title: Associations between disease awareness and health-related quality of life in a multi-ethnic Asian population.
abstract: BACKGROUND
  Health related quality of life (HRQoL) is an important dimension of individuals' well-being, and especially in chronic diseases like diabetes and hypertension. The objective of this study was to evaluate the contributions of disease process, comorbidities, medication or awareness of the disease to HRQoL in diabetes mellitus, hypertension and dyslipidemia.
  
  
  METHODS
  This was a cross-sectional study of 3514 respondents from the general community in Singapore, assessed for HRQoL, disease and comorbid conditions through self-report, clinical and laboratory investigations. HRQoL was assessed using SF-36 health survey version 2. For each condition, participants were categorized as having 1) no disease, 2) undiagnosed, 3) diagnosed, not taking medication, and 4) diagnosed, taking medication. Analysis used one-way ANOVA and multiple linear regression.
  
  
  RESULTS
  Diagnosed disease was associated with lower physical health component summary (PCS) scores across all three conditions. After adjustment for comorbidities, this association remained significant only for those not on medication in diabetes (-2.7±1.2 points, p = 0.03) and dyslipidemia (-1.3±0.4 points, p = 0.003). Diagnosed hypertension (no medication -2.6±0.9 points, p = 0.002; medication -1.4±0.5 points, p = 0.004) and dyslipidemia (no medication -0.9±0.4 points, p = 0.03; medication -1.9±0.5 points, p<0.001) were associated with lower mental health component summary (MCS) scores. Undiagnosed disease was associated with higher MCS in diabetes (2.4±1.0 points, p = 0.01) and dyslipidemia (0.8±0.4 points, p = 0.045), and PCS in hypertension (1.2±0.4 points, p = 0.004).
  
  
  CONCLUSIONS
  Disease awareness was associated with lower HRQoL across the diseases studied, with PCS associations partially mediated by comorbidities. Equally importantly, undiagnosed disease was not associated with HRQoL deficits, which may partly explain why these individuals do not seek medical care.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
authors.forename: Kavita
authors.initials: K
authors.lastname: Venkataraman
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.
authors.forename: ChinMeng
authors.initials: C
authors.lastname: Khoo
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore, Singapore; Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Hwee Lin
authors.initials: HL
authors.lastname: Wee
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
authors.forename: Chuen Seng
authors.initials: CS
authors.lastname: Tan
authors.affiliation: Epidemiology and Disease Control Division, Ministry of Health, Singapore, Singapore.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ma
authors.affiliation: Epidemiology and Disease Control Division, Ministry of Health, Singapore, Singapore.
authors.forename: Derrick
authors.initials: D
authors.lastname: Heng
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore; Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
mesh_terms: D000328:Adult; D044466:Asian People / Q000208:ethnology; D001364:Awareness; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D050171:Dyslipidemias / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012846:Singapore / Q000453:epidemiology