title: Understanding the determinants of health for people with type 2 diabetes.
abstract: OBJECTIVE
  We assessed which of a broad range of determinants of health are most strongly associated with health-related quality of life (HRQL) among people with type 2 diabetes.
  
  
  METHODS
  Our analysis included respondents from the Canadian Community Health Survey Cycle 1.1 (2000-2001) who were aged 18 years and older and who were identified as having type 2 diabetes. We used regression analyses to assess the associations between the Health Utilities Index Mark 3 and determinants of health.
  
  
  RESULTS
  Comorbidities had the largest impact on HRQL, with stroke (-0.11; 95% confidence interval [CI] = -0.17, -0.06) and depression (-0.11; 95% CI = -0.15, -0.06) being associated with the largest deficits. Large differences in HRQL were observed for 2 markers of socioeconomic status: social assistance (-0.07; 95% CI=-0.12, -0.03) and food insecurity (-0.07; 95% CI=-0.10, -0.04). Stress, physical activity, and sense of belonging also were important determinants. Overall, 36% of the variance in the Health Utilities Index Mark 3 was explained.
  
  
  CONCLUSIONS
  Social and environmental factors are important, but comorbidities have the largest impact on HRQL among people with type 2 diabetes.
authors.affiliation: Institute of Health Economics, Edmonton, Alberta, Canada.
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Maddigan
authors.forename: David H
authors.initials: DH
authors.lastname: Feeny
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Karen B
authors.initials: KB
authors.lastname: Farris
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000368:Aged; D002170:Canada; D015897:Comorbidity; D003863:Depression / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012944:Social Support; D020521:Stroke / Q000209:etiology