Health-related quality of life deficits associated with diabetes and comorbidities in a Canadian National Population Health Survey

Objective: To assess the impact of comorbid heart disease, stroke and arthritis on health-related quality of life (HRQL) in people with diabetes in the general Canadian population. Methods: Data were collected as part of the 1996 - 1997 Canadian National Population Health Survey. HRQL was assessed using overall Health Utilities Index Mark 3 (HUI3) and single attribute utility scores. Respondents ( N = 66,093) were classified into 1 of 16 groups based on the presence or absence of diabetes, heart disease, stroke, and arthritis, in all possible combinations and HRQL scores were compared using analysis of covariance. Results: Overall HUI3 scores for respondents with diabetes alone (0.88, 95% CI: 0.87 - 0.89) were lower than controls (0.92: 95% CI: 0.92 - 0.92, p < 0.001). Overall HUI3 scores for diabetes in combination with heart disease ( 0.77, 95% CI: 0.74 - 0.79), arthritis ( 0.78, 95% CI: 0.77 - 0.79) or stroke ( 0.79, 95% CI: 0.74 - 0.85) were considerably lower than diabetes alone. Triplets of comorbidities were associated with overall HRQL deficits of approximately 0.26 - 0.30, relative to controls. Conclusions: The illness burden experienced by individuals with diabetes is not only associated with diabetes itself, but largely with comorbid medical conditions.