a lower general health rating. Obesity was only associated with more functionally limited days, not the total number of mentally or physically unhealthy days. Conclusions: In this study of health-related quality oflife among persons with diabetes in North Carolina, the greatest differences were between socioeconomic groups, with those of lower socioeconomic status having lower HRQOL. In addition, markers of more severe diabetes, including longer duration and use of insulin, are associated with a worse overall health-related quality oflife. The significant degree of difference in the Healthy Days measures between various subgroups of people with diabetes based on the sociodemographic and medical characteristics we studied suggests that medical interventions could help reduce health disparities if targeted accordingly. The continual nature of the BRFSS will allow the NC DCP to track HRQOL over time and compare the results to other subgroups of the population. As the North Carolina Diabetes Control Program participates in efforts to increase the number of healthy years among people with diabetes, following the differences in HRQOL among subgroups will help direct resources and monitor the effectiveness of interventions.