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T. Gamst -Klaussen & F. W. Rudmin Faculty of Health Sciences UIT Norway’s Arctic University

Health Utilities Index (HUI) and Satisfaction With Life (SWL) Show Monotonic Linear Decrements as The Number of Concurrent Chronic Illnesses Increases. T. Gamst -Klaussen & F. W. Rudmin Faculty of Health Sciences UIT Norway’s Arctic University. Acknowledgements:

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T. Gamst -Klaussen & F. W. Rudmin Faculty of Health Sciences UIT Norway’s Arctic University

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  1. Health Utilities Index (HUI) and Satisfaction With Life (SWL) Show Monotonic Linear Decrements as The Number of Concurrent Chronic Illnesses Increases T. Gamst-Klaussen & F. W. RudminFaculty of Health SciencesUIT Norway’s Arctic University

  2. Acknowledgements: The Canadian Community Health Survey data used for this study were generously provided by Statistics Canada via their Data Liberation Initiative. The authors expressly thank Jeffrey Moon, who is the Data & Government Information Librarian at Queen’s University, for his assistance in accessing these data. The analysis and conclusions in this study are those of the authors, and are not those of Statistics Canada.

  3. Data: a) Archived 2009 Canadian Community Health Survey (CCHS) data b) Non-institutional individuals over age 11 proportionate to regional population c) Interviews by phone or in person using English, French or 22 other languages d) 73% response rate (N=124,188) e) 45.5% male; 54.5% female f) One-third were 60+ g) One-third were in highest household income bracket h) One-half had post-secondary education

  4. CCHS queried 15 diagnosed chronic conditions: a) “long term conditions” b) “have lasted or are expected to last six months or more” c) “diagnosed by a health professional” Example: “Remember, we’re interested in conditions diagnosed by a health professional. Do you have high blood pressure?” Responses were: Yes, No, Don’t know, or Refuse to answer.

  5. Independent Variable: Number of Concurrent Chronic Illnesses ( range 0 – 8 ) Two criteria for “Healthy” base-line comparison group with “0” diseases 1) reported “no” for all 15 chronic conditions AND 2) answered “very good” OR “excellent” to self-evaluated general health AND mental health “In general, would you say your [general / mental] health is: excellent?, very good? good? fair? poor? 26% of sample categorized as “healthy” (14% failed criterion 2)

  6. Dependent Variables: 2) Health Utilities Index (HUI-3) 8 Subscales: vision, hearing, speech, mobility, dexterity, emotion, cognition, pain Scores ranged -0.335 to 1.00, with 1.00 meaning highest quality of life 3) Satisfaction with life (SWL): 1 item questions: How do you feel about your life as a whole right now? Answered 0 Very dissatisfied -- to -- 10 Very satisfied Rescaled to range 0.00 to 1.00, with 1.00 meaning highest satisfaction

  7. Prevalence in the Sample Respondents Reporting One and Only One (N = 124,188) of the 15 Diagnosed Chronic Conditions 15 Chronic Conditions N % % n % HUI Score SWL Score of sample (co-morb) of cases Mn SD Mn SD High blood pressure 27,579 22.2% (77%) 6,208 23% .920 .119 .830 .148 Back problems 26,001 20.9% (77%) 5,944 23% .872 .174 .802 .150 Arthritis 25,734 20.7% (85%) 3,932 15% .857 .182 .822 .154 Migraine headaches 12,232 9.8% (69%) 3,799 31% .914 .138 .819 .145 Asthma 10,776 8.7% (69%) 3,391 31% .923 .116 .823 .136 Diabetes 9,784 7.9% (87%) 1,257 13% .907 .147 .822 .158 Mood disorder 9,294 7.5% (85%) 1,413 15% .815 .212 .732 .174 Heart disease 8,526 6.9% (90%) 849 10% .881 .171 .801 .174 Anxiety disorder 7,119 5.7% (85%) 1,060 15% .862 .182 .779 .154 Bowel disorder 6,524 5.3% (84%) 1,063 16% .900 .154 .817 .141 Urinary incontinence 5,737 4.6% (92%) 446 8% .821 .242 .800 .161 C.O.P.D. 4,832 3.9% (93%) 361 7% .885 .151 .806 .159 Stomach/intestinal ulcers 4,133 3.3% (87%) 528 13% .896 .151 .806 .159 Cancer 3,056 2.5% (85%) 465 15% .882 .163 .811 .168 Effects of stroke 1,973 1.6% (93%) 132 7% .808 .239 .786 .181

  8. CO-VARIATES HUI SWL % N Mn SD N Mn SD GENDER F=166 F=57 Male 45.5% 54,974 .868 .200 54,472 .795 .168 Female 54.5% 65,951 .852 .214 66,083 .803 .171 AGE F=1638 F=310 12-19 11.7% 14,329 .903 .148 13,998 .831 .134 20-39 25.3% 31,173 .907 .161 31,006 .809 .150 40-59 29.9% 36,372 .856 .213 36,644 .784 .179 60+ 33.1% 39,051 .808 .240 38,907 .795 .183 FAMILY INCOME F=1761 F=1100 < 20k 12.1% 11,950 .749 .282 12,057 .726 .223 20k - 39k 21.6% 21,472 .818 .236 21,378 .775 .184 40k - 59k 18,6% 18,716 .865 .194 18,645 .802 .160 60k -79k 15.1% 15,263 .889 .170 15,213 .814 .147 80k + 32.6% 33,055 .910 .150 32,949 .833 .132 EDUCATION F=515 F=47 < secondary 25.4% 30,350 .823 .236 29,782 .793 .185 secondary grad. 15.5% 18,753 .860 .203 18,694 .798 .170 other post-sec. 7.1% 8,658 .858 .211 8,724 .789 .168 post-sec. grad. 49.3% 60,016 .879 .188 60,281 .805 .159

  9. VARIABLES HUI SWL % N Mn SD N Mn SD MORBIDITIES F=4528 F=1640 0 26.4% 32,552 .953 .081 32,700 .866 .116 1 24.8% 30,179 .890 .160 30,131 .812 .152 2 15.4% 18,508 .831 .208 18,506 .785 .172 3 9.2% 10,979 .756 .251 10,941 .753 .191 4 5.0% 5,797 .675 .286 5,795 .715 .215 5 2.6% 2,968 .586 .314 2,989 .677 .233 6 1.2% 1,430 .511 .321 1,428 .637 .245 7 0.6% 667 .440 .319 673 .606 .253 8 0.3% 278 .370 .320 285 .577 .261

  10. LINEAR REGRESSION ANALYSIS ( using un-standardized coefficients ) Morbidities predicting HUI scores: R-square = .26 ( r= -.51, n=103,358, p<.001) HUI = .961 - .070 x N-of-Diseases + error With covariates: HUI = .884 - .065 x N-of-Diseases + error Morbidities predicting SWL scores: R-square = .11 ( r= -.33, n=103,448, p<.001) SWL = .860 - .037 x N-of-Diseases + error With covariates: SWL = .785 - .037 x N-of-Diseases + error

  11. Multimorbidities 1st MOST FREQUENT 2nd MOST FREQUENT 3rd MOST FREQUENT 2 Diseases only HIBP, ARTH only BCKP, ARTH only HIBP, BCKP N=19,186 N=2206 (1.8%) N=2057 (1.7%) N=1100 (0.9%) (15,4%) HUI Mn=.83 SD=.20 HUI Mn=.78 SD=.23 HUI Mn=.86 SD=.18 SWL Mn=.82 SD=.15 SWL Mn=.79 SD=.17 SWL Mn=.80 SD=.17 3 Diseases only HIBP, BCKP, ARTH only HIBP, ARTH, DIAB only HIBP, ARTH, HRTDN=11,486 N=1152 (0.9%) N=583 (0.5%) N=397 (0.3%) (9.2%) HUI Mn=.83 SD=.20 HUI Mn=.80 SD=.22 HUI Mn=.77 SD=.23 SWL Mn=.82 SD=.15 SWL Mn=.78 SD=.17 SWL Mn=.80 SD=.17 4 Diseases only HIBP, BCKP, ARTH, only HIBP, BCKP, ARTH, only HIBP, BCKP, ARTH, N=6,152 DIAB HRTD URIN(5.0%) N=312 (0.3%) N=248 (0.2%) N=166 (0.1%) HUI Mn=.67 SD=.27 HUI Mn=.69 SD=.27 HUI Mn=.65 SD=.28 SWL Mn=.73 SD=.20 SWL Mn=.76 SD=.21 SWL Mn=.73 SD=.20 5 Diseases only HIBP, BCKP, ARTH, only HIBP, BCKP, ARTH, only HIBP, BCKP, ARTH, N=3,175 DIAB, HRTD HRTD, URIN DIAB,URIN(2.6%) N=119 (0.09%) N=50 (0.04%) N=46 (0.04%) HUI Mn=.68 SD=.26 HUI Mn=.51 SD=.34 HUI Mn=.49 SD=.31 SWL Mn=.73 SD=.20 SWL Mn=.64 SD=.20 SWL Mn=.66 SD=.26

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