Multimorbidity and quality of life: a closer look

Abstract

Background: The presence of multiple chronic conditions is associated with lower health related quality of life (HRQOL). Disease severity also influences HRQOL. To analyse the effects of all possible combinations of single diseases along with their severity on HRQOL seems cumbersome. Grouping diseases and their severity in specific organ domains may facilitate the study of the complex relationship between multiple chronic conditions and HRQOL. The goal of this study was to analyse impaired organ domains that affect the most HRQOL of patients with multiple chronic conditions in primary care and their possible interactions.

Methods: We analysed data from 238 patients recruited from the clientele of 21 family physicians. We classified all chronic conditions along with the measure of their severity into the 14 organ domains of the Cumulative Illness Rating Scale (CIRS). Patients also completed the 36-item Medical Outcomes Study questionnaire (SF-36). One-way analyses of variance were performed to study the relationship between the severity score for each CIRS domain and both physical component summary (PCS) and mental component summary (MCS) of HRQOL. Two-way analyses of variance were conducted to investigate the significance of possible organ domains interactions. Variables involved in significant bivariate relationships or interactions were candidates for inclusion in a multivariate model. Five additional variables were included in the multivariate model because of their possible confounding effect: perceived social support, age, education, perceived economic status and residual CIRS.

Results: Significant differences in the PCS (p < 0.01) were found in 12 of the 14 CIRS organ domains. A significant difference in MCS was found only in the Psychiatric domain. In the multivariate analysis for the PCS, the CIRS domains Musculoskeletal, Neurological, and Psychiatric, had an independent direct impact on PCS while the Upper gastrointestinal, Vascular, Cardiac and Respiratory domains were involved in interactions. A multivariate model was not necessary for the mental component.

Conclusion: Vascular, Upper gastrointestinal and Musculoskeletal systems have strong negative effects on HRQOL. Among combinations of systems, the respiratory and cardiac combination is of particular concern because of a synergistic negative effect. This study paves the way for a future study with a bigger sample that could yield a model of wider generalizability.

Figure 1

Percentage of sample in each severity level. The percentage of sample in each severity level is shown for the 14 domains covered by the CIRS. It should be noted that The CIRS assigns a value from 0 to 4 to determine a severity score for each domain (0 = no problem; 1 = mild; 2 = moderate; 3 = severe; 4 = extremely severe). Due to the small number of subjects, we combined the "extremely severe" CIRS category with the "severe" category.

Figure 2

Illustration of the interaction between Cardiac and Respiratory CIRS domains. The figure illustrates the interaction between Cardiac and Respiratory domains for subjects with no problems in the musculoskeletal, neurological and vascular domains and no or mild problems in the psychiatric and upper gastrointestinal domains.

Figure 3

Illustration of the interaction between Upper gastrointestinal and Vascular CIRS domains. The figure illustrates the interaction between Upper gastrointestinal and Vascular CIRS domains for subjects with no problems in the musculoskeletal and neurological domains, no or mild problems in the psychiatric and respiratory domains and no severe cardiac problems.