Dataset Information

Health Condition Impacts in a Nationally Representative Cross-Sectional Survey Vary Substantially by Preference-Based Health Index.

ABSTRACT: Many cost-utility analyses rely on generic utility measures for estimates of disease impact. Commonly used generic preference-based indexes may generate different absolute estimates of disease burden despite sharing anchors of dead at 0 and full health at 1.0.We compare the impact of 16 prevalent chronic health conditions using 6 utility-based indexes of health and a visual analog scale.Data were from the National Health Measurement Study (NHMS), a cross-sectional telephone survey of 3844 adults aged 35 to 89 years in the United States.The NHMS included the EuroQol-5D-3L, Health and Activities Limitation Index (HALex), Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3), preference-based scoring for the SF-36v2 (SF-6D), Quality of Well-Being Scale, and visual analog scale. Respondents self-reported 16 chronic conditions. Survey-weighted regression analyses for each index with all health conditions, age, and sex were used to estimate health condition impact estimates in terms of quality-adjusted life years (QALYs) lost over 10 years. All analyses were stratified by ages 35 to 69 and 70 to 89 years.There were significant differences between the indexes for estimates of the absolute impact of most conditions. On average, condition impacts were the smallest with the SF-6D and EQ-5D-3L and the largest with the HALex and HUI3. Likewise, the estimated loss of QALYs varied across indexes. Condition impact estimates for EQ-5D-3L, HUI2, HUI3, and SF-6D generally had strong Spearman correlations across conditions (i.e., >0.69).This analysis uses cross-sectional data and lacks health condition severity information.Health condition impact estimates vary substantially across the indexes. These results imply that it is difficult to standardize results across cost-utility analyses that use different utility measures.

SUBMITTER: Hanmer J

PROVIDER: S-EPMC4856155 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Health Condition Impacts in a Nationally Representative Cross-Sectional Survey Vary Substantially by Preference-Based Health Index.

Hanmer Janel J Cherepanov Dasha D Palta Mari M Kaplan Robert M RM Feeny David D Fryback Dennis G DG

Medical decision making : an international journal of the Society for Medical Decision Making 20150827 2

<h4>Importance</h4>Many cost-utility analyses rely on generic utility measures for estimates of disease impact. Commonly used generic preference-based indexes may generate different absolute estimates of disease burden despite sharing anchors of dead at 0 and full health at 1.0.<h4>Objective</h4>We compare the impact of 16 prevalent chronic health conditions using 6 utility-based indexes of health and a visual analog scale.<h4>Design</h4>Data were from the National Health Measurement Study (NHMS ...[more]

PMID: 26314728

Similar Datasets

Project description:BackgroundWHO estimates that about 170,000 deaths by suicide occur in India every year, but few epidemiological studies of suicide have been done in the country. We aimed to quantify suicide mortality in India in 2010.MethodsThe Registrar General of India implemented a nationally representative mortality survey to determine the cause of deaths occurring between 2001 and 2003 in 1·1 million homes in 6671 small areas chosen randomly from all parts of India. As part of this survey, fieldworkers obtained information about cause of death and risk factors for suicide from close associates or relatives of the deceased individual. Two of 140 trained physicians were randomly allocated (stratified only by their ability to read the local language in which each survey was done) to independently and anonymously assign a cause to each death on the basis of electronic field reports. We then applied the age-specific and sex-specific proportion of suicide deaths in this survey to the 2010 UN estimates of absolute numbers of deaths in India to estimate the number of suicide deaths in India in 2010.FindingsAbout 3% of the surveyed deaths (2684 of 95,335) in individuals aged 15 years or older were due to suicide, corresponding to about 187,000 suicide deaths in India in 2010 at these ages (115,000 men and 72,000 women; age-standardised rates per 100,000 people aged 15 years or older of 26·3 for men and 17·5 for women). For suicide deaths at ages 15 years or older, 40% of suicide deaths in men (45,100 of 114,800) and 56% of suicide deaths in women (40,500 of 72,100) occurred at ages 15-29 years. A 15-year-old individual in India had a cumulative risk of about 1·3% of dying before the age of 80 years by suicide; men had a higher risk (1·7%) than did women (1·0%), with especially high risks in south India (3·5% in men and 1·8% in women). About half of suicide deaths were due to poisoning (mainly ingestions of pesticides).InterpretationSuicide death rates in India are among the highest in the world. A large proportion of adult suicide deaths occur between the ages of 15 years and 29 years, especially in women. Public health interventions such as restrictions in access to pesticides might prevent many suicide deaths in India.FundingUS National Institutes of Health.

Project description:BackgroundFood insecurity, limited or uncertain access to enough food for an active, healthy life, affected over 37 million Americans in 2018. Food insecurity is likely to be associated with worse health-related quality of life (HRQoL), but this association has not been measured with validated instruments in nationally representative samples. Given growing interest understanding food insecurity's role in health outcomes, it would be useful to learn what HRQoL measures best capture the experience of those with food insecurity.ObjectiveTo determine the association between food insecurity and several validated HRQoL instruments in US adults.DesignCross-sectional.ParticipantsUS adults (age ≥ 18), weighted to be nationally representative.Main measuresFood insecurity was assessed with three items derived from the USDA Household Food Security Survey Module. HRQoL was assessed using PROMIS-Preference (PROPr), which contains 7 PROMIS domains, self-rated health (SRH), Euroqol-5D-5L (EQ-5D), Health Utilities Index (HUI), and Short Form-6D (SF-6D).Key resultsIn December 2017, 4142 individuals completed at least part of the survey (31% response rate), of whom 4060 (98.0%) reported food security information. Of survey respondents, 51.7% were women, 12.5% self-identified as black, 15.8% were Hispanic, and 11.0% did not have a high school diploma. 14.1% of respondents reported food insecurity. In adjusted analyses, food insecurity was associated with worse HRQoL across all instruments and PROMIS domains (p < .0001 for all). The magnitude of the difference between food-insecure and food-secure participants was largest with the SF-6D, EQ-5D, and PROPr; among individual PROMIS domain scores, the largest difference was for ability to participate in social roles.ConclusionsFood insecurity is strongly associated with worse HRQoL, with differences between food-secure and food-insecure individuals best measured using the SF-6D, EQ-5D, and PROPr. Future work should develop a specific instrument to measure changes in HRQoL in food insecurity interventions.

Project description:BackgroundMalaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients.MethodsIn April-May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads.ResultsAt the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT.ConclusionsMalawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have basic case management tools, and health worker performance in diagnosing malaria must be improved.

Project description:BackgroundThe principle of equity is fundamental to many current debates about social issues and plays an important role in community and individual health. Traditional research has focused on singular dimensions of equity (e.g., wealth), and often lacks a comprehensive perspective. The goal of this study was to assess relationships among three domains of equity, health, wealth, and civic engagement, in a nationally representative sample of U.S. residents.MethodsWe developed a conceptual framework to guide our inquiry of equity across health, wealth, and civic engagement constructs to generate a broad but nuanced understanding of equity. Through Ipsos' KnowledgePanel service, we conducted a cross-sectional, online survey between May 29-June 20, 2020 designed to be representative of the adult U.S.PopulationBased on our conceptual framework, we assessed the population-weighted prevalence of health outcomes and behaviors, as well as measures of wealth and civic engagement. We linked individual-level data with population-level environmental and social context variables. Using structural equation modeling, we developed latent constructs for wealth and civic engagement, to assess associations with a measured health variable.ResultsWe found that the distribution of sociodemographic, health, and wealth measures in our sample (n = 1267) were comparable to those from other national surveys. Our quantitative illustration of the relationships among the domains of health, wealth, and civic engagement provided support for the interrelationships of constructs within our conceptual model. Latent constructs for wealth and civic engagement were significantly correlated (p = 0.013), and both constructs were used to predict self-reported health. Beta coefficients for all indicators of health, wealth, and civic engagement had the expected direction (positive or negative associations).ConclusionThrough development and assessment of our comprehensive equity framework, we found significant associations among key equity domains. Our conceptual framework and results can serve as a guide for future equity research, encouraging a more thorough assessment of equity.

Project description:Evidence connects mental illness to other adverse health conditions, including oral health. However, longitudinal associations between mental and oral health remain understudied. We aimed to examine mental health-oral health associations prospectively in a nationally representative US cohort. Data were from the Population Assessment of Tobacco and Health (PATH) Study. The Global Appraisal of Individual Needs-Short Screener measured 3 types of mental health symptoms: internalizing, externalizing, and substance use problems. Six self-reported oral health conditions related to periodontal disease were evaluated: self-rated oral health, bleeding gums, loose teeth, tooth extraction, gum disease, and bone loss around teeth. Cross-sectional analysis within PATH Study wave 4 (2016 to 2018, n = 30,746) compared the survey-weighted prevalence of the 6 oral health outcomes according to severity of mental health problems. Prospectively, oral health outcomes were assessed 2 y later (wave 5, 2018 to 2019) according to wave 4 (baseline) mental health problems (n = 26,168). Survey-weighted logistic regression models controlled for confounders (age, sex, tobacco use, etc.) with imputation for missing values. All 6 adverse oral health conditions were greater in prevalence among participants with severe internalizing problems. Multiple conditions were also associated with severe externalizing or substance use problems. Longitudinally associations attenuated, but multiple associations of meaningful magnitude persisted, most with internalizing problems. For example, the adjusted odds ratio was 1.27 (95% CI, 1.08 to 1.50) for bleeding gums and 1.37 (95% CI, 1.12 to 1.68) for tooth extraction when we compared severe versus none/low internalizing problems. Providers should expect higher levels of oral disease among patients with adverse mental health symptoms. Independent of externalizing and substance use problems, symptoms of internalizing problems (related to depression and/or anxiety) are plausible risk factors for future oral disease. Better integration and coordination of mental and oral health treatment and prevention are recommended.

Project description:National malaria death rates are difficult to assess because reliably diagnosed malaria is likely to be cured, and deaths in the community from undiagnosed malaria could be misattributed in retrospective enquiries to other febrile causes of death, or vice-versa. We aimed to estimate plausible ranges of malaria mortality in India, the most populous country where the disease remains common.Full-time non-medical field workers interviewed families or other respondents about each of 122,000 deaths during 2001-03 in 6671 randomly selected areas of India, obtaining a half-page narrative plus answers to specific questions about the severity and course of any fevers. Each field report was sent to two of 130 trained physicians, who independently coded underlying causes, with discrepancies resolved either via anonymous reconciliation or adjudication.Of all coded deaths at ages 1 month to 70 years, 2681 (3·6%) of 75,342 were attributed to malaria. Of these, 2419 (90%) were in rural areas and 2311 (86%) were not in any health-care facility. Death rates attributed to malaria correlated geographically with local malaria transmission ratesderived independently from the Indian malaria control programme. The adjudicated results show 205,000 malaria deaths per year in India before age 70 years (55,000 in early childhood, 30,000 at ages 5-14 years, 120,000 at ages 15-69 years); 1·8% cumulative probability of death from malaria before age 70 years. Plausible lower and upper bounds (on the basis of only the initial coding) were 125,000-277,000. Malaria accounted for a substantial minority of about 1·3 million unattended rural fever deaths attributed to infectious diseases in people younger than 70 years.Despite uncertainty as to which unattended febrile deaths are from malaria, even the lower bound greatly exceeds the WHO estimate of only 15,000 malaria deaths per year in India (5000 early childhood, 10?000 thereafter). This low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide.US National Institutes of Health, Canadian Institute of Health Research, Li Ka Shing Knowledge Institute.

Dataset Information

Health Condition Impacts in a Nationally Representative Cross-Sectional Survey Vary Substantially by Preference-Based Health Index.

Publications

Health Condition Impacts in a Nationally Representative Cross-Sectional Survey Vary Substantially by Preference-Based Health Index.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets