Academic journal article Central European Journal of Public Health

Impact of Comorbidity and Socioeconomic Status on Quality of Life in Patients with Chronic Diseases Who Attend Primary Health Care Centres

Academic journal article Central European Journal of Public Health

Impact of Comorbidity and Socioeconomic Status on Quality of Life in Patients with Chronic Diseases Who Attend Primary Health Care Centres

Article excerpt


Noncommunicable diseases cause 63% of deaths worldwide. Furthermore, it is estimated that deaths from noncommunicable diseases will increase by 15% between 2010 and 2020 (1). As the world's population gets older and the frequency of chronic diseases increases, the frequency of comorbidity will also increase (2, 3). It has been pointed out that in developing countries primary health care is the most available health service to meet the longterm requirements related to chronic diseases (4).

While there are studies concerning the effects of chronic diseases on the quality of life (QoL), studies concerning the interactions amongst chronic diseases and the effects of specific chronic disease combinations, especially at the level of primary health care centres (PHCs) are required (5-9). Because PHCs have a specific role in follow-up and long-term rehabilitation, the factors which determine the level of QoL of the patients can be useful information for conducting services and planning policies.

The frequency of chronic disease is higher in low socioeconomic groups (10, 11). Moreover, comorbidity is more frequently observed in low socioeconomic groups (12, 13), and studies indicate that QoL is lower in these groups (14, 15). It has also been pointed out that the socioeconomic differences determining QoL increase with time (16). These results suggest that studies of the effects of chronic diseases on QoL should also consider the socioeconomic determinants of health.

The aim of this study was to analyse the impact of chronic disease on QoL and how QoL changes with comorbidity and socioeconomic status for persons who attend PHCs.


Study Population

The group of participants consisted of 2,560 people who attend six PHCs in the centre of Ankara province. The data were collected in October 2004, by conducting a face-to-face questionnaire with people ≥ 18 years.


The dependent variable in this research is QoL concerning health, assessed by the World Health Organization Quality of Life Questionnaire Abbreviated Version (WHOQOL-BREF). The independent variables are age, gender, level of education, socioeconomic group, income group, and the chronic diseases reported by the participants.

Socioeconomic Groups

In the questionnaire, one question interrogates the furnishings and assets in the households. For each of the items, a score of 1, 2 or 3 points was assigned, and 'socioeconomic points' were calculated. The total points obtained were used to categorize 3 socioeconomic groups: 0-10 points, 11-20 points and 21 points and higher.

Income Groups

The total income of the family was divided by the total number of people living in the household to obtain the household income per capita. The household income per capita was divided into 4 groups considering the values of the first quarter, median and third quarter.

Chronic Diseases

Chronic diseases are defined as illnesses diagnosed by doctors that persist for > 6 months, as declared by the subjects studied. The source for the classification of the declared chronic diseases was the International Classification of Diseases 10th Revision (ICD 10). Since the most frequently declared diseases were diabetes mellitus (DM) and essential hypertension, these diseases were grouped under their own names, not in the disease groups according to ICD 10 classification. In accordance with ICD 10 classification, those ones listed under the title "Endocrine, nutritional and metabolic diseases" out of DM were the only thyroid diseases so these diseases were listed under their own names. The diseases listed under the title "Diseases of the circulatory system" out of hypertension were named "cardiovascular diseases". Since the only disease reported by the participants from the group of "Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism" was "nutritional anaemia", this disease was included under its own name. …

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