title: Relative impact of multimorbid chronic conditions on health-related quality of life--results from the MultiCare Cohort Study.
abstract: BACKGROUND
  Multimorbidity has a negative impact on health-related quality of life (HRQL). Previous studies included only a limited number of conditions. In this study, we analyse the impact of a large number of conditions on HRQL in multimorbid patients without preselecting particular diseases. We also explore the effects of these conditions on the specific dimensions of HRQL.
  
  
  METHODS
  This analysis is based on a multicenter, prospective cohort study of 3189 multimorbid primary care patients aged 65 to 85. The impact of 45 conditions on HRQL was analysed. The severity of the conditions was rated. The EQ-5D, consisting of 5 dimensions and a visual-analogue-scale (EQ VAS), was employed. Data were analysed using multiple ordinary least squares and multiple logistic regressions. Multimorbidity measured by a weighted count score was significantly associated with lower overall HRQL (EQ VAS), b = -1.02 (SE: 0.06). Parkinson's disease had the most pronounced negative effect on overall HRQL (EQ VAS), b = -12.29 (SE: 2.18), followed by rheumatism, depression, and obesity. With regard to the individual EQ-5D dimensions, depression (OR = 1.39 to 3.3) and obesity (OR = 1.44 to 1.95) affected all five dimensions of the EQ-5D negatively except for the dimension anxiety/depression. Obesity had a positive effect on this dimension, OR = 0.78 (SE: 0.07). The dimensions "self-care", OR = 4.52 (SE: 1.37) and "usual activities", OR = 3.59 (SE: 1.0), were most strongly affected by Parkinson's disease. As a limitation our sample may only represent patients with at most moderate disease severity.
  
  
  CONCLUSIONS
  The overall HRQL of multimorbid patients decreases with an increasing count and severity of conditions. Parkinson's disease, depression and obesity have the strongest impact on HRQL. Further studies should address the impact of disease combinations which require very large sample sizes as well as advanced statistical methods.
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. c.brettschneider@uke.de
authors.forename: Christian
authors.initials: C
authors.lastname: Brettschneider
authors.forename: Hanna
authors.initials: H
authors.lastname: Leicht
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
authors.forename: Anne
authors.initials: A
authors.lastname: Dahlhaus
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.forename: Jochen
authors.initials: J
authors.lastname: Gensichen
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.forename: Steffi
authors.initials: S
authors.lastname: Riedel-Heller
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schäfer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schön
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003863:Depression / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000503:physiopathology; D010300:Parkinson Disease / Q000503:physiopathology; D011446:Prospective Studies; D011788:Quality of Life