Estimating EuroQol EQ-5D Scores from Population Healthy Days Data

Background. Preference-based assessments of population health, which may be used for cost-utility analyses, are lacking for most states and communities. With adequate population data, preference-based values can be estimated from non-preference-based health-related quality of life (HRQOL) data. This study estimates scores on the EuroQol EQ-5D, a preference-based measure, from the Healthy Days Measures.Methods.No data set from the US population asks both the Healthy Days and EQ-5D questions for the same respondents. Therefore, estimates for EQ-5D scores were obtained indirectly by matching cumulative distributions of the 2 measures. These distributions were estimated from the 2000— 2002 Behavioral Risk Factor Surveillance System (BRFSS) and the Medical Expenditure Panel Survey (MEPS). The validity of estimates was examined by comparing the mean estimated and observed scores across particular population subgroups. A simulation study was conducted to compare the performance of the proposed method to the regression method.Results.The overall mean observed EQ-5D index was 0.871 and the mean estimated EQ-5D index was 0.872. In the majority of examined subgroups, the mean scores demonstrated a good match according to sociodemographic variables and health-related conditions and, with the exception of the most impaired health states, the differences tended to be less than 0.04.Conclusions.This study provided preliminary estimates of EQ-5D scores from the Healthy Days Measures and demonstrated acceptable validity of the estimates. Because the Healthy Days Measures have been included in many state and local surveys, preliminary cost-utility analyses and determination of burden of disease might be able to be conducted at the national, state, and community levels as well as over time

Impact of nine chronic conditions for US adults aged 65 years and older: an application of a hybrid estimator of quality-adjusted life years throughout remainder of lifetime

Abstract or Description: Purpose: To estimate quality-adjusted life years (QALY) loss due to each of the following nine chronic conditions—depression, diabetes mellitus, hypertension, heart disease, stroke, emphysema, asthma, arthritis, and cancer. Methods: We ascertained respondents’ health-related quality of life scores and mortality status from the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES) with mortality follow-up data through December 31, 2011. We included respondents aged 65 years and older (n = 2380). A hybrid estimator was used to calculate QALY from two parts: QALY during the follow-up period and QALY beyond the follow-up period. We calculated QALY by each of the nine chronic conditions. Results: For persons aged 65 and older, QALY throughout the reminder of lifetime was 12.3 years. After adjusting for age- and sex-related differences, depression had an associated 8.2 years of QALY loss; diabetes, 5.6 years; hypertension, 2.5 years; heart disease, 5.4 years; stroke, 6.4 years; emphysema, 8.0 years; asthma, 4.8 years; arthritis, 0.3 years; and cancer, 2.5 years. Compared to persons without any chronic conditions, persons with one condition had an associated 4.7 years of QALY loss; persons with two conditions, 7.9 years; and persons with three or more conditions, 10.8 years. Conclusions: This study presents a QALY estimator for respondents in the NHANES-Linked Mortality File and demonstrates the utility of this method to other follow-up data. Continued application of our method would enable the burden of disease to be compared for a range of health conditions and risk factors in the ongoing effort to improve population health

Recent Trends and Geographic Patterns of the Burden of Disease Attributable to Smoking

AbstractPurposeQuality-adjusted life-years (QALYs) use a single number to provide an assessment of the overall health burden of diseases associated both with mortality and morbidity. This study examined the trend and geographic variation of the burden of smoking by calculating smoking-related QALYs lost from 1993 to 2008 for the US adults and individual states.MethodsPopulation health-related quality of life scores were estimated from the 1993 to 2008 Behavioral Risk Factor Surveillance System. The smoking-related QALYs lost are the sum of QALYs lost due to morbidity and future QALYs lost in expected life years due to premature deaths (mortality).ResultsFrom 1993 to 2008, the percent of US adults who smoked declined from 22.7% to 18.5%, but the smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. Although smoking contributed more QALYs lost for men (0.0535) than for women (0.0339), smoking-related QALYs lost decreased by 2.5% for men but increased by 12.6% for women. Kentucky, Oklahoma, Mississippi, West Virginia, and Tennessee had the most smoking-related QALYs lost wheras Utah, California, Connecticut, Minnesota, and Hawaii had the least QALYs lost. The state tobacco tax rate was strongly and negatively associated with both the percent smoked (r = −0.60) and QALYs lost (r = −0.54), as well as the percentage change in both.ConclusionsThis analysis quantified the overall burden of smoking for the nation and individual states from 1993 to 2008. Such data might assist in providing specified quantitative targets for the Healthy People 2020 smoking-related health objectives and for tracking changes on a yearly basis

Dose-response effect of smoking status on quality-adjusted life years among U.S. adults aged 65 years and older

Background: To estimate the impact of smoking on quality-adjusted life years (QALY) for US adults aged 65 years and older. Methods: Using the 2003–08 National Health and Nutrition Examination Survey Linked Mortality File, we estimated the mean QALY throughout the remaining lifetime by participants' smoking status as well as smoking intensity and time since cessation. Results: Never, former and current smokers had a mean QALY of 16.1, 12.7 and 7.3 years, respectively. Among current smokers, those who started smoking before age 18 had fewer QALYs than those who started at or after age 18 (6.0 and 8.5 years, respectively) and those smoking ≥20 cigarettes per day had fewer QALYs than those smoking <20 cigarettes per day (6.6 and 8.1 years, respectively). QALYs also declined with a longer duration of smoking and a shorter time since cessation. The potential gains if a person quit smoking would be 5.4 QALYs, and the gains would increase with a longer time since quitting as well as quitting at a younger age. Conclusions: This study demonstrated the dose–response effect of smoking status on QALY. The results indicate the health benefits of tobacco cessation at any age and sizeable losses for former or current smokers

Trends in Quality-Adjusted Life-Years Lost Contributed by Smoking and Obesity

Background: Quality-adjusted life-years (QALYs) use preference-based measurements of health-related quality-of-life (HRQOL) to provide an assessment of the overall burden of disease using a single number. Purpose: This study estimated QALYs lost contributed by smoking and obesity for U.S. adults from 1993 to 2008. Methods: Population HRQOL data were from the 1993–2008 Behavioral Risk Factor Surveillance System. The QALYs lost contributed by a risk factor is the sum of QALYs lost due to morbidity in the current year and future QALYs lost in expected life-years due to premature deaths (mortality). Premature deaths were estimated from the National Health Interview Survey Linked Mortality Files and mortality statistics. Results: From 1993 to 2008, the proportion of smokers among U.S. adults declined 18.5% whereas the proportion of obese people increased 85%. The smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. In 1993 the QALYs lost were much smaller for obesity compared to smoking, with obesity contributing about 0.0204 QALYs lost. However, as a result of the increasing prevalence of obesity, the contribution of obesity-related QALYs lost increased consistently and had increased by 127% in 2008 when obesity resulted in 0.0464 QALYs lost, slightly more than smoking did. Smoking had a bigger impact on mortality than morbidity, whereas obesity had a bigger impact on morbidity than mortality. Conclusions: This study estimated the overall burden of smoking and obesity over time and results indicate that because of the marked increase in the proportion of obese people, obesity has become an equal, if not greater, contributor to the burden of disease than smoking. Such data are essential in setting targets for reducing modifiable health risks and eliminating health disparities

Dose-response effect of smoking status on quality-adjusted life years among U.S. adults aged 65 years and older

Background: To estimate the impact of smoking on quality-adjusted life years (QALY) for US adults aged 65 years and older. Methods: Using the 2003–08 National Health and Nutrition Examination Survey Linked Mortality File, we estimated the mean QALY throughout the remaining lifetime by participants' smoking status as well as smoking intensity and time since cessation. Results: Never, former and current smokers had a mean QALY of 16.1, 12.7 and 7.3 years, respectively. Among current smokers, those who started smoking before age 18 had fewer QALYs than those who started at or after age 18 (6.0 and 8.5 years, respectively) and those smoking ≥20 cigarettes per day had fewer QALYs than those smoking <20 cigarettes per day (6.6 and 8.1 years, respectively). QALYs also declined with a longer duration of smoking and a shorter time since cessation. The potential gains if a person quit smoking would be 5.4 QALYs, and the gains would increase with a longer time since quitting as well as quitting at a younger age. Conclusions: This study demonstrated the dose–response effect of smoking status on QALY. The results indicate the health benefits of tobacco cessation at any age and sizeable losses for former or current smokers

Trends in HPV Vaccine Initiation and Completion among Girls in Texas: Behavioral Risk Factor Surveillance System Data, 2008–2010

Objective: The objective of this study was to evaluate the trend of HPV vaccine initiation and completion among girls in Texas from 2008 to 2010. Methods: Data were obtained from the Behavioral Risk Factors Surveillance System (BRFSS) over 3 years (2008–2010). The information regarding HPV vaccination was gathered from the parents of 9- to 17-year-old daughters (choosing only 1 per household) in randomly selected households in the sample area. Results: The highest prevalence of vaccine initiation and completion were detected in 2010 (20.9% and 9.7%, respectively). Over the study period, HPV vaccine initiation statistically significantly increased (2008, 14.9%; 2009, 20.7%; 2010, 24.3%; p = 0.002), corresponding to an annual increase in coverage of 33.5% (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.11–1.60). Similarly, HPV vaccination completion increased (2008, 6.3%; 2009, 9.6%; 2010, 11.6%; p = 0.021), corresponding to an annual increase in coverage of 37.1% (OR = 1.37; 95% CI: 1.05–1.79). Increasing trends in HPV vaccination initiation and completion were observed in mothers, white, non- Hispanic parents, parents who had attended some college or were college graduates, parents who were married/partnered, and parents who lived in urban areas. Conclusion: Although HPV vaccination coverage in Texas is lower than recommended, there have been increases in the trends of vaccine initiation and completion. The campaigns promoting HPV vaccination should target specific population groups in which HPV immunization rates did not increase over time

The burden of disease associated with being African-American in the United States and the contribution of socio-economic status

The burden of disease associated with being African-American in the US, and the contribution of socio-economic status (SES) to that burden have not been quantified. We derived burden of disease estimates for African-Americans and whites by age group, with and without adjustment for SES (income and education). We used (1) EQ-5D Index scores from the 2000 US Medical Expenditure Panel Survey to derive quality-adjusted life year (QALY) compatible estimates of health-related quality of life (HRQL); (2) 1990–1992 US National Health Interview Survey data linked to National Death Index data through 1995 to derive mortality risks; and (3) 2000 US mortality data from the National Center for Health Statistics to derive current mortality estimates for the US population. We found that relative to whites, African-Americans suffer 67,000 more deaths annually, resulting in 2.2 million years of life lost, and 1.1 million years after SES adjustment. Total QALYs lost (HRQL and mortality) dropped from 2.3 million to 902,000 after SES adjustment. SES differences between African-Americans and whites appear to explain all the HRQL disparity but only half the mortality disparity. Better understanding of the disparate effects of SES may inform interventions to address health disparities adversely affecting African-Americans

Gender and the Burden of Disease Attributable to Obesity

Objectives. We estimated the burden of disease in the United States attributable to obesity by gender, with life expectancy, quality-adjusted life expectancy, years of life lost annually, and quality-adjusted life years lost annually as outcome measures. Methods. We obtained burden of disease estimates for adults falling into the following body-mass index categories: normal weight (23 to <25), overweight (25 to <30), and obese (≥ 30). We analyzed the 2000 Medical Expenditure Panel Survey to obtain health-related quality-of-life scores and the 1990–1992 National Health Interview Survey linked to National Death Index data through the end of 1995 for mortality. Results. Overweight men and women lost 270 000 and 1.8 million quality-adjusted life years, respectively, relative to their normal-weight counterparts. Obese men and women lost 1.9 million and 3.4 million quality-adjusted life years, respectively, per year. Much of the burden of disease among overweight and obese women arose from lower health-related quality of life and late life mortality. Conclusions. Relative to men, women suffer a disproportionate burden of disease attributable to overweight and obesity, mostly because of differences in health-related quality of life

Burden of disease associated with lower levels of income among US adults aged 65 and older

Background: Persons aged 65 years and older represent a heterogeneous group whose prevalence in the USA is expected to markedly increase. Few investigations have examined the total burden of disease attributable to lower levels of income in a single number that accounts for morbidity and mortality. Methods: We ascertained respondents’ health-related quality of life (HRQOL) scores and mortality status from the 2003 to 2004, 2005 to 2006, 2007 to 2008 and 2009 to 2010 cohorts of the National Health and Nutrition Examination Survey (NHANES) with mortality follow-up through 31 December 2011. A mapping algorithm based on respondents’ age and answers to the 4 core Healthy Days questions was used to obtain values of a preference-based measure of HRQOL, the EuroQol five dimensions questionnaire (EQ-5D) index, which enables quality-adjusted life years (QALYs) to be calculated. We included only respondents aged 65 years and older at the baseline, yielding a total sample size of 4952. We estimated mean QALYs according to different categories of income based on the percentage of Federal Poverty Level (FPL). Results: After adjusting for age, gender and education, the remaining QALYs decreased with each successive decrement of category of income, ranging from 18.4 QALY (≥500% FPL) to 8.6 QALY (\u3c100% FPL). Compared with participants with a mean income of ≥250% FPL, participants with an income \u3c250% FPL had significant losses in QALY for most of the sociodemographic groups examined. In contrast, persons with a lower educational attainment did not show a corresponding loss in QALY according to income category. Conclusions: This study confirmed the association between lower income category and greater burden of disease, as measured by QALYs lost, among the US population aged 65 years and older. Our findings provide additional evidence of the role played by other key determinants of health and how factors not traditionally addressed by the healthcare system impact the life cycle of individuals and communities