Assessment of children's health-related quality of life in the United States with a multidimensional index.
OBJECTIVE
Using nationally representative data, we examined biological, medical system, and sociodemographic factors that are associated with health-related quality of life as measured by a multidimensional index that accounts for a wide range of child health domains.


METHODS
Children aged > or = 6 years (N = 69,031) were drawn from the 2003/2004 National Survey of Children's Health. A random 25% sample was used to create a 12-item index of health-related quality of life with a range of 0 to 100, based on the conceptual framework of the Child Health and Illness Profile. Bivariate and multivariable regression analyses were conducted to identify the unadjusted and independent associations of key biological, medical system, and sociodemographic variables with health-related quality of life.


RESULTS
The index mean was 72.3 (SD: 14.5), median value was 73.7, and range was 11.1 to 99.9. Only 0.2% of children had a score at the ceiling. In multivariable regression analysis, the following variables were independently associated with lower health-related quality of life: biological factors (greater disease burden, severe asthma, and overweight status); medical system factors (unmet medical needs, lack of a regular health care provider, Medicaid insurance, or being uninsured previously during the year); and sociodemographic factors (older age groups, lower family education, single-mother family, having a smoker in the household, black race, and poverty).


CONCLUSIONS
Health-related quality of life in the United States is poorest for children and youth in lower socioeconomic status groups, those with access barriers, adolescents compared with children, and individuals with medical conditions. A multidimensional health-related quality-of-life index is an alternative to conventional measures (eg, mortality) for national monitoring of child health.
Johns Hopkins University, USA. fpa8@cdc.gov
Alan E
AE
Simon
Kitty S
KS
Chan
Christopher B
CB
Forrest
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D008484:Medicaid / Q000592:standards* / Q000639:trends; D008913:Minority Groups / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D011203:Poverty; D011788:Quality of Life; D012044:Regression Analysis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States