Self-reported health-related quality of life of the general population in Alberta, Canada during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has impacted various aspects of people's life and wellbeing around the world. This study aimed to examine the impact of the COVID-19 pandemic on health-related quality of life (HRQL), measured by the EQ-5D-5L, amongst the general population in the province of Alberta, Canada, and explore whether the impact varied across population subgroups based on age, gender, and dwelling. METHODS: Data came from two waves of a repeated cross-sectional population-based survey, the COVID-19 Experiences and Impact Survey, administered by the Health Quality Council of Alberta. The first data collection (survey 1: n = 8790) was during May/June 2020 and the second (survey 2: n = 9263) during Oct 2020. We examined the comparability of weighted survey data and their representativeness to Alberta's general population. We then explored between-survey differences in EQ-5D-5L index, EQ-VAS and dimension responses, and differences across subgroups within each survey. We compared HRQL of the pooled sample (survey 1&2) with the Alberta population norms data from the pre-pandemic period. RESULTS: Mean EQ-5D-5L index and EQ-VAS scores were 0.81 (0.15) and 72.54 (18.57), and 0.82 (0.14) and 71.98 (18.96) in surveys 1 and 2, respectively. The anxiety/depression dimension had the most reported problems (survey 1: 69.5%, survey 2: 70.2%). Respondents aged 16-24 or 75 and older, who identified themselves as a woman, or residing in urban areas had significantly lower EQ-5D-5L index scores compared to their counterparts in both surveys. Between-survey differences were not substantially different. Comparing the pooled sample with the pre-pandemic Alberta population norms, EQ-5D-5L index scores (0.82 vs. 0.84) and EQ-VAS scores (72.26 vs. 77.40) were significantly lower, and respondents aged 16-44, women, or urban residents were more impacted. More problems were reported in the anxiety/depression (69.9% vs. 37.2%) and usual activities dimensions (40.5% vs. 26.0%) during the pandemic period, especially for respondents aged 16-44, women, and those residing in urban areas. CONCLUSIONS: Lower HRQL was reported during the COVID-19 pandemic compared to pre-pandemic HRQL in this population, with anxiety/depression and usual activities affected the most. People who were younger, women, and residing in urban areas were most impacted. The government responses to COVID-19 policies during population outbreaks should consider the needs of Albertans in these particular groups.

The impact of COVID-19 pandemic on health-related quality of life of adults visiting emergency departments and primary care settings in Alberta.

OBJECTIVES: To examine the impact of COVID-19 pandemic on health-related quality of life (HRQL) of adults visiting emergency departments (ED) and primary care (PC) settings in Alberta, Canada, and explore whether this impact varies across demographic subgroups. METHODS: Data from two repeated cross-sectional surveys that measured HRQL using EQ-5D-5L were used; "pre-COVID" Sept 2019-Feb 2020 (ED, N=5927; PC, N=317), "Wave-1" Mar 2020-Aug 2020 (ED, N=4781; PC, N=375), and "Wave-2" Sept 2020-Jan 2021 (ED, N=4443; PC, N=327). RESULTS: In the ED sample, there were decrements in mild-extreme problems of 3.7% in mobility and 4.1% in usual activities from pre-COVID to wave 2. There were very minor changes in mild-extreme problems in self-care (decrement=1.3%), pain/discomfort (decrement=2.6%), and anxiety/depression (decrement=0.9%). In the PC sample, there were increases of 4.8% in mild-extreme pain/discomfort and 10.7% in anxiety/depression from pre-COVID to wave 2. Despite these changes, HRQL of both samples pre-COVID and during waves 1 and 2 was worse than that of the general Alberta population. There were no significant variations in the impact of COVID-19 pandemic on HRQL across age, sex, and income subgroups in the ED survey; however, such variations were observed in the PC survey whereby younger adults, females, and those with high income had the largest HRQL deteriorations. CONCLUSION: The impact of COVID-19 pandemic on HRQL was minimal in adults seeking ED care, but more pronounced in those seen in PC, especially in terms of mental health. Policies around COVID-19 should take into account the needs of certain groups of the population, especially women and young people.

RéSUMé: OBJECTIFS: Examiner l'impact de la pandémie de COVID-19 sur la qualité de vie liée à la santé (QVLS) des adultes visitant les services d'urgence (SU) et les établissements de soins primaires (SP) en Alberta, au Canada, et déterminer si cet impact varie selon les sous-groupes démographiques. MéTHODES: Les données de deux enquêtes transversales répétées qui ont mesuré la QVL à l'aide de l'EQ-5D-5L ont été utilisées; « pré-COVID ¼ septembre 2019-février 2020 (SU, N=5 927; SP, N=317), « Vague-1 ¼ mars 2020-août 2020 (SU, N=4 781; SP, N=375) et « Vague-2 ¼ septembre 2020-janvier 2021 (SU, N=4 443; SP, N=327). RéSULTATS: Dans l'échantillon du SU, il y a eu des diminutions des problèmes légers à extrêmes de 3,7 % dans la mobilité et de 4,1 % dans les activités habituelles de la période pré-COVID à la vague 2. Il y a eu des changements très mineurs dans les problèmes légers à extrêmes dans les soins personnels (diminution = 1,3 %), douleur/gêne (diminution=2,6 %) et anxiété/dépression (diminution=0,9 %). Dans l'échantillon SP, il y a eu des augmentations de 4,8 % de la douleur/gêne légère à extrême et de 10,7 % de l'anxiété/de la dépression de la période pré-COVID à la vague 2. Malgré ces changements, la QVLS des deux échantillons avant la COVID et pendant les vagues 1 et 2 était pire que celle de la population générale de l'Alberta. Il n'y avait pas de variations significatives de l'impact de la pandémie de COVID-19 sur la QVLS selon l'âge, le sexe et les sous-groupes de revenu dans l'enquête SU; cependant, de telles variations ont été observées dans l'enquête SP, où les jeunes adultes, les femmes et les personnes à revenu élevé présentaient les plus fortes détériorations de la QVLS. CONCLUSION: L'impact de la pandémie de COVID-19 sur la QVLS était minime chez les adultes cherchant des SU, mais plus prononcé chez ceux observés dans le SP, en particulier en termes de santé mentale. Les politiques autour de COVID-19 devraient prendre en compte les besoins de certains groupes de la population, en particulier les femmes et les jeunes.

The relationship of neighbourhood-level material and social deprivation with health-related quality of life.

PURPOSE: To examine the relationship of neighbourhood-level material and social deprivation with health-related quality of life, measured by the EQ-5D-5L, in the general adult population. METHODS: A sample of 11,835 adults living in Alberta, Canada was drawn from three combined annual Health Quality Council of Alberta Satisfaction and Experiences with Health Care Services surveys from 2012 to 2016. Neighbourhood-level material and social deprivation indices were derived using the Pampalon index and the 2006 Canadian census. The EQ-5D-5L dimensions, index and VAS scores were compared across the deprivation indices quintiles in the overall sample and by participants' sub-groups. Differences were tested using ANOVA or Chi-square test as appropriate. Multivariate linear regression models were conducted to examine the independent association of material and social deprivation with the EQ-5D-5L index and VAS scores, and multinomial logistic regression models with each of the EQ-5D-5L dimensions. RESULTS: Respondents in higher material or social deprivation categories had lower EQ-5D-5L index and VAS scores than those in the least deprived categories. Additionally, respondents with higher material deprivation were more likely to report problems on mobility, usual activities, and pain/discomfort; those with higher social deprivation were more likely to report problems on mobility, self-care, usual activities, and anxiety/depression. CONCLUSION: Higher neighbourhood-level material and social deprivation is significantly associated with lower health-related quality of life in the general adult population. Examining the factors leading to this inequity in health between individuals living in the least and most deprived neighbourhoods is imperative to mitigating these inequities.

Comparing the EQ-5D 3L and 5L: measurement properties and association with chronic conditions and multimorbidity in the general population.

BACKGROUND: Studies comparing the measurement properties of EQ-5D 3L (3L) and EQ-5D 5L (5L) are limited to specific patient populations with small sample sizes. Using a general population sample, we compared 3L and 5L in terms of their measurement properties and association with number of chronic conditions, including multimorbidity--the concurrent occurrence of two or more chronic conditions. METHODS: Data were available from two consecutive cycles of a cross-sectional telephone interview survey using 3L (2010 cycle) and 5L (2012 cycle), in the general population of adults (age ≥ 18 years) in Alberta, Canada. Measurement properties were compared by determining their feasibility, ceiling effect, and discriminatory power (Shannon indices) for 3L and 5L. Linear regression models were fitted to test the associations between multimorbidity and EQ-5D index score. RESULTS: Data were available for 4946 (2010) and 4752 (2012) survey respondents with information on HRQL. Compared to 3L, 5L showed lower ceiling effect (32.3% versus 42.1%), higher absolute discriminatory power (Shannon index, mean 0.79 versus 0.52) and higher relative discriminatory power (Shannon Evenness index, mean 0.09 versus 0.06 for 3L). Despite these differences, similar relationships of lower HRQL with greater multimorbidity were observed for the 3L (ß = -0.13, 95% CI -0.15; -0.11) and 5L (ß = -0.12, 95% CI -0.13; -0.11). CONCLUSIONS: Using a general population sample, the EQ-5D 5L showed better measurement properties than the EQ-5D 3L. Nonetheless, clinically important differences in HRQL associated with multimorbidity were similar in magnitude using both versions of EQ-5D.

Mental health and the relationship between health promotion counseling and health outcomes in chronic conditions: cross-sectional population-based study.

OBJECTIVE: To explore the relationship between health promotion counseling (HPC) provided by FPs and health-related quality of life (HRQL) and the use of health care services among patients with chronic conditions, while assessing the effect of mental health on these relationships. DESIGN: Telephone survey using random-digit dialing. SETTING: Alberta. PARTICIPANTS: A total of 1615 participants with chronic conditions. MAIN OUTCOME MEASURES: Health promotion counseling provided by FPs, which was assessed using 4 questions; HRQL using the Euro quality of life 5-dimensions (EQ-5D) questionnaire; and the use of health care services assessed with self-reported emergency department (ED) visits and hospitalizations. RESULTS: Of the 1615 participants with chronic conditions, 55% were female and more than two-thirds were older than age 45 years. Less than two-thirds of participants received HPC from their FPs. In patients without anxiety or depression, those who needed help from their FPs in making changes to prevent illness had a 0.05 lower EQ-5D score than those who did not (P < .001); and those who received diet counseling had a 0.03 higher EQ-5D score than their counterparts did (P = .048). However, these associations were not observed in patients with anxiety or depression. Patients were more likely to have visited EDs if they needed their physicians' help in making changes to prevent illness (odds ratio 1.43, 95% CI 1.08 to 1.89) and less likely to visit EDs if they had been encouraged by their physicians to talk about their health concerns (odds ratio 0.69, 95% CI 0.52 to 0.91). None of the HPC items was associated with hospitalizations. CONCLUSION: Not all patients with chronic conditions are receiving HPC from their FPs. Also, there is an association between HPC and important health outcomes (ie, HRQL and ED visits), but this association is not apparent for those with anxiety or depression.

Multimorbidity prevalence in the general population: the role of obesity in chronic disease clustering.

BACKGROUND: The role of obesity in the prevalence and clustering of multimorbidity, the occurrence of two or more chronic conditions, is understudied. We estimated the prevalence of multimorbidity by obesity status, and the interaction of obesity with other predictors of multimorbidity. METHODS: Data from adult respondents (18 years and over) to the Health Quality Council of Alberta 2012 Patient Experience Survey were analyzed. Multivariable regression models were fitted to test for associations. RESULTS: The survey sample included 4803 respondents; 55.8% were female and the mean age was 47.8 years (SD, 17.1). The majority (62.0%) of respondents reported having at least one chronic condition. The prevalence of multimorbidity, including obesity, was 36.0% (95% CI, 34.8 - 37.3). The prevalence of obesity alone was 28.1% (95% CI 26.6 - 29.5). Having obesity was associated with more than double the odds of multimorbidity (odds ratio = 2.2, 95% CI 1.9 - 2.7) compared to non-obese. CONCLUSIONS: The prevalence of multimorbidity in the general population is high, but even higher in obese than non-obese persons. These findings may be relevant for surveillance, prevention and management strategies for multimorbidity.

Health-related quality of life and healthcare utilization in multimorbidity: results of a cross-sectional survey.

PURPOSE: We assessed the associations between multimorbidity and health-related quality of life (HRQL), and healthcare utilization, based on 16 common self-reported chronic conditions. METHODS: A cross-sectional questionnaire survey including the EQ-5D was conducted in a sample of the general population of adults (≥18 years) living in Alberta, Canada. Multiple linear and logistic regressions were used to assess the association between multiple chronic conditions and HRQL, hospitalization and emergency department (ED) use. RESULTS: A total of 4,946 respondents reported their HRQL, noting problems mostly with pain or discomfort (48.0%). All chronic conditions were associated with a clinically important reduction in HRQL, the highest burden with anxiety or depression (-0.19, 95% CI -0.21, -0.16) and chronic pain (-0.19, 95% CI -0.21, -0.17). Multimorbidity was associated with a clinically important reduction in the EQ-5D index score (-0.12, 95% CI -0.14, -0.11) and twice the likelihood of being hospitalized (OR = 2.2, 95% CI 1.7, 2.9) or having an ED visit (OR = 1.8, 95% CI 1.4, 2.2). CONCLUSIONS: Pain or discomfort is a common problem in people living with chronic conditions, and the existence of multimorbidity in these individuals is associated with a reduction in the HRQL as well as frequent hospitalization and emergency department visits.

Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey.

BACKGROUND: Studies on the prevalence of multimorbidity, defined as having two or more chronic conditions, have predominantly focused on the elderly. We estimated the prevalence and specific patterns of multimorbidity across different adult age groups. Furthermore, we examined the associations of multimorbidity with socio-demographic factors. METHODS: Using data from the Health Quality Council of Alberta (HQCA) 2010 Patient Experience Survey, the prevalence of self reported multimorbidity was assessed by telephone interview among a sample of 5010 adults (18 years and over) from the general population. Logistic regression analyses were performed to determine the association between a range of socio-demographic factors and multimorbidity. RESULTS: The overall age- and sex-standardized prevalence of multimorbidity was 19.0% in the surveyed general population. Of those with multimorbidity, 70.2% were aged less than 65 years. The most common pairing of chronic conditions was chronic pain and arthritis. Age, sex, income and family structure were independently associated with multimorbidity. CONCLUSIONS: Multimorbidity is a common occurrence in the general adult population, and is not limited to the elderly. Future prevention programs and practice guidelines should take into account the common patterns of multimorbidity.