Health related quality of life and Health related quality of life and satisfaction with lifesatisfaction with life

in Croatiain Croatia

Gorka Vuletic, BPsychol, PhDGorka Vuletic, BPsychol, PhD

Andrija Stampar School of Public HealthAndrija Stampar School of Public HealthMedical Faculty, University of ZagrebMedical Faculty, University of Zagreb

CroatiaCroatia

Republic of Republic of CroatiaCroatia

One of 6 former Yugoslavian republicsOne of 6 former Yugoslavian republics Estimated Croatian population cca. Estimated Croatian population cca.

4,500,0004,500,000 Capital city Zagreb Capital city Zagreb ~~ 800,000 800,000

How did Croatia become involved How did Croatia become involved in QoL research?in QoL research?

Deakin Uni 2001-2002 (PhD research)Deakin Uni 2001-2002 (PhD research)

= basis for further research in Croatia= basis for further research in Croatia

TThe 2003 Croatian he 2003 Croatian NationalNational HealthHealth survey survey

Through the survey we obtainedThrough the survey we obtained

Population Population normative data fornormative data for:: SubjectiveSubjective quality of life quality of life (satisfaction (satisfaction

with life)with life) Health status (SF-36) Health status (SF-36)

ProjectProjectCroatian National Health Croatian National Health

Survey 2003Survey 2003

Founded by World BankFounded by World Bank Co-operators:Co-operators:

Republic of Croatia Ministry of Health Republic of Croatia Ministry of Health Canadian Society for International HealthCanadian Society for International Health

Project team was formed from:Project team was formed from: Andrija Stampar School of Public Andrija Stampar School of Public

Health & Health & National Institute for Public HealthNational Institute for Public Health

SampleSample

10,766 households were selected to participate 10,766 households were selected to participate in the in the survey (based on Census 2001).survey (based on Census 2001).

Out of these selected households a response Out of these selected households a response was obtained from was obtained from 9,0709,070 individualsindividuals ( (overall overall response rate 84.3%response rate 84.3%).).

The questionnaire was administered face-to-The questionnaire was administered face-to-face to respondents by trained public health face to respondents by trained public health nurses. nurses.

RepresentativeRepresentative forfor Croatian adult population in Croatian adult population in terms of its regional, gender and age terms of its regional, gender and age structurestructure..

Participants were asked about illnesses, Participants were asked about illnesses, health related behaviour, health related health related behaviour, health related quality of life, use of health care services quality of life, use of health care services and subjective quality of life.and subjective quality of life.

Health related quality of life was Health related quality of life was measured bymeasured by

→ → Health status questionnaire ( SF-36) Health status questionnaire ( SF-36) which measure self perceived health which measure self perceived health status.status.

SF-36SF-368 dimensions of health8 dimensions of health

Physical Physical ffunctioningunctioning Role limitation due to Role limitation due to pphysical problemshysical problems PainPain General General hhealth ealth pperceptionerception Energy Energy / v/ vitalityitality Social Social ffunctioningunctioning Role limitation due to Role limitation due to eemotional problemsmotional problems Mental Mental hhealtealthh

SScored 0-100 cored 0-100

Measure of Subjective Quality of Measure of Subjective Quality of Life:Life:

How are you satisfied with your life as a whole?How are you satisfied with your life as a whole?

CompletelyCompletely CompletelyCompletelydissatisfieddissatisfied satisfiedsatisfied

0--------1----------2--------3--------4------5-------6-------7------8------0--------1----------2--------3--------4------5-------6-------7------8------9------109------10

Original scores were converted and presented Original scores were converted and presented in a form of percentage of scale maximum in a form of percentage of scale maximum (% SM)(% SM)

RESULTS

Quality of life

(QoL)

Croatian average satisfaction with lifeCroatian average satisfaction with life::

Sample:Sample: N= 9,068N= 9,068 56.9656.96 2 26.066.06 %SM%SM

MenMen N= 2,888N= 2,888 5656..2222 2 26.046.04 %% SMSM

Women N= 6,180Women N= 6,180 57.3157.31 2 26.076.07 %% SMSM

p = 0.064p = 0.064

Population mean:Population mean:

60.11 60.11 25.12 25.12 %% SMSM (based on (based on

weighted values)weighted values)

N= 3,479,134N= 3,479,134

According to 1991 censusAccording to 1991 census::

population of Croatiapopulation of Croatia == 4 437 4694 437 469

Subjestive quality of lifeSubjestive quality of lifeby age groupsby age groups

70.32

58.4

50.46

18.80

61.10

20.09

0

10

20

30

40

50

60

70

80

90

100

18-29 30-64 65 + years

%

M %SM represent % population

Self pSelf peerceived economic status rceived economic status and QoLand QoL

38.99

50.75

63.44

74.4281.23

16.2821.22

50.60

10.061.81

0

10

20

30

40

50

60

70

80

90

100

MUCH WORSE THANAVERAGE

SOMEWHAT WORSETHAN AVERAGE

AVERAGE SOMEWHAT BETTERTHAN AVERAGE

MUCH BETTER THANAVERAGEeconomic status

%

QoL %SM % population

2004 GDP per capita US $ = 7,724.2

Unemployment rate: 18%Unemployment rate: 18%

RESULTS

Health

Health status by Health status by dimensionsdimensions

DimensionMean Standard

Deviation

Physical Functioning 70.20 29.93

Role limitation due to Physical problems 62.73 44.29

Pain 65.51 30.16

General Health Perception 55.47 22.81

Energy Vitality 53.99 22.32

Social Functioning 74.57 27.10

Role limitation due to Emotional problems 70.66 42.48

Mental Health 63.24 20.51

Comparison with other Comparison with other countries...countries...

0

10

20

30

40

50

60

70

80

90

100

PhysicalFunctioning

Physicallimitations

Pain Generalhealth

Vitality Socialfunctioning

Emotionallimitations

Mentalhealth

sc

ore

Australia Canada Croatia

Health profiles – gender Health profiles – gender differencesdifferences

0

10

20

30

40

50

60

70

80

90

100

PhysicalFunctioning

Role limitationdue to

Physicalproblems

Pain General HealthPerception

Energy Vitality SocialFunctioning

Role limitationdue to

Emotionalproblems

Mental Health

sco

re

men women

Gender differences by age Gender differences by age groupsgroups

MEN WOMEN

0

10

20

30

40

50

60

70

80

90

100

PF RP BP GH VT SF RE MH PF RP BP GH VT SF RE MH

population 18-24 25-34 35-44 45-54 55-64 65 +

SummariesSummaries

Older women in the worst positionOlder women in the worst position

Low QoL and not very good healthLow QoL and not very good health Difficulties in everyday functioning Difficulties in everyday functioning

due to poor healthdue to poor health

- Regional differences exist- Regional differences exist- Mediterranean area better- Mediterranean area better

72.17

62.18

67.2069.10

64.60

53.20

61.90

80.34

76.44

58.33

74.52 73.87

68.60

54.80

61.50

73.80

20

30

40

50

60

70

80

90

100

PhysicalFunctioning

Role limitationdue to Physical

problems

Pain General HealthPerception

Energy Vitality SocialFunctioning

Role limitationdue to Emotional

problems

Mental Health

Islands

Croatia

Factor analysisFactor analysis SF-36 - Croatian sampleSF-36 - Croatian sample

 Component

1 2

pf .273 .820

rp .329 .810

bp .331 .760

gh .553 .598

vt .772 .436

sf .677 .506

re .663 .362

mh .909 .193

Compo-nent

Rotation Sums of Squared Loadings

Total% of

VarianceCumulative

%

1 physical health

2.919 36.489 36.489

2 mental health 2.877 35.960 72.449

Predictors of subjective Predictors of subjective quality of life (SQOL)quality of life (SQOL)

Best predictors of SQBest predictors of SQOOL:L: Mental health (23 % variance explained)Mental health (23 % variance explained) General health (2.8 % variance explained)General health (2.8 % variance explained)

All together 8 dimensions explained 27% of All together 8 dimensions explained 27% of SQSQOOLL

Subjective quality of life and health related Subjective quality of life and health related quality of life must be measured quality of life must be measured independently/separatelyindependently/separately

Different concept & different contentDifferent concept & different content

ConclusionConclusion(for further health surveys (for further health surveys

in Croatia)in Croatia)

Importance of measuring QOL was Importance of measuring QOL was recognisedrecognised

Subjective QSubjective QOOL incorporated in L incorporated in health surveys is independent of health surveys is independent of health related QOL measures so it health related QOL measures so it will be measured independently.will be measured independently.