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The added effect of comorbidity on health-related quality of life in patients with asthma

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Abstract

Purpose

To examine the effect of comorbidities on health-related quality of life (HRQoL) and their interaction with asthma control.

Methods

In a random sample of adults with asthma, we measured generic (EQ5D) and disease-specific (AQ5D) utility scores. Asthma symptom control was determined using the 2014 Global Initiative for Asthma Management Strategy. Comorbidity scores were calculated using a validated questionnaire. We used two-part regression models to measure the adjusted difference in utility across levels of symptom control and comorbidity scores and to examine the relative role of symptom control and comorbidity in explaining the variation in HRQoL.

Results

A total of 2,299 observations from 460 adult patients (mean age 52 years, 67 % women) were included. Compared to controlled asthma, uncontrolled asthma was associated with −0.018 reduction (95 % CI −0.028, −0.009) in EQ5D and −0.076 reduction (95 % CI −0.115, −0.052) in AQ5D utilities. An increase by one standard deviation in comorbidity score relative to the mean was associated with a change of −0.029 (95 % CI −0.043, −0.016) in EQ5D and −0.010 (95 % CI −0.020, −0.004) in AQLQ utilities. The impact of comorbidity was greater than asthma symptom control in explaining EQ5D variance (12 vs. 1 %) but smaller in explaining AQ5D variance (3 vs. 12 %).

Conclusions

Generic and disease-specific HRQoL instruments differentially capture the impact of symptom control and comorbidity in asthma. The selection of HRQoL instruments for asthma studies should depend on the prevalence of comorbidity in the target population and the impact of interventions on asthma control and comorbidity.

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Acknowledgments

We acknowledge the financial support through the Collaborative Innovative Research Fund (CIRF), an investigator-initiated, peer-reviewed competition sponsored by GlaxoSmithKline Canada. None of the sponsors played a role in the study design, data analysis, or interpretation of the results. Dr. Marra holds a tier 2 Canada Research Chair in Pharmaceutical Outcomes Research, and Dr. Sadatsafavi receives salary support from the National Sanatorium Association. We would like to thank other members of the Economic Burden of Asthma study team: Satvir Dhoot; Lisa Dinh; Jennie Chan; Jesmin Dhillon; Gurleen Gill; Jessika Iwanski; Zaakir Jiwa; Intan Agoes; Richie Li; Jordan Deppiesse; Samantha Gray; Elena Terekhova; Nicole Brunton; Dayna Taylor; Madeline Ludwig; Laura FitzGerald; Douglass Rolfe; Wan Tan Hogg.

Conflict of interest

Dr. Fitzgerald has severed on advisory boards for GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Boehringer-Ingelheim, Takeda, Merck. He has also been a member of speakers’ bureaus for Glaxo-SmithKline, AstraZeneca, Novartis, Aerocrine, Boehringer-Ingelheim, Pfizer, and Merck. Dr. FitzGerald is a member of the Global Initiative for Asthma (GINA) and is chair of the GINA Executive and a member of its Science Committee. None of the other authors have declared any conflict of interest.

Ethical standard

This study was approved by the Human Ethics board of the University of British Columbia (University of British Columbia Human Ethics No. H10-01542). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

    Wenjia Chen, Larry D. Lynd & Carlo A. Marra

  2. Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    J. Mark FitzGerald, Roxanne Rousseau & Mohsen Sadatsafavi

  3. Institute for Heart and Lung Health, University of British Columbia, Vancouver, BC, Canada

    J. Mark FitzGerald & Mohsen Sadatsafavi

  4. Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada

    Larry D. Lynd & Carlo A. Marra

  5. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

    J. Mark FitzGerald & Mohsen Sadatsafavi

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  1. Wenjia Chen
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  2. Larry D. Lynd
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  3. J. Mark FitzGerald
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  4. Carlo A. Marra
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  6. Mohsen Sadatsafavi
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Correspondence to Mohsen Sadatsafavi.

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Chen, W., Lynd, L.D., FitzGerald, J.M. et al. The added effect of comorbidity on health-related quality of life in patients with asthma. Qual Life Res 24, 2507–2517 (2015). https://doi.org/10.1007/s11136-015-0995-6

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