Atherosclerotic Cardiovascular Disease and Health-Related Quality of Life Among Adults in the United States: National Health Interview Survey 2013-2017

Abstract

ABSTRACTBackgroundA brief health-related quality of life (HRQoL) tool with construct validity for atherosclerotic cardiovascular disease (ASCVD) may facilitate integration into healthcare delivery. We examined ASCVD-related changes in the Health and Activity Limitation Index (HALex), a generic HRQoL measure comprising perceived health and activity limitation.MethodsUsing data of 155,130 respondents of the National Health Interview Survey 2013-2017, we evaluated HALex scores by ASCVD (angina, heart attack, and stroke). Lower HALex scores reflected worse HRQoL and a 0.03 change was regarded as the threshold for clinical significance. Multivariable two-part models were used to assess HALex changes (β, 95%CI) associated with ASCVD overall and in sex, age, and race/ethnicity groups.ResultsOverall, participants with ASCVD – 6.8%, representing 15.7 million adults – had lower HALex scores (0.67) than those without ASCVD (0.87). Females, age ≥ 65 years, and non-Hispanic Blacks had the lowest HALex scores. Overall, ASCVD was associated with a substantial decrement in HALex (−0.10, [−0.10, −0.09]). Interactions between ASCVD and sex, and race/ethnicity were both significant (p < 0.001). ASCVD-associated decrement in HALex was clinically greater in: females (−0.11, [−0.12, −0.10]) than in males (−0.08, [−0.09, −0.07]); and non-Hispanic Black (−0.13, [−0.15, −0.1]) than in non-Hispanic White (−0.09, [−0.10, −0.08]). Though ASCVD impact on HALex was greater in age 18-64 years (−0.09, [−0.10, −0.08]), it was not statistically different from the elderly (−0.06, [−0.07, −0.06]).ConclusionsASCVD was consistently associated with lower HRQoL, as measured by HALex, across major demographics. HALex presents a feasible HRQoL tool to implement in healthcare.