Newly Developed Chronic Conditions and Changes in Health-Related Quality of Life in Postmenopausal Women.
OBJECTIVE
To prospectively assess the effects of newly developed chronic conditions on changes in health-related quality of life (HRQoL) in postmenopausal women.


METHODS
Prospective cohort study.


METHODS
Forty clinical centers in the United States.


METHODS
Women aged 50 to 79 enrolled in the Women's Health Initiative Observational Study during 1993-98 (N = 75,198).


METHODS
Onset of seven chronic conditions (hypertension, heart disease, stroke, cancer, osteoporosis, diabetes mellitus, arthritis), HRQoL based on the Medical Outcomes Study 36-item Short Form survey (SF-36), and change in HRQoL from baseline to Year 3 in scores on the Physical (PCS) and Mental (MCS) Component Summary of the SF-36.


RESULTS
Each of the seven chronic conditions was statistically significantly associated with HRQoL for physical and mental health. Women with incident stroke had the greatest decline in HRQoL for physical and mental health (PCS: 10.2, 95% confidence interval (CI) = 8.3-12.1;
10.4, 95% CI = 8.8-12.1), which exceeded minimal clinically important differences (MCID). Having more new chronic conditions was associated with greater decrease in HRQoL. Declines in HRQoL in women with two or more chronic conditions exceeded MCID. Those with heart disease and stroke had the largest decline in physical health, and those with stroke and arthritis had the greatest decline in mental health. For all conditions other than stroke and diabetes mellitus, the more recently a condition was diagnosed, the greater the decrease in PCS. For stroke and cancer, a similar pattern was observed for MCS.


CONCLUSIONS
The more conditions a woman developed, the greater reduction in HRQoL she experienced. Declines in HRQoL in women with stroke, cancer, and some combinations exceeded MCID. Findings from this study might lead to more-effective patient-centered approaches to health care for women with multiple chronic conditions.
Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana.
Juhua
J
Luo
Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana.
Michael
M
Hendryx
Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Monika M
MM
Safford
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
Robert
R
Wallace
HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
Rebecca
R
Rossom
Department of Family Medicine, Alpert Medical School, Brown University, Providence, Rhode Island.|Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.|Family Care Center, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island.
Charles
C
Eaton
Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Shari
S
Bassuk
HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
Karen L
KL
Margolis
D000368:Aged; D001168:Arthritis / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology; D002908:Chronic Disease; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology; D010024:Osteoporosis / Q000209:etiology; D017698:Postmenopause / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D020521:Stroke / Q000209:etiology
chronic conditions; health-related quality of life; postmenopausal women