Health And Quality Of Life Outcomes[JOURNAL]
Sun
200 papers
"That kind of changes things": a meta-synthesis of the lived experiences of people with chronic heart disease.
Nebel L, Le Butt T, Sell C … +2 more , Herrmann-Lingen C, Broschmann D
Health Qual Life Outcomes · 2025 Sep · PMID 40968375 · Full text
AIMS: To explore the lived experiences of people with chronic heart disease (PCHD). DESIGN: Systematic meta-synthesis. METHODS: Following preregistration on PROSPERO, a systematic literature search was conducted in PubMe...
AIMS: To explore the lived experiences of people with chronic heart disease (PCHD). DESIGN: Systematic meta-synthesis. METHODS: Following preregistration on PROSPERO, a systematic literature search was conducted in PubMed, PsycInfo, PsycArticles, and PSYNDEX between February 2023 and March 2024. Articles were assessed for eligibility based on predefined criteria and evaluated for methodological quality using a modified CASP tool. The results of the included primary studies were weighted according to their methodological quality and synthesized using Interpretative Phenomenological Analysis. The reporting adheres to PRISMA and ENTREQ guidelines. RESULTS: The analysis of 43 articles revealed an overarching theme: “The broken flow of life.” This theme illustrates the disruption of normalcy, as perceived by patients through distinct dimensions. These dimensions are represented by the four subthemes: (1) I no longer feel safe in my body, (2) Suddenly, I have less of a future, (3) My identity feels shattered, and (4) My disease strains my relationships. CONCLUSIONS: The findings suggest that PCHD perceive their condition as a profound disruption of normalcy, affecting bodily, relational, and psychological dimensions that extend beyond established HRQOL measures. IMPLICATIONS: The findings have direct implications for the assessment of HRQOL in medicine. To adequately evaluate holistic treatments, a deeper understanding of how the disease affects life planning and future perspectives is essential. Consequently, established HRQOL measures may need to be extended both in content and temporal scope to capture these broader impacts.
Health-related quality of life among adults with hypertension with or without anxiety and depression: estimates from a national US data.
Alwhaibi M, Balkhi B
Health Qual Life Outcomes · 2025 Sep · PMID 40926255 · Full text
BACKGROUND: Hypertension is a prevalent chronic medical condition that can impact health-related quality of life (HRQoL). While a relationship between mental disorders and hypertension is established, the incremental imp...
BACKGROUND: Hypertension is a prevalent chronic medical condition that can impact health-related quality of life (HRQoL). While a relationship between mental disorders and hypertension is established, the incremental impact of co-occurring mental disorders on HRQoL in hypertensive individuals has not been well-quantified. This study’s primary objective is to examine this relationship using a nationally representative sample. METHODS: A retrospective cross-sectional study design was employed. This research uses data from 2016 to 2021 from the Medical Expenditure Panel Survey (MEPS). The study included adult patients with hypertension diagnosis who were 18 years of age or older. The Veterans RAND 12 Item Health Survey (VR-12©) was used to determine HRQoL. A linear regression model was used to estimate the predictors of HRQoL. RESULTS: A total of 11,773 adults with hypertension were identified. Among them, 8.0% had depression, 9.8% had anxiety, and 6.1% had both illnesses. Hypertensive patients with anxiety or depression had a significantly lower mean PCS score and MCS score compared to those without these mental illnesses. After adjusting for other variables, the HRQoL of hypertensive patients with depression (MCS: β = -6.398), anxiety (MCS: β = -4.438), and both illnesses (MCS: β = -9.211) was significantly lower than that of individuals without these conditions. CONCLUSIONS: Depression and anxiety were significantly associated with reduced HRQoL among adults with hypertension. These findings emphasize the significant mental burden in this population. Given the cross-sectional natural of this study, causal relationships could not be established; therefore, future longitudinal studies are needed to explore the direction and mechanisms of these associations.
A reinvigorated Health and Quality of Life Outcomes: recent successes and renewed aims & scope.
Oremus M, Mulhern B, Rivero-Arias O … +1 more , Rencz F
Health Qual Life Outcomes · 2025 Sep · PMID 40914796 · Full text
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Evaluating the impact of self-management interventions on COPD outcomes in low- and middle-income countries in Asia: a systematic review.
Adhikari S, Thapa S, Rattanapan C … +3 more , Laosee O, Sriram S, Bhatta J
Health Qual Life Outcomes · 2025 Aug · PMID 40885979 · Full text
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) presents a significant health and economic challenge in low- and middle-income countries (LMICs) in Asia, where healthcare resources are often limited. Self-manage...
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) presents a significant health and economic challenge in low- and middle-income countries (LMICs) in Asia, where healthcare resources are often limited. Self-management programs (SMPs) offer a potential solution by empowering patients to manage their condition and reduce healthcare costs. However, there needs to be more consolidated evidence on the effectiveness of these programs in LMICs, and their success may depend on specific contextual factors. METHODS: This systematic review analyzed studies on COPD self-management interventions in Asian LMICs, focusing on outcomes such as health-related quality of life (HRQoL), exacerbation rates, healthcare utilization, and out-of-pocket (OOP) costs. Two databases- PubMed and Scopus were systematically searched following PRISMA guidelines, and data were extracted and analyzed to identify the effectiveness of these programs and the challenges encountered during implementation. RESULTS: The findings indicate that self-management programs in LMICs can improve HRQoL, reduce exacerbation rates, and lower OOP costs in specific contexts. However, the effectiveness of these programs is influenced by local healthcare infrastructure, digital and health literacy, and economic barriers. Digital interventions tended to be more beneficial in urban areas with better infrastructure, while programs led by community health workers were more effective in rural settings. CONCLUSION: Self-management interventions show promise for managing COPD in resource-limited settings, but context-specific adaptations are essential. Flexible program designs tailored to local conditions and strengthened collaborations among healthcare providers and policymakers are crucial for sustainable implementation and scaling.
Predicting children and adolescents at high risk of poor health‑related quality of life using machine learning methods.
Xiong C, Zhang L, Li Z … +2 more , Chen J, Qian H
Health Qual Life Outcomes · 2025 Aug · PMID 40859335 · Full text
BACKGROUND: Existing research has identified health‑related quality of life (HRQoL) is influenced by a multitude of factors among children and adolescents. However, there has been relatively limited exploration of the mu...
BACKGROUND: Existing research has identified health‑related quality of life (HRQoL) is influenced by a multitude of factors among children and adolescents. However, there has been relatively limited exploration of the multidimensional predictive factors (individual characteristics, health risk behaviors, and negative life events) that contribute to HRQoL. This study aimed to develop a nomogram to predict the HRQoL in children and adolescents. METHODS: A total of 12,145 children and adolescents were surveyed using stratified cluster sampling method, randomly divided into a training set (n = 8503) and a validation set (n = 3642). Logistic regression, lasso regression, and random forest models were combined to identify the most significant predictors of HRQoL. A nomogram was constructed using multivariate logistic regression. The receiver operating characteristic curve, k-fold cross-validation, decision curve analysis (DCA), and internal validation were used to assess the accuracy, discrimination, and generalization of the nomogram. RESULTS: Non-suicidal self-injury, academic burnout, parental abuse, stress, bullying victimization, healthy diet, and sleep were found to be significant predictors of HRQoL. The area under the curve (AUC) of the training set was 0.765, whereas that of the validation data was 0.775. The k-fold cross-validation (k = 10) revealed good discrimination in internal validation (mean AUC = 0.771). The nomogram had good clinical use since the DCA covered a large threshold probability: 5%-89% (in the training set) and 4%-81% (in the validation set). CONCLUSIONS: The nomogram prediction model constructed in this study can provide a reference for predicting HRQoL in children and adolescents.
Explainable machine learning identifies key quality-of-life-related predictors of arthritis status: evidence from the China health and retirement longitudinal study.
Lin K, Jiang T, Liao J … +5 more , Zhou X, Wang Z, Chen Y, Xu X, Zhou B
Health Qual Life Outcomes · 2025 Aug · PMID 40859240 · Full text
BACKGROUND: Arthritis is a prevalent chronic disease substantially impacting patients' quality of life (QoL). While identifying key determinants associated with arthritis is critical for targeted interventions, tradition...
BACKGROUND: Arthritis is a prevalent chronic disease substantially impacting patients' quality of life (QoL). While identifying key determinants associated with arthritis is critical for targeted interventions, traditional statistical methods often struggle with complex interactions, and existing machine learning (ML) approaches frequently lack the interpretability needed to guide clinical decisions. This study integrates a comprehensive, explainable machine learning (XAI) workflow to identify and interpret key QoL-related predictors of arthritis status in a large national cohort. METHODS: Data were obtained from 15,011 participants aged > 45 years in the 2020 China Health and Retirement Longitudinal Study (CHARLS). We initially selected 55 potential QoL-related predictors spanning demographic, functional, pain, psychosocial, and lifestyle domains. Feature engineering was performed to create aggregate scores, indicators, and binned variables. Missing data were handled using imputation combined with missing indicator variables. A LightGBM-based feature selection process identified 68 key predictors. Nine ML models (including Logistic Regression, RandomForest, GradientBoosting, LightGBM, CatBoost, XGBoost, DecisionTree, NaiveBayes, KNN) were developed using SMOTE-resampled training data, with hyperparameters optimized via Optuna targeting recall. Performance was evaluated on a held-out test set using Area Under the ROC Curve (AUC), Average Precision (AP), Recall, Specificity, Precison, and F1-score. SHapley Additive exPlanations (SHAP) analysis was applied to the best-performing model (GradientBoosting) for interpretation. RESULTS: Several models achieved strong predictive performance, with GradientBoosting yielding the highest AUC (0.767, 95% CI: 0.752-0.782) and high AP (0.678, 95% CI: 0.655-0.702). SHAP analysis identified multi-site pain burden (particularly knee/leg pain and pain location count), age, self-rated health, sleep quality, functional limitations (ADL counts/scores), and negative affect as the most influential predictors driving arthritis status prediction. CONCLUSIONS: This study successfully applied an XAI pipeline to identify and rank key QoL-related factors predictive of arthritis status in a large Chinese cohort, achieving robust model performance. Pain burden, age, subjective health, sleep, functional status, and psychological well-being are critical determinants. These interpretable findings can inform risk stratification and guide targeted interventions focusing on these key areas to potentially improve arthritis management.
Validation and comparison of EQ-5D-5L and SF-6Dv1 in myopic patients requiring corneal refractive surgery in China.
Liang G, Zhang AX, Li FY … +8 more , Liu JH, Zheng YJ, Qin Y, Li YZ, Ma R, Pan CW, Li DL, Wang P
Health Qual Life Outcomes · 2025 Aug · PMID 40847350 · Full text
PURPOSE: Different health-related quality of life scales are suitable for various populations and scenarios; hence, the selection of measurement tools must be based on research objectives and focal points. To facilitate...
PURPOSE: Different health-related quality of life scales are suitable for various populations and scenarios; hence, the selection of measurement tools must be based on research objectives and focal points. To facilitate the choice between EQ-5D-5L and SF-6Dv1 in clinical and economic research of myopic patients undergoing corneal refractive surgery, the study aims to assess and compare EQ-5D-5L and SF-6Dv1 among the patients in China. METHODS: A total of 411 participants with a mean age of 25.6 years were recruited. Information collected including demographic characteristics, EQ-5D-5L and SF-6Dv1. The ceiling effect was evaluated by calculating the proportion of participants who reported the best possible health states. Agreement between EQ-5D-5L and SF-6Dv1 health utility scores (HUSs) was tested using intraclass correlation coefficient (ICC) and Bland-Altman plot. Convergent validity of EQ-5D-5L and SF-6Dv1 HUSs was evaluated using the Spearman correlation coefficient (r) with VF-14 as a calibration standard. RESULTS: Ceiling effects were 75.2% and 40.4% for EQ-5D-5L and SF-6Dv1, respectively. ICC between the two HUSs was 0.611 (average-measure). Bland-Altman plots showed that the agreement varied across different HUS segments. Correlation between EQ-5D-5L HUS and VF-14 (r = 0.363) was higher than that between SF-6Dv1 HUS and VF-14 (r = 0.226). EQ-5D-5L and SF-6Dv1 HUSs can only distinguish one clinical condition (i.e., chronic pain symptom); but they can identify health differences across all self-reported known-groups. EQ-5D-5L HUS had greater sensitivity; but SF-6Dv1 HUS was more responsive at follow-ups. CONCLUSIONS: EQ-5D-5L and SF-6Dv1 HUS cannot be used interchangeably in myopic patients undergoing corneal refractive surgery. It appears that EQ-5D-5L HUS performs better in terms of convergent validity and sensitivity; but SF-6Dv1 HUS is more responsive.
Addressing reporting heterogeneity in visual analogue scales: a double-index model approach using anchoring vignettes.
Huang Z, Kämpfen F
Health Qual Life Outcomes · 2025 Aug · PMID 40784945 · Full text
In this study, we propose several methods to account for reporting heterogeneity in self-reported data coming from Visual Analogue Scales (VAS) using corresponding VAS-based anchoring vignettes. Though widely used as a m...
In this study, we propose several methods to account for reporting heterogeneity in self-reported data coming from Visual Analogue Scales (VAS) using corresponding VAS-based anchoring vignettes. Though widely used as a measurement tool in many disciplines, VAS may suffer from reporting heterogeneity. Such reporting heterogeneity and potential solutions to solve this problem in the context of VAS measures have not yet been addressed in the literature. Using VAS-based anchoring vignettes and standard vignettes assumptions, we show how double-index models can be used to address reporting heterogeneity in VAS. We then apply our methods to real data assessing reporting heterogeneity in VAS-measured Quality of Life (QoL) among students in Switzerland. We show that the findings of previous studies showing positive associations between being a female and QoL might be entirely driven by reporting heterogeneity.
Socio-demographic characteristics associated with SF-6D v2 utility scores in patients undergoing dialysis in China: contributions of the quantile regression.
Zhang Y, Yang L, Chen Z
Health Qual Life Outcomes · 2025 Jul · PMID 40722091 · Full text
BACKGROUND: Generic preference-based instruments, such as the Short Form 6-Dimensions (SF-6D) and EuroQol 5-Dimensions (EQ-5D), can generate utility scores that facilitate the estimation of health-related quality of life...
BACKGROUND: Generic preference-based instruments, such as the Short Form 6-Dimensions (SF-6D) and EuroQol 5-Dimensions (EQ-5D), can generate utility scores that facilitate the estimation of health-related quality of life (HRQoL) which is commonly used in cost-utility analysis. This study investigated the associations between utility scores and potential socio-demographic factors in Chinese patients with dialysis using quantile regression. METHODS: Patients were recruited in a multicenter survey conducted between November 2023 and January 2024 for dialysis patients in China. Patient responses to the SF-6D version 2 (SF-6Dv2) instruments were used to calculate utility scores. The relationships between utility scores and potential socio-demographic factors were examined using both ordinary least squares (OLS) and quantile regression models. The Wald test was employed to test the differences in coefficients across quantiles in quantile regression. Model performance was assessed using 5-fold cross-validation. RESULTS: A total of 378 patients were included. Age, education level, having a loan due to illness, currently working, monthly income > 8000 RMB and number of comorbidities were associated with utility scores. The quantile regression coefficients and Wald test suggested that the size of the associations between the utility scores and factors varied along with the utility score distribution. Quantile regression yielded more accurate fitted and predicted values compared to OLS regression. CONCLUSION: Quantile regression offers a valuable complement in analyzing factors associated with utility scores among Chinese dialysis patients. For policymakers, differentiated nonclinical strategies may be needed to improve HRQoL across varying health states within this population.
Associations between 24-hour movement guidelines and health-related quality of life among urban preschool children in Singapore, Japan, and China.
Chung HJ, Kim H, Ma J … +5 more , Chua T, Low ST, Li D, Guo H, Chia MYH
Health Qual Life Outcomes · 2025 Jul · PMID 40722021 · Full text
BACKGROUND: Health-related quality of life (HRQoL) is increasingly recognized as a critical indicator of well-being in early childhood, yet its associations with 24-hour movement behaviors-physical activity, screen time,...
BACKGROUND: Health-related quality of life (HRQoL) is increasingly recognized as a critical indicator of well-being in early childhood, yet its associations with 24-hour movement behaviors-physical activity, screen time, and sleep-remain underexplored in Asian populations. This study aims to examine the association between adherence to the 24-hour movement guidelines (24-MG) and health-related quality of life (HRQOL) among preschoolers residing in major urban areas of Singapore, Japan, and China. METHODS: A cross-sectional survey was conducted among 6,634 children aged 3-6 years across Singapore (n = 3,672), Japan (n = 760), and China (n = 2,202). Movement behaviors were assessed using the validated SMALLQ tool, and HRQoL was evaluated using the Pediatric Quality of Life Inventory (PedsQL™). Logistic regression models were applied to determine the associations between different patterns of 24-h MG adherence and HRQoL, adjusting for demographic variables. RESULTS: Full adherence to all three 24-h MG components was significantly associated with higher physical and psychosocial HRQoL scores in Singapore and China. In Japan, adherence to physical activity guidelines alone is associated with higher HRQoL. Notably, Chinese children had the highest adherence rates across all individual and combined movement behaviors. Conversely, Japanese children had the lowest rates of full adherence and were more likely to fall short of all guidelines. CONCLUSIONS: This study provides novel evidence from three urban Asian contexts that adherence to the 24-hour movement guidelines positively correlates with HRQoL in preschool-aged children. The findings highlight the importance of integrated movement behavior frameworks and support the development of culturally tailored public health policies to improve early childhood well-being.
Factor structure and trends in SF-12v2 health-related quality of life scores among pre-and post-pandemic samples in Thailand: confirmatory factor analysis and Rasch analysis.
Kangwanrattanakul K
Health Qual Life Outcomes · 2025 Jul · PMID 40691581 · Full text
BACKGROUND: The Thai Short Form Health Survey, version 2 (SF-12v2), is widely used to evaluate health-related quality of life (HRQoL) in Thailand. Lifestyle changes during the COVID-19 pandemic may have influenced how in...
BACKGROUND: The Thai Short Form Health Survey, version 2 (SF-12v2), is widely used to evaluate health-related quality of life (HRQoL) in Thailand. Lifestyle changes during the COVID-19 pandemic may have influenced how individuals interpreted and responded to SF-12v2 items across pre- and post-pandemic time periods. This study examined differences in mean scores, item interpretations due to differential item functioning (DIF), and factor structure invariance using confirmatory factor analysis (CFA) between the pre- and post-pandemic periods. METHODS: Data was drawn from two national surveys (n = 1,200 prepandemic; n = 2,000 postpandemic). CFA was conducted on randomly selected subsamples (n = 1,050 prepandemic; n = 1,850 postpandemic), with 150 participants per group reserved for DIF analyses using two-way ANOVA. Subscale score differences were assessed using generalized linear models. RESULTS: The CFA confirmed the two-factor model (PCS and MCS). Older participants and those with comorbidities scored significantly lower on physical subscales (PF, RP, BP, GH, and PCS), while only comorbid participants reported significantly lower on SF and RE subscales (all p < 0.05). A non-uniform DIF was observed for PF and PCS against dataset, age, and health status, and for MCS against dataset and age. CONCLUSIONS: The SF-12v2 factor structure was stable across time points. Although MCS scores increased after the pandemic, this change may not accurately reflect the impact of COVID-19 due to the absence of participants who had recovered from the infection. To improve generalizability, future studies should include COVID-19 cases and broader assessments of mental health.
An Australian Value Set for the EQ-5D-Y-3L.
Pan T, Roudijk B, Devlin N … +2 more , Mulhern B, Norman R
Health Qual Life Outcomes · 2025 Jul · PMID 40660259 · Full text
BACKGROUND: Australia has a well-established health technology assessment process and there is extensive use of generic health related quality of life (HRQoL) instruments in evidence presented to it. However, there are g...
BACKGROUND: Australia has a well-established health technology assessment process and there is extensive use of generic health related quality of life (HRQoL) instruments in evidence presented to it. However, there are gaps in tools and evidence available to support evaluation of paediatric health. The aim of this paper is to produce an Australian EQ-5D-Y-3L (Y-3L) value set. METHODS: The methods follow the international Y-3L valuation protocol, but with an expanded design. Data were collected using Composite Time Trade Off (cTTO) and Discrete Choice Experiment (DCE) data from two independent samples of adult members of the Australian general public. In total, 52 Y-3L health states, assigned into four blocks of 14 health states each containing health state 33333, were valued using cTTO. cTTO data were collected via videoconferencing interview and each respondent valued 14 health states. Mean observed cTTO values were adjusted for censoring at -1 using a Tobit model. For the DCE component, 150 latent scale DCE choice pairs were collected via an online survey with each participant completing 15 pairs. DCE data were modelled using a garbage class mixed logit model. Two approaches to anchor DCE data to the Quality Adjusted Life Years (QALYs) scale were explored: anchoring on the value for the worst health state (33333); and mapping DCE data onto the mean cTTO values using all 52 health states. Two evaluation criteria were used to select the final value set: (1) coefficient significance and logical consistency; (2) prediction accuracy of the mean observed cTTO values. RESULTS: In total, 268 individuals participated in the cTTO interviews, and 1002 completed the DCE. The linear mapping without intercept performed best and was selected as the final value set. Health state values ranged between 0.142 and 1. The relative importance of domains by level 3 coefficients (ordered from most to least important) was: pain/discomfort, then feeling worried, sad or unhappy, usual activities, looking after myself, and mobility. CONCLUSION: This study reports an Australian value set for the Y-3L, which enables the calculation of QALYs for use in the economic evaluation of paediatric interventions and can support evidence development and decision making.
Association between out-of-pocket expenditure and health-related quality of life among patients receiving cancer treatment: a cross-sectional study from Nepal.
Khanal P, Sapkota S, Poudel N … +8 more , Pandey AR, Bhattarai B, Khatiwada E, Mishra RK, Karmacharya BM, Adhikari SR, Johansson KA, Aryal KK
Health Qual Life Outcomes · 2025 Jul · PMID 40660255 · Full text
BACKGROUND: The financial burden of cancer care may significantly impair patients' health-related quality of life (HRQoL), yet the extent and nature of this relationship remain underexplored, particularly in low-resource...
BACKGROUND: The financial burden of cancer care may significantly impair patients' health-related quality of life (HRQoL), yet the extent and nature of this relationship remain underexplored, particularly in low-resource settings. This study aimed to report the HRQoL of patients currently receiving treatment for selected cancers (breast, cervical, lung, oesophageal and stomach) in Nepal. We further investigate the association of out-of-pocket expenditure (OOPE) with HRQoL. METHODS: A cross-sectional survey was conducted from April to May 2024 among 353 patients undergoing cancer treatment in two tertiary cancer hospitals in Nepal. We used the European Quality of Life 5 dimensions (EQ-5D-5L) and the European Quality of Life Visual Analogue Scale (EQ-VAS) to obtain their HRQoL. Similarly, we collected sociodemographic and treatment-related data, including OOPE and patient satisfaction. We used the ordinary least squares estimation with robust standard errors to identify the association between OOPE and HRQoL (EQ-5D-5L index score). RESULTS: The mean (SD) EQ-5D-5L index score was 0.39 (0.42), and the mean (SD) EQ-VAS score was 56.65 (21.71). Anxiety/depression and pain/discomfort were the most common reported problems (> 90% of the study participants), whereas pain/discomfort had the greatest disability weight (0.17). In the regression analysis, the logarithms of OOPE (β = -0.086; 95% CI: -0.132 to -0.040) was significantly associated with a lower EQ-5D-5L index score. Other significant covariates included being currently not married (β = -0.149; 95% CI: -0.274 to -0.024), having stage IV cancer during diagnosis (β = -0.212; 95% CI: -0.364 to -0.061) and patient satisfaction score (β = 0.015; 95% CI: 0.001 to 0.030). CONCLUSIONS: The study revealed a moderate quality of life among patients currently receiving cancer treatment in Nepal. Higher OOPE along with stage IV cancer during diagnosis and being currently not married were associated with lower HRQoL, whereas higher patient satisfaction score was associated with higher HRQoL. These insights might be helpful for providing targeted interventions such as emphasizing early diagnosis and management and focusing on patient satisfaction and those at financial risk to improve the HRQoL of people with cancer.
Comparison of the measurement properties of EQ-5D-5L and SF-6Dv2 in Chinese patients on dialysis.
Zhang Y, Chen Z, Yang L … +1 more , Jarl J
Health Qual Life Outcomes · 2025 Jul · PMID 40640853 · Full text
BACKGROUND: Measuring health-related quality of life (HRQoL) in dialysis patients is essential for clinical assessment and economic evaluation. Despite the emergence and increasing use of updated instruments, evidence co...
BACKGROUND: Measuring health-related quality of life (HRQoL) in dialysis patients is essential for clinical assessment and economic evaluation. Despite the emergence and increasing use of updated instruments, evidence comparing their performance in Chinese dialysis patients remains limited. The aim of this study was to compare the measurement properties of the EQ-5D-5L and the SF-6Dv2 instruments in Chinese patients on dialysis and to provide a reference for future utility scale choice for Chinese dialysis patients. METHODS: Data were obtained using Wen Juan Xing questionnaire from dialysis patients during November 2023 to January 2024 in hospitals in China. The questionnaire included the EQ-5D-5L, SF-6Dv2, the kidney disease quality of life instrument (KDQOL-36), clinical and socio-demographic characteristics. The agreement of utility scores was assessed using intra class correlation coefficients (ICC) and Bland-Altman plots. The construct validity was evaluated using Spearman's correlation coefficient. The known group validity was evaluated by comparing the scores among patients with different health states, and sensitivity was compared using relative efficiency and the effect size. RESULTS: A total of 378 patients (male, 49.5%; mean age, 49.1 years) were included in this study. The ICC between EQ-5D-5L and SF-6Dv2 utility values was 0.639. The correlation between the two scales was strong (0.767). Both scales showed known groups validity, although the SF-6Dv2 was more sensitive. The differences in the SF-6Dv2 scores for patients in better and worse health state were greater than those measured by the EQ-5D-5L scores. CONCLUSIONS: Both EQ-5D-5L and SF-6Dv2 instruments are valid for dialysis patients. However, the two scales cannot be used interchangeably, and it appears that the SF-6Dv2 was more sensitive in capturing health state differences for dialysis patients in China.
Health-related quality of life of patients with multiple sclerosis in China: a national online survey.
Song X, Qiao X, Jia Y … +3 more , Li H, Wang P, Hu M
Health Qual Life Outcomes · 2025 Jul · PMID 40634940 · Full text
BACKGROUND: To measure and value the health-related quality of life (HRQOL) of Chinese Multiple sclerosis (MS) patients, and to explore the influencing factors. METHODS: A national online survey amongst the patients was...
BACKGROUND: To measure and value the health-related quality of life (HRQOL) of Chinese Multiple sclerosis (MS) patients, and to explore the influencing factors. METHODS: A national online survey amongst the patients was conducted in July 2022. Information on patient demographics, clinical characteristics (MS subtype and disability status), and the HRQOL measured by EQ-5D-5L were collected. Disability status was classified based on the self-reported Expanded Disability Status Scale (EDSS). Both the Tobit and logistic regression models were adopted to assess the impact of clinical characteristics on HRQOL with the adjustment of demographic characteristics. RESULTS: A total of 733 eligible patients (mean age 34.31 years; 67.7% females) were included in the analysis. The mean EQ-5D-5L health utility score (HUS) and VAS score were 0.73(SD:0.29) and 68.7(SD:23.9), respectively. MS patients reported a high prevalence of health problems in all the EQ-5D dimensions, ranging from 25.6% (self-care) to 74.9% (anxiety/depression). According to Tobit regression analyses, secondary progressive MS was associated with lower VAS compared to relapsing-remitting MS. Worse disability status measured by EDSS was related to the lower HUS and VAS scores. Demographic characteristics including younger age, higher education level, and employment were also identified as protective factors of the patients' HRQOL. CONCLUSIONS: This study assessed HRQOL of Chinese MS patients using the EQ-5D-5L. Our finding revealed that MS subtypes and disability status are the most important factors affecting their HRQOL.
Physical activity and health-related quality of life after lung cancer surgery- cross-sectional analyses 3 and 12 months postoperatively.
Jonsson M, Hurtig-Wennlöf A, Ahlsson A … +1 more , Westerdahl E
Health Qual Life Outcomes · 2025 Jul · PMID 40629419 · Full text
BACKGROUND: Lung cancer is one of the most frequently diagnosed cancers, and the leading cause of cancer deaths worldwide. Surgical resection is the primary curative treatment. The World Health Organization (WHO) recomme...
BACKGROUND: Lung cancer is one of the most frequently diagnosed cancers, and the leading cause of cancer deaths worldwide. Surgical resection is the primary curative treatment. The World Health Organization (WHO) recommends that all adults, including cancer survivors, should engage in at least 150 to 300 min of moderate-intensity aerobic physical activity per week. Positive associations have been found between self-reported physical activity and health-related quality of life (HRQoL) after lung cancer surgery. However, there is a lack of studies concerning objectively measured physical activity levels, and longer follow-ups are also missing. This study investigated the relationship between objectively measured physical activity levels and HRQoL in patients 3 and 12 months after lung cancer surgery. METHODS: Utilizing a cross-sectional design, patients were followed up 3 (n = 83) and 12 (n = 57) months after lung cancer surgery. HRQoL was assessed with the cancer-specific questionnaire EORTC QLQ-C30 and the lung-cancer-specific module LC13. Physical activity was measured with a tri-axial accelerometer (ActiGraph GT3X+). RESULTS: At 3 months after surgery, 51% (n = 42) of the patients reached the level of physical activity recommended by the WHO; the corresponding result at 12 months was 42% (n = 24). Patients who reached the recommended level of physical activity reported a better HRQoL, with better global health status and physical function as well as lower symptoms of fatigue, at both 3 and 12 months postoperatively. CONCLUSIONS: Physical activity was positively associated with HRQoL. Encouraging and supporting patients to engage in regular physical activity could contribute to better HRQoL after lung cancer surgery. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov (NCT01961700), registration date 20,131,009.
Predicting Quality of Life in People Living with HIV: A Machine Learning Model Integrating Multidimensional Determinants.
Xie M, Zhang Z, Yu Y … +3 more , Zhang L, Zhang J, Wu D
Health Qual Life Outcomes · 2025 Jul · PMID 40616079 · Full text
OBJECTIVE: With survival steadily improving among people living with HIV(PLWH), quality of life (QoL) has emerged as the ultimate benchmark of therapeutic success. We therefore aimed to develop and validate machine learn...
OBJECTIVE: With survival steadily improving among people living with HIV(PLWH), quality of life (QoL) has emerged as the ultimate benchmark of therapeutic success. We therefore aimed to develop and validate machine learning models that predict QoL trend in PLWH, identifying key determinants to inform personalized interventions and optimize long-term well-being. METHODS: In this longitudinal observational study, PLWH were recruited from March 2024 to December 2024. Sociodemographic and clinical variables were collected, and the 31-item WHOQOL-HIV BREF was adopted as the QoL measure. The symptom experience was assessed using the Self-Report Symptom Scale (SRSS). All variables were incorporated into machine learning models to develop predictive algorithms. RESULTS: This study included 676 eligible participants with HIV in the cohort. The Gaussian Process (GP) model demonstrated the highest testing AUC of 0.811 and 0.815 in the training dataset. The GP model excels in metrics such as accuracy, AUC, recall, precision, F1 score, Kappa, MCC, Log Loss, and Brier score. In the decision curve analysis (DCA), the five machine learning models exhibited similar net benefits over a broad range of threshold probabilities (ranging from 0.2 to 0.8) compared to the Random Forest (RF) model. The GP and the MLP showed enhanced net benefits at intermediate to high threshold probabilities (30 ~ 60%). The SHAP technique identified the top four predictors of QoL, ranked by importance, with symptom burden being highlighted as the most critical predictor variable. CONCLUSIONS: The machine-learning model, predominantly a GP model, demonstrated the better predictive performance among the six models evaluated, for detecting the QoL predictor in PLWH, indicating that symptom burden influences QoL level. Our findings highlight a non-linear relationship between ART duration and QoL, with diminished well-being during mid-treatment (6 ~ 10 years) linked to treatment fatigue and cumulative toxicities, emphasizing the necessity of dynamic psychosocial support and tailored interventions to sustain long-term QoL in HIV care.
Findings from a roundtable discussion with Pakistani stakeholders on measuring and valuing health and health-related quality of life for children and adolescents.
Malik M, Hussain A, Purba FD … +1 more , Gu NY
Health Qual Life Outcomes · 2025 Jul · PMID 40598511 · Full text
BACKGROUND: Children and adolescents represent a distinct population with specific healthcare needs, requiring appropriate consideration in health-related quality of life (HRQoL) measurements and economic evaluations. In...
BACKGROUND: Children and adolescents represent a distinct population with specific healthcare needs, requiring appropriate consideration in health-related quality of life (HRQoL) measurements and economic evaluations. In Pakistan, the absence of local value sets for children and adolescent health states and the limited application of health technology assessment (HTA) pose challenges to informed equitable decision-making and resource allocation. Valuing children and adolescents' health involves methodological and ethical complexities, particularly in determining whose preferences should be considered and how trade-offs between length and quality of life should be addressed. This study aimed to explore the views of key national stakeholders on these valuation issues to inform the development of a localized EQ-5D-Y-3 L value set for Pakistan. METHODS: A total of 12 stakeholders were identified via the investigators' network from different cities in Pakistan and diverse backgrounds. An in-person 3.5-hour meeting was held in Islamabad to discuss a range of topics including (a) the need for a Pakistani value set for the EQ-5D-Y-3 L, (b) willingness to pay more for quality-adjusted life-year (QALY) gains for children versus adults, (c) source of health preferences (adults vs. children), (d) potential ethical concerns and, (e) other challenges in a youth valuation to obtain deeper insights for understanding of the health valuation. The session was recorded, transcribed, and summarized. RESULTS: Stakeholders confirmed that QALYs have not yet been widely used in Pakistan's healthcare system, although HRQoL instruments like EQ-5D-3 L and EQ-5D-5 L are increasingly applied by researchers for evidence generation. Stakeholders agreed that adolescents aged 11 and above can complete valuation tasks and should be involved in data collection. Moreover, 33% of stakeholders (4 out of 12) specifically recommended using adult preferences initially due to budgetary and technical constraints, while 66% (8 out of 12) did not explicitly oppose using adult preferences initially, they emphasized the importance of involving adolescents in the process either concurrently or in subsequent phases. Participants acknowledged that societal willingness to pay more per QALY for children varied, with some viewing it as a strategic investment. Ethical concerns about life-year trade-offs for children were not seen as major barriers in the local context. Parents or caregivers were deemed the most appropriate proxy respondents when self-reporting was not possible. Challenges identified included limited awareness of QALYs among policymakers, scarce local utility data, technical capacity gaps, and constrained health budgets. CONCLUSION: Pakistani stakeholders encouraged the use of health valuation data such as the EQ-5D-Y-3 L measures in decision-making and provided useful perspectives to youth valuation with a local context.
Quality of life and patient reported outcomes in the UK Mammo-50 randomised trial of annual versus less frequent mammographic surveillance in people with breast cancer aged 50 years and over.
Marshall A, Donnelly P, Elbeltagi N … +8 more , Gasson S, Broadfield A, Hopkins A, Hartup S, Turner L, Young A, Watson EK, Dunn JA
Health Qual Life Outcomes · 2025 Jul · PMID 40598487 · Full text
BACKGROUND: Mammo-50, a randomised phase III trial, demonstrated that for women aged 50 years or older and 3-years post breast cancer diagnosis, less frequent mammograms (2-yearly after conservation surgery; 3-yearly aft...
BACKGROUND: Mammo-50, a randomised phase III trial, demonstrated that for women aged 50 years or older and 3-years post breast cancer diagnosis, less frequent mammograms (2-yearly after conservation surgery; 3-yearly after a mastectomy) were non-inferior to annual mammograms in terms of detection of recurrences, or new breast primaries. It is important to assess Quality of life (QoL) in this population to ensure no detriment is associated with a less frequent mammographic surveillance schedule. METHODS: A mixed methods QoL sub-study was undertaken to explore potential differences between the trial arms in terms of fear of recurrence, QoL and distress levels and to explore patient reported experiences. Participants were asked to complete a questionnaire booklet annually whilst on the trial. Longitudinal random effects regression models were fitted to assess changes in QoL over time and across trial arms. Free text data were collected on participants worries or concerns. RESULTS: 5235 women were randomised between April 2014 and September 2018, from 114 UK sites of which 4488 women (86%) returned a baseline QoL booklet. With a median 5.7 years follow-up (8.7 years post-curative-surgery), no differences between trial arms were identified for any of the QoL scales measured. Themes identified from the free text data included co-morbidities, family problems and side-effects of hormone therapy. CONCLUSIONS: There were no differences in any of the QoL scales between the trial arms of Mammo-50, implying that less frequent mammographic surveillance does not adversely impact participants’ QoL. Women were concerned with co-morbidities or family problems and side-effects of treatment rather than worries about having less frequent mammograms. TRIAL REGISTRATION: ISRCTN48534559, 26 February 2014.
Mapping the EORTC QLQ-C30 and QLQ-LC13 to the SF-6D utility index in patients with lung cancer using machine learning and traditional regression methods.
Jiang L, Li K, Lu S … +10 more , Hong Z, Wang Y, Xie Q, He Q, Wei S, Zhou A, Kang H, Leng X, Yang Q, Miao Y
Health Qual Life Outcomes · 2025 Jul · PMID 40597342 · Full text
BACKGROUND: Preference-based measures of health-related quality of life (HRQoL), such as the Short Form Six-Dimension (SF-6D) is essential for health economic evaluations. However, these measures are rarely included in c...
BACKGROUND: Preference-based measures of health-related quality of life (HRQoL), such as the Short Form Six-Dimension (SF-6D) is essential for health economic evaluations. However, these measures are rarely included in clinical trials for lung cancer. This study aims to develop mapping algorithms to predict SF-6D health utility scores from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30) and Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13). METHOD: The study sample comprised a Chinese population with lung cancer (n = 625). Traditional regression techniques, including Ordinary Least Squares regression, Generalized Linear Model, as well as machine learning techniques, such as Gradient Boosting Tree, Support Vector Regression, Ridge Regression are used. Five-fold cross-validation was performed. The performance metrics used to evaluate the models including R, root mean square error (RMSE),mean absolute error (MAE) and mean absolute percentage error (MAPE) were used to screen the optimal model. RESULTS: The mean and median of SF-6D health utility values were 0.774 (SD = 0.154) and 7.795, respectively. The model with the best mapping performance was the Ridge regression model Five-fold cross-validation (CV) results show that the Ridge regression model has the best mapping performance, the final prediction indexes are R = 0.753, RMSE = 0.074, MAE = 0.057, MAPE = 8.169%. CONCLUSIONS: This study developed an optimized mapping algorithm to predict the utility index from the QLQ-C30 QLQ-LC13 to the SF-6D. This algorithm offers provides an effective alternative for estimating SF-6D estimation when the preference-based health utility values are unavailable.
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