title: Marginal differences in health-related quality of life of diabetic patients with and without macrovascular comorbid conditions in the United States.
abstract: OBJECTIVE
  To examine and quantify, at the US national level, the marginal differences in health-related quality of life (HRQoL) of diabetic patients with and without macrovascular comorbid conditions (MaVCC).
  
  
  METHODS
  Using the pooled Medical Expenditure Panel Survey (MEPS) 2001 and 2003 data, a nationally representative community-dwelling adult sample (age ≥ 18) was included in the study. HRQoL measures included the preference-based EQ-5D index, Euroqol visual analogue scale (EQ-VAS), SF-12 physical component summary (PCS), and SF-12 mental component summary (MCS). Given the censored distribution of the data, a two-part model was used to identify the relationship between MaVCC and the EQ-5D index after controlling for age, sex, race, ethnicity, education, income, employment status, health insurance, smoking status, diabetes severity, and comorbidities. Censored least absolute deviation and ordinary least square models were employed to analyze EQ-VAS and SF-12 PCS/MCS, respectively.
  
  
  RESULTS
  Compared to diabetic patients without MaVCC (N = 2431), those with MaVCC (N = 747) had significantly lower EQ-5D index (-0.062), EQ-VAS (-9.2), SF-12 PCS (-5.0), and MCS (-2.1) after controlling for differences in sociodemographics, smoking status, diabetes severity, and comorbidities (all P < 0.001).
  
  
  CONCLUSIONS
  MaVCC is consistently associated with lower HRQoL for patients with diabetes in the United States. Results of this study are valuable for future comparative-effectiveness and cost-effectiveness analyses in diabetes.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue/JJN3-01, Cleveland, OH 44195, USA. fuz@ccf.org
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Fu
authors.forename: Ying
authors.initials: Y
authors.lastname: Qiu
authors.forename: Larry
authors.initials: L
authors.lastname: Radican
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus; D003925:Diabetic Angiopathies; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult