Mortality Prediction by Quality-Adjusted Life Year Compatible Health Measures: Findings in a Nationally Representative US Sample

BackgroundResponses to single-item categorical self-rated health (SRH) measures predict mortality, but performance of quality-adjusted life year (QALY) compatible health measures in this regard has not been much investigated. ObjectivesTo examine mortality prediction and discrimination by 4 QALY compatible health measures, a reference single-item categorical SRH measure, and 1-year declines in those measures. Research DesignCox survival and area under the curve (AUC) (discrimination) analyses of the 2000 to 2002 Medical Expenditures Panel Survey respondent data linked to the National Death Index through 2006, with and without adjustment for sociodemographic characteristics (age, sex, race/ethnicity, education, and income). SubjectsA total of 22,259 respondents aged 18 to 90. MeasuresEQ-5D summary index (EQ-5D); predicted EQ-5D (pEQ-5D) derived from the SF-12; SF-6D; EQ visual analog scale (EQ VAS); and a single-item categorical SRH measure. ResultsAdjusted mortality hazard ratios for 0.1 point decrements in QALY compatible health measure scores were: EQ-5D, 1.24 [95% confidence interval (CI): 1.20, 1.29); pEQ-5D, 1.40 (95% CI: 1.34, 1.47); EQ VAS, 1.30 (95% CI: 1.26, 1.35); SF-6D, 1.37 (95% CI: 1.30, 1.43)]. In adjusted AUC analyses, baseline scores on all study health measures discriminated mortality risk, but the pEQ-5D, EQ VAS, and single-item categorical SRH measures were statistically superior in this regard. One-year declines also predicted mortality for all study health measures, but only pEQ-5D decline discriminated mortality risk in adjusted AUC analyses. ConclusionsFor all of the study health measures, baseline scores and 1-year declines in scores predicted mortality. The pEQ-5D also consistently discriminated mortality risk in adjusted AUC analyses.

[1]  R. Angel,et al.  Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study. , 1990, American journal of public health.

[2]  B. Modan,et al.  Gender differences in the self-rated health-mortality association: is it poor self-rated health that predicts mortality or excellent self-rated health that predicts survival? , 2003, The Gerontologist.

[3]  J. Brazier,et al.  The Estimation of a Preference-Based Measure of Health From the SF-12 , 2004, Medical care.

[4]  A. Wu,et al.  Utilities Derived from Visual Analog Scale Scores in Patients with HIV/AIDS , 2003, Medical decision making : an international journal of the Society for Medical Decision Making.

[5]  M. Lenzen,et al.  Health-related quality of life predicts long-term survival in patients with peripheral artery disease , 2010, Vascular medicine.

[6]  R. Hakim,et al.  A comparison of SF-36 and SF-12 composite scores and subsequent hospitalization and mortality risks in long-term dialysis patients. , 2010, Clinical journal of the American Society of Nephrology : CJASN.

[7]  W H Rogers,et al.  Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. , 1995, Medical care.

[8]  Adam Wilcox,et al.  Use of Health‐Related, Quality‐of‐Life Metrics to Predict Mortality and Hospitalizations in Community‐Dwelling Seniors , 2006, Journal of the American Geriatrics Society.

[9]  C. McHorney,et al.  The MOS 36‐Item Short‐Form Health Survey (SF‐36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Constructs , 1993, Medical care.

[10]  M. Ruggeri,et al.  A comparison of SF-6D and EQ-5D utility scores in a study of patients with schizophrenia. , 2009, The journal of mental health policy and economics.

[11]  E. van Doorslaer,et al.  Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data. , 2003, Social science & medicine.

[12]  Christopher McCabe,et al.  Visual Analogue Scales: do they have a role in the measurement of preferences for health states? , 2004 .

[13]  Y. Benyamini,et al.  Self-rated health and mortality: a review of twenty-seven community studies. , 1997, Journal of health and social behavior.

[14]  K. Muir,et al.  Do estimates of cost-utility based on the EQ-5D differ from those based on the mapping of utility scores? , 2008, Health and quality of life outcomes.

[15]  R. Luben,et al.  The Short-Form Six-Dimension utility index predicted mortality in the European Prospective Investigation into Cancer-Norfolk prospective population-based study. , 2010, Journal of clinical epidemiology.

[16]  A. Keech,et al.  Using the EQ-5D Index Score as a Predictor of Outcomes in Patients With Type 2 Diabetes , 2009, Medical care.

[17]  Thomas E. Moritz,et al.  Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. Participants of the Department of Veterans Affairs Cooperative Study Group on Processes, Structures, and Outcomes of Care in Cardiac Surgery. , 1999, JAMA.

[18]  K. Fiscella,et al.  Sociodemographics, self-rated health, and mortality in the US. , 2003, Social science & medicine.

[19]  J. Larson.  The MOS 36-Item Short form Health Survey , 1997, Evaluation & the health professions.

[20]  N. Adler,et al.  Prospective change in health-related quality of life and subsequent mortality among middle-aged and older women. , 2008, American journal of public health.

[21]  R. Wolfe,et al.  Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). , 2003, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[22]  M. Botteman,et al.  Economic evaluation of major knee surgery with recombinant activated factor VII in hemophilia patients with high titer inhibitors and advanced knee arthropathy: exploratory results via literature-based modeling , 2008, Current medical research and opinion.

[23]  W. Mathews,et al.  EuroQol (EQ-5D) measure of quality of life predicts mortality, emergency department utilization, and hospital discharge rates in HIV-infected adults under care , 2007, Health and quality of life outcomes.

[24]  D. Chae,et al.  Quality of life and mortality from a nephrologist's view: a prospective observational study , 2009, BMC nephrology.

[25]  J. Brazier,et al.  Deriving a preference-based single index from the UK SF-36 Health Survey. , 1998, Journal of clinical epidemiology.

[26]  R. G. Rogers,et al.  Wealth, Race, and Mortality* , 2003 .

[27]  L. Jarvik,et al.  Predictors of two-year mortality in a prospective "UPBEAT" study of elderly veterans with comorbid medical and psychiatric symptoms. , 2002, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[28]  M. Helweg-Larsen,et al.  Do age and social relations moderate the relationship between self-rated health and mortality among adult Danes? , 2003, Social science & medicine.

[29]  Murtuza Bharmal,et al.  Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. , 2006, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[30]  A. Muller,et al.  Education, income inequality, and mortality: a multiple regression analysis , 2002, BMJ : British Medical Journal.

[31]  T. Kawada.  Self-rated health and life prognosis. , 2003, Archives of medical research.

[32]  M. Simoons,et al.  The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: a report from the Euro Heart Survey on Coronary Revascularisation , 2006, Heart.

[33]  D. Ghosh,et al.  Are health-related quality-of-life and self-rated health associated with mortality? Insights from Translating Research Into Action for Diabetes (TRIAD). , 2009, Primary care diabetes.

[34]  Y. Benyamini,et al.  Community Studies Reporting Association between Self-Rated Health and Mortality , 1999 .

[35]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[36]  Roger Newson,et al.  Parameters behind “Nonparametric” Statistics: Kendall's tau, Somers’ D and Median Differences , 2002 .

[37]  Jiang He,et al.  Mortality prediction with a single general self-rated health question , 2006, Journal of General Internal Medicine.

[38]  R. Rabin,et al.  EQ-SD: a measure of health status from the EuroQol Group , 2001, Annals of medicine.

[39]  K. Fiscella,et al.  Poverty or income inequality as predictor of mortality: longitudinal cohort study , 1997, BMJ.

[40]  D. Fryback,et al.  Relative Disutilities of 47 Risk Factors and Conditions Assessed with Seven Preference-Based Health Status Measures in a National U.S. Sample: Toward Consistency in Cost-Effectiveness Analyses , 2006, Medical care.