Marginal differences in health-related quality of life of diabetic patients with and without macrovascular comorbid conditions in the United States

To examine and quantify, at the US national level, the marginal differences in health-related quality of life (HRQoL) of diabetic patients with and without macrovascular comorbid conditions (MaVCC). Using the pooled Medical Expenditure Panel Survey (MEPS) 2001 and 2003 data, a nationally representative community-dwelling adult sample (age a parts per thousand yen 18) was included in the study. HRQoL measures included the preference-based EQ-5D index, Euroqol visual analogue scale (EQ-VAS), SF-12 physical component summary (PCS), and SF-12 mental component summary (MCS). Given the censored distribution of the data, a two-part model was used to identify the relationship between MaVCC and the EQ-5D index after controlling for age, sex, race, ethnicity, education, income, employment status, health insurance, smoking status, diabetes severity, and comorbidities. Censored least absolute deviation and ordinary least square models were employed to analyze EQ-VAS and SF-12 PCS/MCS, respectively. Compared to diabetic patients without MaVCC (N = 2431), those with MaVCC (N = 747) had significantly lower EQ-5D index (-0.062), EQ-VAS (-9.2), SF-12 PCS (-5.0), and MCS (-2.1) after controlling for differences in sociodemographics, smoking status, diabetes severity, and comorbidities (all P < 0.001). MaVCC is consistently associated with lower HRQoL for patients with diabetes in the United States. Results of this study are valuable for future comparative-effectiveness and cost-effectiveness analyses in diabetes.