title: Health-related quality of life as a predictor of mortality among community-dwelling older persons.
abstract: Health-related quality of life (HRQOL) measures predict cause-specific mortality, but few studies have explored whether generic self-reported HRQOL measures are independently associated with mortality in community-dwelling older persons. We postulated that a general measure of HRQOL, the short form 36-item questionnaire (SF-36), would be independently predictive of mortality among community-dwelling older persons. To evaluate this hypothesis, we followed a fixed cohort of 4,424 community-dwelling older persons recruited from a 2000 population-based survey in Taiwan until 2003 and investigated whether HRQOL was predictive of 3-year mortality, even after adjusting for traditional clinical risk variables. The data were collected via a door-to-door survey, and interviewers collected information on the subjects' demographics, medical history, utilization of health services, functional ability, falls, and self-reported physical and mental symptoms. Of the 6053 eligible subjects, 4,424 residents agreed to participate in the baseline survey and were contacted in 2003. During the 3-year period, the 3-year cumulative mortality rate for the study population was 5%. Mortality was significantly higher among males (5.57% vs. 4.27%, p = 0.049), and cumulative mortality increased with age (chi (2)-test for trend; chi (2) = 7.734, p = 0.001). For all scales except bodily pain, there was a significant relationship between a 10-point lower baseline score and mortality. Our primary multivariate risk model, which included two summary measures of HRQOL and significant clinical variables, demonstrated that a 10-point decrease in either the baseline Physical Component Summary (PCS) score or the baseline Mental Component Summary (MCS) score was associated with higher mortality (PCS: RR: 1.60, 95% CI: 1.39-1.83; p < 0.001; MCS: RR: 1.16, 95% CI: 1.01-1.34; p = 0.036). The findings suggested that low baseline PCS and MCS scores were important independent risk factors for 3-year mortality among community-dwelling older persons, even after adjusting for other risk factors.
authors.affiliation: Department of Health Management, I-Shou University, No. 1 Sec. 1 Syuecheng Rd., Dashu Township, Kaohsiung Country 840, Kaohsiung, Taiwan ROC. sytsai@isu.edu.tw
authors.forename: Su-Ying
authors.initials: SY
authors.lastname: Tsai
authors.forename: Lin-Yang
authors.initials: LY
authors.lastname: Chi
authors.forename: Chen-Hsen
authors.initials: CH
authors.lastname: Lee
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009026:Mortality; D011788:Quality of Life; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology