BACKGROUND/OBJECTIVES:The effects of illness extend beyond the individual to caregivers and family members. This study identified evidence of spillover of illness onto household members' health-related quality of life. METHODS:Medical Expenditures Panel Survey (MEPS) data from 2000-2003 were analyzed using multivariable regression to identify spillover of household members' chronic conditions onto individuals' health-related quality of life as measured by the EuroQol-5D (EQ-5D) score (N = 24,188). Spillover was assessed by disease category, timing of occurrence (preexisting or new conditions), and age of the household member (adult or child). RESULTS:Controlling for an individual's own health conditions and other known predictors of EQ-5D scores, the authors found that the odds of an individual reporting full health (an EQ-5D score of 1.0, relative to <1.0) were lower with the presence of existing mental (odds ratio 0.71; 95% confidence interval, 0.64-0.79), respiratory (0.85; 0.75-0.97), and musculoskeletal (0.83; 0.75-0.93) conditions among adults and with mental (0.72; 0.62-0.82) and respiratory (0.80; 0.81-0.96) conditions among children in the household. The odds of an individual reporting full health were also lower for newly occurring chronic conditions in the household, including adults' mental (0.79; 0.65-0.97), nervous/sensory system (0.76; 0.61-0.96), and musculoskeletal (0.78; 0.65-0.95) conditions and children's mental conditions (0.64; 0.48-0.86). EQ-5D dimensions may be unsuited to fully capture spillover utility among household members, and MEPS lacks condition severity and caregiver status among household members. CONCLUSIONS:Evidence from a US sample suggests that individuals who live with chronically ill household members have lower EQ-5D scores than those who live either alone or with healthy household members. Averting spillover effects may confer substantial additional benefit at the population level for interventions that prevent or alleviate conditions that incur such effects.

译文

背景/目的:疾病的影响范围从个人扩展到照顾者和家庭成员。这项研究确定了疾病蔓延到家庭成员健康相关生活质量的证据。
方法:使用多变量回归分析2000-2003年的医疗支出面板调查(MEPS)数据,以通过EuroQol-5D(EQ-5D)得分来确定家庭成员的慢性病对个人与健康相关的生活质量的溢出(N = 24,188)。通过疾病类别,发生时间(既有疾病或新疾病)和家庭成员(成人或儿童)的年龄对溢出进行评估。
结果:控制个人自身的健康状况和其他已知的EQ-5D得分预测因素后,作者发现,存在健康状况的个人报告EQ-5D得分的机率(EQ-5D得分为1.0,相对于<1.0)较低成人和精神疾病(0.72; 0.62-0.82)的现有精神状况(比值0.71; 95%置信区间为0.64-0.79),呼吸道(0.85; 0.75-0.97)和肌肉骨骼(0.83; 0.75-0.93)和家庭中儿童的呼吸(0.80; 0.81-0.96)状况。对于家庭中新出现的慢性疾病,包括成年人的精神疾病(0.79; 0.65-0.97),神经/感觉系统(0.76; 0.61-0.96)和肌肉骨骼(0.78; 0.65)的人报告完全健康的几率也较低。 -0.95)状况和儿童的心理状况(0.64; 0.48-0.86)。 EQ-5D尺寸可能不适合完全捕获住户成员之间的溢出效用,而MEPS缺乏住户成员之间的病情严重程度和看护者状态。
结论:来自美国的证据表明,与长期居住的家庭成员生活的个体相比,与单独居住或与健康家庭成员生活的个体相比,其EQ-5D得分较低。避免溢出效应可在人群一级为预防或减轻引起这种效应的条件的干预措施带来实质性的额外收益。

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