A Cross-Sectional Study of Health-Related Quality of Life in Patients with Predominantly Antibody Deficiency

Abstract

Health-related quality of life (HRQoL) measures individual well-being across physical, psychological, and social domains. Patients with predominantly antibody deficiency (PAD) are at risk for morbidity and mortality, however, the effect of these complications on HRQoL requires additional study. Patients with PAD were asked to voluntarily complete the Centers for Disease Control (CDC) HRQoL-14 Healthy Days Measure questionnaire. These results were compared to data from the CDC-initiated Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional questionnaire including questions from CDC-HRQOL-14. Statistical analyses included two-proportion Z-test, t-tests, and analysis of variance. 83 patients with PAD completed the survey. Patients were sub-stratified into mild (23.7%), moderate (35.5%), severe (40.8%), and secondary (8.4%) PAD. "Fair or poor" health status was reported in 52.6% of PAD patients. Mental health challenges ≥ 14 days/month occurred in 25% of patients. Physical health issues ≥ 14 days/month was reported in 44.7% of patients. Activity limitations were noted by 80.3% of patients. There were no statistically significant differences by PAD severity. Patients with autoinflammatory disease co-morbidities reported more mental health challenges compared to those without (78% vs. 54.3%, p = 0.02). Compared to the CDC-BRFSS data, significantly more patients with PAD reported "fair or poor" health status (53% vs 12.0%; p < 0.0001), mental health challenges (24.1% vs 14.7%; p = 0.02), and poor physical health (44.6% vs 8.0%; p < 0.0001). Patients with PAD had significantly reduced HRQoL compared to CDC-BRFSS respondents from a similar geographical region. Decreased HRQoL was prevalent across all PAD severity levels. Additional research is needed to improve HRQoL for patients with PAD.

Keywords: Behavioral risk factor surveillance system; CDC HRQoL-14; Chronic disease management; Common variable immunodeficiency; Health-related quality of life; Hypogammaglobulinemia; Immunodeficiency; Immunoglobulin therapy; Mental health; Patient-reported outcomes; Physical health; Predominantly antibody deficiency.

Figure 1. Percentage of poor self-rated health status, mental health, and physical health among primary PAD patients by clinical severity.

The figure represents the distribution of self-rated health status: A) Fair or poor self-rated health status, B) Mental health not good for ≥14 days, and C) Physical health not good for ≥14 days, segregated by disease severity. The vertical axis indicates the percentage of respondents, and the horizontal axis classifies the severity of PAD into mild (green bar; n=18), moderate (yellow bar; n=27), and severe (red bar; n=31) PAD adult patients. Each bar indicates the proportion of individuals who reported their health status. Error bars represent the 95% confidence interval of the proportion of respondents. Although a trend of increased poor health status with greater disease severity is observed, the differences did not reach statistical significance.

Figure 2. Percentage of poor self-rated health status, mental health, and physical health among primary PAD patients compared to secondary PAD.

The figure represents the distribution of self-rated health status: A) Fair or poor self-rated health status, B) Mental health not good for ≥14 days, and C) Physical health not good for ≥14 days, compared between adult patients with primary PAD (red bar; n=76) and secondary PAD (purple bar; n=7). Each bar indicates the proportion of individuals who reported their health status. Error bars represent the 95% confidence interval of the proportion of respondents. Although primary PAD patients show a trend of worse health status compared to secondary PAD patients, the differences did not achieve statistical significance.

Figure 3. Percentage of poor self-rated health status, mental health, and physical health among CVID patients by complication status.

The figure represents the distribution of self-rated health status: A) Fair or poor self-rated health status, B) Mental health not good for ≥14 days, and C) Physical health not good for ≥14 days, compared between complicated (maroon bar; n=44) and uncomplicated (cyan bar; n=20) CVID patients. Each bar indicates the proportion of individuals who reported their health status. Error bars represent the 95% confidence interval of the proportion of respondents.

Figure 4. Percentage of poor self-rated health status, mental health, and physical health among primary PAD patients by autoinflammatory features.

The figure represents the distribution of self-rated health status: A) Fair or poor self-rated health status, B) Mental health not good for ≥14 days, and C) Physical health not good for ≥14 days, segregated by presence of autoinflammatory features. The vertical axis indicates the percentage of respondents, and the horizontal axis differentiates between PAD patients with (maroon bar; n=41) and without (cyan bar; n=35) autoinflammatory features. Each bar shows the proportion of individuals reporting their health status. Error bars indicate the 95% confidence interval of the proportion of respondents. A significant difference in mental health status is noted (*p<0.05), with worse mental health observed in patients with present autoinflammatory features.

Figure 5. Percentage of poor self-rated health status, mental health, and physical health among PAD patients compared to CDC-BRFSS data controls.

The figure represents the distribution of self-rated health status: A) Fair or poor self-rated health status, B) Mental health not good for ≥14 days, and C) Physical health not good for ≥14 days, compared between adult patients with PAD (red bar; n=83) and control data derived from the CDC’s BRFSS data surveying the general population (gray bar; n=801,582). Each bar indicates the proportion of individuals who reported their health status. HC stands for healthy controls from CDC-BRFSS data. Error bars represent the 95% confidence interval of the proportion of respondents. *p<0.05. The results demonstrate that PAD patients have significantly lower HRQoL across all measured domains compared to the control group.