Lower health-related quality of life predicts all-cause hospitalization among HIV-infected individuals

Abstract

BackgroundHealth-related quality of life (HRQOL) is a patient-centered outcome measure used in assessing the individual’s overall functional health status but studies looking at HRQOL as a predictive tool are few. This work examines whether summary scores of HRQOL are predictive of all-cause hospitalization in the US Military HIV Natural History Study (NHS) cohort.MethodsThe Short Form 36 (SF-36) was administered between 2006 and 2010 to 1711 NHS cohort members whose hospitalization records we had also obtained. Physical component summary scores (PCSS) and mental component summary scores (MCSS) were computed based on standard algorithms. Terciles of PCSS and MCSS were generated with the upper terciles (higher HRQOL) as referent groups. Proportional hazards multivariate regression models were used to estimate the hazard of hospitalization for PCSS and MCSS separately (models 1 and 2, respectively) and combined (model 3).ResultsThe hazard ratios (HR) of hospitalization were respectively 2.12 times (95% CI: 1.59–2.84) and 1.59 times (95% CI: 1.19–2.14) higher for the lower and middle terciles compared to the upper PCSS tercile. The HR of hospitalization was 1.33 times (95% CI: 1.02–1.73) higher for the lower compared to the upper MCSS tercile. Other predictors of hospitalization were CD4 count < 200 cells/mm3 (HR = 2.84, 95% CI: 1.96, 4.12), CD4 count 200–349 cells/mm3 (HR = 1.67, 95% CI: 1.24, 2.26), CD4 count 350–499 cells/mm3 (HR = 1.41, 95% CI: 1.09, 1.83), plasma viral load > 50 copies/mL (HR = 1.82, 95% CI: 1.46, 2.26), and yearly increment in duration of HIV infection (HR = 0.94, 95% CI: 0.93, 0.96) (model 3).ConclusionAfter controlling for factors associated with hospitalization among those with HIV, both PCSS and MCSS were predictive of all-cause hospitalization in the NHS cohort. HRQOL assessment using the SF-36 may be useful in stratifying hospitalization risk among HIV-infected populations.

Prospective association of social circumstance, socioeconomic, lifestyle and mental health factors with subsequent hospitalisation over 6–7 year follow up in people living with HIV

“…There is little research on the impact of social support, relationship and family status on the risk of hospitalisation in PLHIV. Two US studies did not find an association between marital status and hospitalisation [ 11 , 14 ], whereas we found that not having a stable partner and having children were associated with higher hazard of hospitalisation in all PLHIV, with evidence for an effect of lower social support. The effect of having children was not attenuated after adjusting for demographic group, and was similar in those with and without a current partner (test for interaction=0.60).…”

“…Previous longitudinal and cross-sectional studies in high-income settings in the cART era have found that demographic factors [6] (including older age [ 4 , [7] , [8] , [9] , [10] , [11] , [12] , [13] ], female gender [ 4 , 9 , 14 ], black or minority ethnicity [ 13 , 15 ]) and clinical HIV markers (including low CD4 count [ 4 , 7 , 9 , 11 , 13 ], high viral load [ 7 , 9 , 11 , 13 , 16 ], Hepatitis C or B coinfection [ 4 , 9 , 17 ] and ART non-adherence [16] ) predict hospitalisation among PLHIV. Other studies found evidence that poor mental health was predictive of hospitalisation [ 8 , 12 , 14 , 18 ]; findings were less consistent for social [ 11 , 14 ], socioeconomic [ 10 , 12 , 14 , 19 ] and lifestyle factors [ 8 , 10 , 12 , 14 , 15 , 18 , 20 ]. Most studies of hospitalisation among PLHIV were conducted in the US, a setting without universal access to healthcare, and few included data beyond 2010 [ 4 , 9 , 14 , [16] , [17] , [18] , 20 ].…”

All-cause hospitalization according to demographic group in people living with HIV in the current antiretroviral therapy era

“…Other US studies [ 11 – 15 ], one French study [ 16 ] and one that combined data from France and Brazil [ 17 ] did not find a statistically significant association between gender and hospitalization. Several other US studies did not find an association between ethnicity and hospitalization in PLHIV [ 11 , 14 , 15 ]. However, in our analysis, we found hospitalization risk to be higher in MSW than in women, and higher in ‘other ethnicity’ MSW and women than Black African MSW and women.…”

Assessing quality of life in people with HIV in Spain: psychometric testing of the Spanish version of WHOQOL-HIV-BREF

“…Interventions that can improve HRQoL through mechanisms such as social support and self-empowerment may have far-reaching consequences for individual PLHIV and for health systems. A recent longitudinal study found that both physical and mental HRQoL dimensions’ scores were predictive of all-cause hospitalization in a cohort of PLHIV, suggesting that improving HRQoL in this population can result in better health outcomes [50].…”