Preferences for current health and their association with outcomes in patients with kidney disease.
BACKGROUND
Patients with chronic disease who express stronger preference for their current health might be expected to have better outcomes than patients who assign lower utility to their current health state.


OBJECTIVE
We sought to examine associations between preferences for current health and outcomes in a national cohort of incident hemodialysis patients.


METHODS
In 567 patients treated at 74 clinics, we measured patients' preferences by time trade-off on a 0-1 scale (1=willingness to sacrifice no life expectancy to achieve perfect health; 0=zero value of current health). Associations between these preferences and outcomes were examined with Poisson (hospitalization), logistic (progression of comorbidity and clinical performance), and Cox proportional hazards (mortality) models.


RESULTS
The distribution of preference scores was skewed, with a mean of 0.69 and a median of 0.83. Highest (1.0) scores were associated with decreased incidence of hospitalization (incidence risk ratio=0.88, 95% confidence interval=0.80-0.97), relative to the lowest (<0.50) scores, a finding that was consistent across gender and race, with women and white subjects having greater decreases (Pinteraction<0.001). Higher preferences for current health also were associated with less worsening of comorbidity. Adjusted risks of death for patients with intermediate (>or=0.50-1.0) and the highest preference scores for current health were not different from those with lower scores.


CONCLUSIONS
In patients with chronic kidney disease, a stronger preference for current health is associated with lower hospital admission rates and improved comorbidity but not better survival.
Plantinga
Laura C
LC
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.
Fink
Nancy E
NE
Bass
Eric B
EB
Boulware
L Ebony
LE
Meyer
Klemens B
KB
Powe
Neil R
NR
D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors