title: Quantifying the importance of disease burden on perceived general health and depressive symptoms in patients within the Mayo Clinic Biobank.
abstract: BACKGROUND
  Deficits in health-related quality of life (HRQOL) may be associated with worse patient experiences, outcomes and even survival. While there exists evidence to identify risk factors associated with deficits in HRQOL among patients with individual medical conditions such as cancer, it is less well established in more general populations without attention to specific illnesses. This study used patients with a wide range of medical conditions to identify contributors with the greatest influence on HRQOL deficits.
  
  
  METHODS
  Self-perceived general health and depressive symptoms were assessed using data from 21,736 Mayo Clinic Biobank (MCB) participants. Each domain was dichotomized into categories related to poor health: deficit (poor/fair for general health and ≥3 for PHQ-2 depressive symptoms) or non-deficit. Logistic regression models were used to test the association of commonly collected demographic characteristics and disease burden with each HRQOL domain, adjusting for age and gender. Gradient boosting machine (GBM) models were applied to quantify the relative influence of contributors on each HRQOL domain.
  
  
  RESULTS
  The prevalence of participants with a deficit was 9.5 % for perception of general health and 4.6 % for depressive symptoms. For both groups, disease burden had the strongest influence for deficit in HRQOL (63 % for general health and 42 % for depressive symptoms). For depressive symptoms, age was equally influential. The prevalence of a deficit in general health increased slightly with age for males, but remained stable across age for females. Deficit in depressive symptoms was inversely associated with age. For both HRQOL domains, risk of a deficit was associated with higher disease burden, lower levels of education, no alcohol consumption, smoking, and obesity. Subjects with deficits were less likely to report that they were currently working for pay than those without a deficit; this association was stronger among males than females.
  
  
  CONCLUSIONS
  Comorbid health burden has the strongest influence on deficits in self-perceived general health, while demographic factors show relatively minimal impact. For depressive symptoms, both age and comorbid health burden were equally important, with decreasing deficits in depressive symptoms with increasing age. For interpreting patient-reported metrics and comparison, one must account for comorbid health burden.
authors.affiliation: Department of Health Sciences Research, Rochester, MN, USA. ryu.euijung@mayo.edu.
authors.forename: Euijung
authors.initials: E
authors.lastname: Ryu
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, MN, USA. takahashi.paul@mayo.edu.
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Takahashi
authors.affiliation: Department of Health Sciences Research, Rochester, MN, USA. olsonj@mayo.edu.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Olson
authors.affiliation: Department of Health Sciences Research, Rochester, MN, USA. hathcock.matthew@mayo.edu.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Hathcock
authors.affiliation: Department of Health Sciences Research, Rochester, MN, USA. novotny@mayo.edu.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Novotny
authors.affiliation: Department of Health Sciences Research, Rochester, MN, USA. pathak.jyotishman@mayo.edu.
authors.forename: Jyotishman
authors.initials: J
authors.lastname: Pathak
authors.affiliation: Department of Health Sciences Research, Rochester, MN, USA. bielinski.suzette@mayo.edu.
authors.forename: Suzette J
authors.initials: SJ
authors.lastname: Bielinski
authors.affiliation: Department of Health Sciences Research, Rochester, MN, USA. cerhan.james@mayo.edu.
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
authors.affiliation: Department of Health Sciences Research, Rochester, MN, USA. jsloan@mayo.edu.
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology