Julie Bernier

Health behavior change following chronic illness in middle and later life

OBJECTIVES Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life. METHODS Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease. RESULTS Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors. DISCUSSION Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

Bodyweight, gender, and quality of life: a population-based longitudinal study

PurposeThe objective of the paper is to describe trajectories of health-related quality of life (HRQL) associated with categories of body mass index (BMI): underweight, normal weight, overweight, obese class I, and obese classes II and III.MethodsData come from the longitudinal Canadian National Population Health Survey. Analyses are based on data for 3,864 men and 4,745 women who were 40+ in 1998/1999 and followed through 2006/2007. HRQL was measured with the Health Utilities Index Mark 3. Multi-level growth modeling was used.ResultsHRQL declined with age. For men, there was a large HRQL decrement for being underweight; trajectories for all other BMI categories were very similar. For women being underweight was associated with higher HRQL at younger ages but lower at older ages. Otherwise, for women, HRQL was ordered from highest to lowest: normal, overweight, obese class I, and obese classes II and III.ConclusionsGiven that excess weight is a risk factor for mortality and the development of chronic conditions, the HRQL results for men are surprising. The HRQL results for women may reflect both the importance of body image on mental health and the health effects of excess weight.

Trajectories of health-related quality of life by socio-economic status in a nationally representative Canadian cohort

Background Mortality and morbidity have been shown to follow a ‘social gradient’ in Canada and many other countries around the world. Comparatively little, however, is known about whether ageing amplifies, diminishes or sustains socio-economic inequalities in health. Methods Growth curve analysis of seven cycles of the Canadian National Population Health Survey (n=13 682) for adults aged 20 and older at baseline (1994/95). The outcome of interest is the Health Utilities Index Mark 3, a measure of health-related quality of life (HRQL). Models include the deceased so as not to present overly optimistic HRQL values. Socio-economic position is measured separately by household-size-adjusted income and highest level of education attained. Results HRQL is consistently highest for the most affluent and the most highly educated men and women, and is lower, in turn, for middle and lower income and education groups. HRQL declines with age for both men and women. The rate of the decline in HRQL, however, was related neither to income nor to education for men, suggesting stability in the social gradient in HRQL over time for men. There was a sharper decline in HRQL for upper-middle and highest-income groups for women than for the poorest women. Conclusion HRQL is graded by both income and education in Canadian men and women. The grading of HRQL by social position appears to be ‘set’ in early adulthood and is stable through mid- and later life.

Physical activity matters: associations among body mass index, physical activity, and health-related quality of life trajectories over 10 years.

BACKGROUND The objective of this study was to assess the associations among body mass index (BMI), leisure time physical activity (LTPA) and health-related quality of life (HRQL) trajectories among adults. METHODS Self-reported data were drawn from the Canadian National Population Health Survey, with respondents being interviewed every 2 years between 1996-97 and 2006-07. Using growth curve modeling, HRQL trajectories for individuals aged 18 and over were associated with measures of BMI and LTPA. Growth models were constructed separately for males and females. RESULTS Findings suggested that, for males, BMI categories had little impact on baseline HRQL, and no impact on the rate of change in HRQL. Among women, higher BMI categories were associated with significantly lower baseline HRQL. However, BMI had no impact on the rate of change of HRQL. Conversely, for both men and women and regardless of BMI category, LTPA had significant impacts on baseline HRQL, as well as the rate of change in HRQL. Individuals who were inactive or sedentary had much steeper declines in HRQL as they aged, as compared with individuals who were active in their leisure time. CONCLUSIONS The results underscore the importance of LTPA in shaping trajectories of HRQL.

Thirty-day in-hospital revascularization and mortality rates after acute myocardial infarction in seven Canadian provinces.

BACKGROUND Recent clinical trials have demonstrated benefit with early revascularization following acute myocardial infarction (AMI). Trends in and the association between early revascularization after (ie, 30 days or fewer) AMI and early death were determined. METHODS AND RESULTS The Statistics Canada Health Person-Oriented Information Database, consisting of hospital discharge records for seven provinces from the Canadian Institute for Health Information Hospital Morbidity Database, was used. If there was no AMI in the preceding year, the first AMI visit within a fiscal year for a patient 20 years of age or older was included. Times to death in hospital and to revascularization procedures were counted from the admission date of the first AMI visit. Mixed model regression analyses with random slopes were used to assess the relationship between early revascularization and mortality. The overall rate of revascularization within 30 days of AMI increased significantly from 12.5% in 1995 to 37.4% in 2003, while the 30-day mortality rate decreased significantly from 13.5% to 10.6%. There was a linearly decreasing relationship - higher regional use of revascularization was associated with lower mortality in both men and women. CONCLUSIONS These population-based utilization and outcome findings are consistent with clinical trial evidence of improved 30-day in-hospital mortality with increased early revascularization after AMI.

The association between alcohol use and long-term care placement among older Canadians: a 14-year population-based study.

Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.

The burden of disability in children and youths associated with impairments of psychological functions.

The immense burden of health conditions in children that is associated with mental disorders worldwide is increasingly being recognized. In comparison, the burden of disability associated with childrens impairments of psychological functions (IPFs) is not well documented. The goal of this population-based study was to derive a measure of the burden of disability in children associated with IPFs that takes into account the highly variable impact such impairments might have on childrens everyday activities. Data came from the 2001 Participation and Activity Limitation Survey, a national survey of individuals with disabilities living in Canada. Latent class analysis was used to obtain a maximum likelihood estimate of the proportion of children with IPFs living in Canada who were severely limited in their everyday activities, by age and sex. As expected, the burden of disability was not evenly shared among children with IPFs. In fact, only a minority of children with IPFs were severely limited in their everyday activities. This represents approximately 15% of 5-14year-old boys with a disability and 10% of their female counterparts living in Canada. These estimates provide a better appraisal of the burden of disability in children associated with IPFs than previous estimates, which only considered the presence or absence of IPFs.

Measuring health related quality of life (HRQoL) in community and facility-based care settings with the interRAI assessment instruments: development of a crosswalk to HUI3

BackgroundHealth-related quality of life (HRQoL) measures are of interest because they can be used to describe health of populations and represent a broader health outcome for population health analyses than mortality rates or life expectancy. The most widely used measure of HRQoL for deriving estimates of health-adjusted life expectancy is the Health Utilities Index Mark 3 (HUI3). The HUI3 is available in most national surveys administered by Statistics Canada, and has been used as part of a microsimulation model to examine the impact of neurological conditions over the life course. Persons receiving home care and nursing home services are often not well-represented in these surveys; however, interRAI assessment instruments are now used as part of normal clinical practice in these settings for nine Canadian provinces/territories. Building on previous research that developed a HUI2 crosswalk for the interRAI assessments, the present study examined a new interRAI HRQoL index crosswalked to the HUI3.MethodsinterRAI and survey data were used to examine the distributional properties of global and domain-specific interRAI HRQoL and HUI3 index scores, respectively. Three populations were considered: well-elderly persons not receiving home care, home care clients and nursing home residents.ResultsThe mean HUI3 and interRAI HRQoL index global scores declined from independent healthy older persons to home care clients, followed by nursing home residents. For the home care and nursing home populations, the interRAI HRQoL global estimates tended to be lower than HUI3 global scores obtained from survey respondents. While there were some statistically significant age, sex and diagnostic group differences in global scores and within attributes, the most notable differences were between populations from different care settings.DiscussionThe present study provides strong evidence for the validity of the interRAI HRQoL based on comparisons of distributional properties with those obtained with survey data based on the HUI3. The results demonstrate the importance of admission criteria for home care and nursing home settings, where function plays a more important role than demographic or diagnostic criteria. The interRAI HRQoL has a distinct advantage because it is gathered as part of normal clinical practice in care settings where interRAI instruments are mandatory and are used to assess all eligible persons in those sectors. In particular, those with severe cognitive and functional impairments (who tend to be under-represented in survey data) will be evaluated using the interRAI tools. Future research should build on this work by providing direct, person-level comparisons of interRAI HRQoL index and HUI3 scores, as well as longitudinal analyses to examine responsiveness to change.

Erratum to: Bodyweight, gender, and quality of life: a population-based longitudinal study

Erratum to: Qual Life ResDOI 10.1007/s11136-011-9989-1In the original article, the two equations appearing in theAppendix were reversed. The correct version of theAppendix is as follows:As noted in the main text of the paper, overall HUI3scores were highly skewed and were transformed using thearcsine transformation to achieve normally distributedresiduals.The methods are explained in detail in Bernier et al.[52]. The formula used to adjust HUI3 values is givenbelow:arcsin HUI3