Health-related quality of life and risk factor control: the importance of educational level in prevention of cardiovascular diseases.
BACKGROUND
This study aimed to describe and to analyse the importance of educational level for controlled risk factors and health-related quality of life (HRQoL).


METHODS
This observational study was conducted in nine European countries (5632 patients in 249 practices). We compared patients with a low level of education (up to 9 years) with patients with a high level of education (>9 years), with regard to controlled cardiovascular disease risk factors and HRQoL. A multilevel approach was used for statistical analysis.


RESULTS
Patients with a low level of education were older (P < 0.001), more often female (P < 0.001), more often single (P < 0.001) and had a higher number of other conditions (e.g. heart failure) (P < 0.001). Significant differences in terms of controlled risk factors were revealed for blood pressure (RR) ≤ 140/90 mmHg (P = 0.039) and the sum of controlled risk factors (P = 0.027). Higher age, lower education, female gender, living as single, patient group (coronary heart disease patients) and the number of other conditions were negatively associated with HRQoL. A higher sum of controlled risk factors were positively associated with higher HRQoL in the whole sample (r = 0.0086, P < 0.001) as well as in both educational-level groups (r = 0.0075, P = 0.038 in the low-level group and r = 0.0082, P = 0.001 in the high-level group).


CONCLUSIONS
Patients with a lower educational level were more often females, singles, had a higher number of other conditions, a higher number of uncontrolled risk factors and a lower HRQoL. However, the higher the control of risk factors was, the higher the HRQoL was overall as well as in both educational-level groups.
1 Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany dominik.ose@med.uni-heidelberg.de.
Dominik
D
Ose
2 Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Justine
J
Rochon
1 Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany3 Institute for Population Health-Centre for Primary Care, University of Manchester, Manchester, United Kingdom.
Stephen M
SM
Campbell
1 Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany4 Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
Michel
M
Wensing
1 Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany.
Tobias
T
Freund
4 Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
Jan
J
van Lieshout
1 Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany.
Gerda
G
Längst
1 Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany.
Joachim
J
Szecsenyi
1 Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany.
Sabine
S
Ludt
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires