title: The impact of multimorbidity on quality of life among midlife women: findings from a U.S. nationally representative survey.
abstract: BACKGROUND
  Little is known about the prevalence and cumulative burden of coexisting health conditions including chronic joint and muscular pain, urinary incontinence (UI), depression, osteoporosis risk, moderate/severe vasomotor symptoms, and vulvar/vaginal atrophy (VVA). We surveyed a nationally representative U.S. sample of midlife (age 40-64 years) women to ascertain the prevalence, general health-related quality of life (HRQoL), and health-seeking behaviors associated with these six conditions.
  
  
  METHODS
  This cross-sectional, telephone survey collected data from a sample of English- and Spanish-speaking U.S. women. The survey contained demographic and menopausal status questions, and also five condition-specific symptom/disease risk-screening instruments. The EuroQol 5 dimensions (EQ-5D) questionnaire was used to measure HRQoL. Health-seeking behavior was measured based on clinician discussion of and recent treatment for each condition.
  
  
  RESULTS
  Three thousand fifty eight women (mean age 53.4 years) completed the survey. The majority were white (75.6%), married (60.5%), employed full- or part-time (59.0%), and postmenopausal (69.8%; based on self-report). The prevalence [95% confidence interval] of 0, 1, 2, and ≥3 conditions was 35.2% [33.5-36.9], 34.2% [32.5-35.9], 17.9% [16.6-19.3], and 12.7% [11.5-13.9], respectively. Osteoporosis risk (30.6%) was most prevalent, followed by VVA (27.8%) and UI (26.6%). UI and VVA coexisted most frequently (11.3%), followed by osteoporosis risk and VVA (9.8%). EQ-5D scores decreased with increasing number of illnesses (0, 1, 2, and ≥3 conditions, means: 0.92, 0.87, 0.77, 0.61, respectively; p<0.01). Health-seeking behavior varied by condition.
  
  
  CONCLUSIONS
  Over 25% of women surveyed had multiple coexisting conditions. Lower HRQoL was associated with multiple conditions and with each added condition.
authors.affiliation: 1 Boston Health Economics, Inc. , Waltham, Massachusetts.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lang
authors.forename: Ivy M
authors.initials: IM
authors.lastname: Alexander
authors.forename: James
authors.initials: J
authors.lastname: Simon
authors.forename: Matthew
authors.initials: M
authors.lastname: Sussman
authors.forename: Iris
authors.initials: I
authors.lastname: Lin
authors.forename: Joseph
authors.initials: J
authors.lastname: Menzin
authors.forename: Mark
authors.initials: M
authors.lastname: Friedman
authors.forename: David
authors.initials: D
authors.lastname: Dutwin
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Bushmakin
authors.forename: Maia
authors.initials: M
authors.lastname: Thrift-Perry
authors.forename: Corrado
authors.initials: C
authors.lastname: Altomare
authors.forename: Ming-Ann
authors.initials: MA
authors.lastname: Hsu
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014481:United States; D014549:Urinary Incontinence / Q000453:epidemiology*; D014623:Vaginal Diseases / Q000453:epidemiology*