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Each Added Comorbidity Cuts 4 Points Off QOL Index in US Women With HIV
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"The WIHS investigators concluded that in a population of US women with high rates of HIV, multimorbidity, and health disparities, a growing number of comorbidities significantly erodes health-related QOL. They called for more research "to optimize multimorbidity screening and prevention in this population."
IDWeek 2023, October 11-15, 2023, Boston
Mark Mascolini
Each comorbidity a woman added to her medical record lopped 4 points off a quality-of-life (QOL) index in a study of 3036 US women with or without HIV infection [1]. Neither age nor HIV status affected this association between number of comorbidities and skidding health-related QOL.
Researchers at Atlanta's Emory University and collaborators from other centers noted that women with HIV run a higher risk of age-related non-AIDS comorbidities at a younger age than women without HIV. But the impact of comorbidity burden on health-related QOL remained largely unexplored before this analysis of the Women's Interagency HIV Study (WIHS), the biggest and longest observational cohort of women with or without HIV.
This analysis focused on WIHS women in follow-up in 2009 or later, when more than 80% of women with HIV reported taking antiretroviral therapy. Researchers considered QOL in nine domains and used the MOS-HIV instrument [2] to create a summary QOL index. They used linear regression analysis to assess the impact of comorbidities on QOL. Linear regression models were unadjusted, partially adjusted (including all possible interaction terms), or adjusted (all terms plus covariates).
The 3036 WIHS women analyzed had a median age of 50 (interquartile range 43 to 56), 72% had HIV infection, 66% were black, and 51% had income below $12,000 yearly. Women averaged 3.4 comorbidities.
Average QOL index proved nearly identical in WIHS women with HIV and their counterparts without HIV (68 vs 69, P = 0.40), but it dropped consistently with older age (P < 0.001): under 40 years QOL 75, 40-49 years QOL 71, 50-59 years QOL 65, and 60-69 years QOL 63.
The unadjusted linear regression model charted a negative association between each additional comorbidity and QOL index-the more comorbidities, the lower the QOL. The partially adjusted model figured that older age (P = 0.02) but not HIV infection modified the impact of comorbidity burden on QOL. A model considering race, body mass index, use of cigarettes, alcohol, or crack, menopausal status, and socioeconomic status linked higher comorbidity burden to lower QOL (P < 0.001). But neither age nor HIV infection modified the impact of comorbidity burden on QOL.
A linear regression model partially adjusted for HIV status, age group, and number of comorbidities determined that each additional comorbidity a woman acquires subtracts 4.4 points from her QOL index (95% confidence interval -4.7 to -4.1, P < 0.001).
Although HIV status did not affect the impact of comorbidities on QOL, further analysis determined that having versus not having HIV infection further depressed the QOL index for each of 10 age-related comorbidities:
Change in average QOL with versus without HIV
- Psychiatric illness: -19.8
- Cardiovascular disease: -11.6
- Lung disease: -11.3
- Hypertension: -10.5
- Kidney disease: -9.8
- Bone disease: -9.3
- Non-AIDS cancer: -8.7
- Diabetes: -8.0
- Liver disease: -7.1
- Dyslipidemia: -6.6
The WIHS investigators concluded that in a population of US women with high rates of HIV, multimorbidity, and health disparities, a growing number of comorbidities significantly erodes health-related QOL. They called for more research "to optimize multimorbidity screening and prevention in this population."
References
1. Collins LF, Ofotokun I, Green Q, et al. The association of aging-related comorbidity burden and quality of life among women with and without HIV in the U.S. IDWeek 2023, October 11-15, 2023, Boston.
2. Wu AW, Revicki DA, Jacobson D, Malitz FE. Evidence for reliability, validity and usefulness of the Medical Outcomes Study HIV Health Survey (MOS-HIV). Quality of Life Research. 1997;6:481-493.Https://www.researchgate.net/profile/Albert-Wu-13/publication/
13895645_Evidence_for_reliability_validity_and_usefulness_of_the_Medical_Outcomes_Study_HIV_Health_Survey_MOS-HIV/links/54e4b1e40cf22703d5bf1cf9/Evidence-for-reliability-validity-and-usefulness-of-the-Medical-Outcomes-Study-HIV-Health-Survey-MOS-HIV.pdf
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