Health-related quality of life among North Carolina adults with diabetes mellitus
Background: Previous research on health-related quality of life among people with diabetes used subgroups of diabetics who were not representative of a larger population and long questionnaires that are not practical for surveillance. Objective: To identify people with diabetes in North Carolina who are at risk for a poor quality of life based on demographic and medical characteristics using surveillance data. Methods: Analysis of Behavior Risk Factor Surveillance System data from North Carolina, years 1998 through 2001, to examine associations between demographic and medical characteristics among people with diabetes and four different health-related quality-of-life outcome indicators, including general health status, physically unhealthy, mentally unhealthy, and functionally limited days. The demographic and medical characteristics studied were age, sex, ethnicity, marital status, education, income, health insurance, obesity, duration of diabetes, and insulin use. These same characteristics were also tested for independent associations with functionally limited days. Results: Ethnicity and gender were not associated with any of the quality-of-life measures among people with diabetes. Those younger than age 65 were more likely to have mentally unhealthy days, but age was not related to the other outcomes. A household income of less than $20,000 was related to poor general health and greater than one week each of physically unhealthy, mentally unhealthy, and functionally limited days. Subjects with a high school education or less, no health insurance, and those not married or cohabiting had at least one poor health-related quality-of-life outcome. Obesity, duration of diabetes of ten or more years, and insulin use were also associated with at least one poor quality-of-life outcome. The only characteristic that was independently related to the number of functionally limited days was income. People with diabetes of working age and with low incomes were more likely to have greater than one week of functionally limited days (aOR = 10.3; 95% CI = 4.9-21.5). Conclusions: Our results suggest an association between poor quality of life and low-socioeconomic status among people with diabetes in North Carolina.