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Joe, Lee, and Park: Factors Influencing Health-related Quality of Life of Young Adults and Elderly with Multimorbiditiy: A Secondary Analysis of the 2013 Korea Health Panel Data
Original Article

Journal of Korean Academy of Community Health Nursing 2016; 27(4): 358-369.

Published online: 31 December 2016

DOI: https://doi.org/10.12799/jkachn.2016.27.4.358

Factors Influencing Health-related Quality of Life of Young Adults and Elderly with Multimorbiditiy: A Secondary Analysis of the 2013 Korea Health Panel Data

Seunyoung Joe1, Insook Lee2, Bohyun Park2

1Korea Armed Forces Nursing Academy, Daejeon, Korea.

2Department of Nursing, Changwon National University, Changwon, Korea.

Corresponding author: Lee, Insook. Department of Nursing, Changwon National University, 20 Changwondaehak-ro, Uichang-gu, Changwon 51140, Korea. Tel: +82-55-213-3570, Fax: +82-55-213-3579, dobest75@changwon.ac.kr

Received 3 June 2016       Revised 16 November 2016       Accepted 5 December 2016

© 2016 Korean Academy of Community Health Nursing

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was to identify health-related quality of life of Korean young adults and elderly with multimorbidity and to examine factors influencing their health-related quality of life.

Methods

Health-related quality of life was measured by the Korean version of the EQ-5D. Using a descriptive study, the study incorporated a secondary analysis of the Korean version of the EQ-5D data from the 8th wave of the Korea Health Panel Survey in 2013. Selected demographic data and the Korean version of the EQ-5D were analyzed using χ2-test, t-test, ANOVA and multiple regression analysis.

Results

Education, drinking, type of health insurance, and number of chronic disease significantly affected the health-related quality of life in the young adults with multimorbidity. Educational level, occupational type, drinking, physical activity, number of chronic disease, unmet healthcare need and the type of multimorbidity significantly affected the health-related quality of life in the elderly with multimorbidity.

Conclusion

The factors influencing health-related quality of life were different for young adults versus elderly with multimorbidity. Therefore, there is a need for age-specific health care programs that may improve health-related quality of life of adults with multimorbidity.

Keywords: Multimorbidity, Chronic disease, Quality of life, Young adults, Elderly

Figures and Tables

Table 1

Combinations of Multimorbidity (N=1,006)

jkachn-27-358-i001
Combination of multimorbidity Total Young and middle-aged adults Older adults
1st Disease 2nd Disease 3rd Disease n (%) n (%) n (%)
Hypertension Diabetes Hyperlipidemia 263 (26.1) 63 (33.2) 200 (24.5)
Hypertension Diabetes Arthritis 178 (17.7) 14 (7.4) 164 (20.1)
Hypertension Hyperlipidemia Arthritis 173 (17.2) 28 (14.7) 145 (17.8)
Hypertension Arthritis Lumbar pain 34 (3.4) 2 (1.1) 32 (3.9)
Hypertension Hyperlipidemia Angina 33 (3.3) 10 (5.3) 23 (2.8)
Hypertension Arthritis Angina 29 (2.9) 1 (0.5) 28 (3.4)
Hypertension Arthritis Osteoporosis 28 (2.8) 1 (0.5) 27 (3.3)
Hypertension Diabetes Angina 25 (2.5) 9 (4.7) 16 (2.0)
Hypertension Arthritis Disc herniation 24 (2.4) 6 (3.2) 18 (2.2)
Diabetes Hyperlipidemia Arthritis 21 (2.1) 9 (4.7) 12 (1.5)
Hypertension Hyperlipidemia Crebral infarction 18 (1.8) 5 (2.6) 13 (1.6)
Hypertension Diabetes Stroke 17 (1.7) 1 (0.5) 16 (2.0)
Hypertension Arthritis Stroke 15 (1.5) 0 (0.0) 15 (1.8)
Hypertension Diabetes Lumbar pain 13 (1.3) 1 (0.5) 12 (1.5)
Hypertension Hyperlipidemia Spinal stenosis 13 (1.3) 5 (2.6) 8 (1.0)
Hypertension Diabetes Crebral infarction 12 (1.2) 2 (1.1) 10 (1.2)
Hypertension Diabetes Disc herniation 12 (1.2) 3 (1.6) 9 (1.1)
Hypertension Hyperlipidemia Gout 12 (1.2) 5 (2.6) 7 (0.9)
Hypertension Hyperlipidemia Disc herniation 12 (1.2) 8 (4.2) 4 (0.5)
Hypertension Hyperlipidemia Osteoporosis 12 (1.2) 1 (0.5) 11 (1.3)
Hypertension Arthritis Crebral infarction 12 (1.2) 3 (1.6) 9 (1.1)
Hypertension Hyperlipidemia Allergic rhinitis 10 (1.0) 8 (4.2) 2 (0.2)
Hypertension Hyperlipidemia Rheumatoid arthritis 10 (1.0) 2 (1.1) 8 (1.0)
Hypertension Arthritis Ischemic heart disease 10 (1.0) 0 (0.0) 10 (1.2)
Hypertension Arthritis Spinal stenosis 10 (1.0) 0 (0.0) 10 (1.2)
Hypertension Arthritis Frozen shoulder 10 (1.0) 3 (1.6) 7 (0.9)
Total 1,006 (100.0) 190 (100.0) 816 (100.0)
Table 2

General and Medical related Characteristics of Participants (N=1,006)†

jkachn-27-358-i002
Characteristics Categories Total (N=1,006) Young and middle-aged adults (N=190) Older adults (N=816)
n (%) or M±SD n (%) or M±SD n (%) or M±SD
Age (year) 71.99±8.87 58.00±5.24 75.25±5.86
Gender Male 289 (28.7) 73 (38.4) 216 (26.5)
Female 717 (71.3) 117 (61.6) 600 (73.5)
Educational level ≤Middle school 743 (73.9) 98 (51.6) 645 (79.0)
High school 186 (18.5) 61 (32.1) 125 (15.3)
≥Bachelors 77 (7.7) 31 (16.3) 46 (5.6)
Annual income of household (million won) 27.03±31.73 43.29±52.40 23.25±23.00
1 quintile (bottom 20%) 374 (37.2) 33 (17.4) 341 (41.8)
2 quintile (20~40%) 245 (24.4) 31 (16.3) 214 (26.2)
3 quintile (40~60%) 175 (17.4) 44 (23.2) 131 (16.1)
4 quintile (60~80%) 123 (12.2) 46 (24.2) 77 (9.4)
5 quintile (above 80%) 88 (8.8) 36 (18.9) 52 (6.4)
Religion Seoul 136 (13.5) 29 (15.3) 107 (13.1)
Metropolitan city 249 (24.8) 49 (25.8) 200 (24.5)
Province 621 (61.7) 112 (58.9) 509 (62.4)
Occupational type Unemployed 681 (67.7) 75 (39.5) 606 (74.3)
Paid worker 141 (14.0) 73 (38.4) 68 (8.3)
Businessman, self-employed 118 (11.7) 29 (15.3) 89 (10.9)
Unpaid family worker 66 (6.6) 13 (6.8) 53 (6.5)
Smoking Never smoke 704 (71.5) 123 (66.1) 581 (72.8)
Former smoker/current nonsmoker 182 (18.5) 34 (18.3) 148 (18.5)
Current smoker 98 (10.0) 29 (15.6) 69 (8.6)
Drinking Non drinker 590 (60.0) 71 (38.2) 519 (65.0)
Moderate drinker 293 (29.8) 67 (36.0) 226 (28.3)
Heavy drinker 101 (10.3) 48 (25.8) 53 (6.6)
Moderate physical activity <3 times a week 721 (73.3) 119 (64.0) 602 (75.4)
≥3 times a week 263 (26.7) 67 (36.0) 196 (24.6)
Type of health insurance National health insurance 911 (90.6) 171 (90.0) 740 (90.7)
Medical care assistance 95 (9.4) 19 (10.0) 76 (9.3)
Number of chronic disease 5.75±2.29 5.03±2.12 5.92±2.30
3~6 692 (68.8) 153 (80.5) 539 (66.1)
7~9 242 (24.1) 29 (15.3) 213 (26.1)
≥10 72 (7.2) 8 (4.2) 64 (7.8)
Type of multimorbidity Not included musculoskeletal condition 378 (37.6) 98 (51.6) 280 (34.3)
Included musculoskeletal condition 628 (62.4) 92 (48.4) 536 (65.7)
Unmet healthcare needs Unmet healthcare needs 217 (22.1) 44 (23.7) 173 (21.7)
Not unmet healthcare needs 767 (77.9) 142 (76.3) 625 (78.3)

† Missing data excluded.

Table 3

Health-related Quality of Life by General and Medical related Characteristics of Participants (N=1,006)†

jkachn-27-358-i003
Characteristics Young and middle-aged adults (N=190) Older adults (N=816)
M±SD t or F (p) M±SD t or F (p)
HRQOL 0.87±0.12 0.84±0.12 3.30‡ (.001)
Gender Male 0.87±0.15 −0.27 (.791) 0.88±0.09 6.99 (<.001)
Female 0.87±0.09 0.82±0.13
Educational level ≤Middle schoola 0.87±0.11 4.21 (.016)
a, b<c		 0.83±0.12 11.75 (<.001)
a<b, c
High schoolb 0.85±0.15 0.87±0.10
≥Bachelorsc 0.92±0.05 0.88±0.09
Annual income of household (million won) 1 quintile (bottom 20%)a 0.80±0.14 4.59 (.001)
a<e		 0.82±0.13 2.97 (.019)
a<d
2 quintile (20~40%)b 0.88±0.12 0.84±0.12
3 quintile (40~60%)c 0.88±0.08 0.85±0.12
4 quintile (60~80%)d 0.86±0.14 0.86±0.11
5 quintile (above 80%)e 0.92±0.05 0.86±0.11
Religion Seoul 0.88±0.08 0.24 (.789) 0.85±0.11 0.90 (.408)
Metropolitan city 0.87±0.11 0.83±0.13
Province 0.87±0.13 0.84±0.12
Occupational type Unemployeda 0.84±0.16 2.20 (.090) 0.82±0.13 10.98 (<.001)
a<b, c
b>d
Paid workerb 0.89±0.08 0.89±0.07
Businessman, self-employedc 0.89±0.08 0.88±0.09
Unpaid family workerd 0.88±0.10 0.85±0.09
Smoking Never smokea 0.88±0.09 1.18 (.311) 0.83±0.13 5.83 (.003)
a<b
Former smoker/current nonsmokerb 0.85±0.18 0.86±0.10
Current smokerc 0.85±0.13 0.85±0.11
Drinking Non drinkera 0.85±0.14 2.59 (.078) 0.82±0.13 16.45 (<.001)
a<b, c
Moderate drinkerb 0.88±0.11 0.86±0.09
Heavy drinkerc 0.89±0.09 0.89±0.08
Moderate physical activity <3 times a week 0.86±0.13 −2.17 (.031) 0.83±0.13 −5.65 (<.001)
≥3 times a week 0.89±0.08 0.87±0.09
Type of health insurance National health insurance 0.88±0.11 2.69 (.015) 0.84±0.12 3.34 (.001)
Medical care assistance 0.77±0.16 0.79±0.11
Number of chronic disease 3~6a 0.89±0.11 9.50 (<.001)
a>b>c		 0.85±0.10 30.45 (<.001)
a>b>c
7~9b 0.82±0.14 0.82±0.12
≥10c 0.75±0.11 0.74±0.20
Type of multimorbidity Not included musculoskeletal condition 0.86±0.14 −1.05 (.297) 0.86±0.13 3.68 (<.001)
Included musculoskeletal condition 0.88±0.08 0.83±0.12
Unmet healthcare needs Unmet healthcare needs 0.86±0.13 −0.90 (.369) 0.79±0.13 −6.33 (<.001)
Not unmet healthcare needs 0.88±0.11 0.85±0.11

HRQOL=health-related quality of life; †Missing data excluded; ‡Result of indepent t-test between young and middle-aged, and older adult.

Table 4

Factors influencing HRQOL of Participants (N=1,006)†

jkachn-27-358-i004
Variables Model 1 Model 2
Young and middle-aged adults (n=190) Older adults (n=816)
B t p B t p
Female (Male=0) 0.01 0.42 .676 −0.02 −1.23 .220
Education (Below middle school=0)
 High school 0.00 −0.14 .888 0.03 2.68 .008
≥Bachelors 0.07 2.58 .011 0.03 1.53 .126
Annual income of household (million won) 0.35 0.21 .831 −0.30 −0.16 .873
Occupational type (Paid worker=0)
 Unemployed 0.00 −0.21 .830 −0.04 −2.72 .007
 Businessman/self-employed 0.01 0.48 .633 −0.01 −0.66 .507
 Unpaid family worker −0.02 −0.45 .657 −0.02 −1.00 .320
Smoking (Never smoke=0)
 Former smoker/current nonsmoker −0.05 −1.66 .100 −0.01 −0.39 .694
 Current smoker −0.07 −2.19 .030 −0.01 −0.69 .488
Drinking (Non drinker=0)
 Moderate drinker 0.02 1.01 .314 0.03 3.07 .002
 Heavy drinker 0.05 2.04 .043 0.02 1.01 .315
Moderate physical activity (<3 times a week=0)
 More than 3 times a week 0.02 0.91 .362 0.02 2.45 .015
Type of health insurance (NHI=0)
 Medical care assistance −0.04 −1.35 .180 −0.01 −0.71 .476
Number of chronic disease −0.01 −3.66 <.001 −0.01 −6.35 <.001
Type of multimorbidity (NMC=0)
 Included musculoskeletal condition 0.01 0.56 .575 −0.03 −3.08 .002
Unmet healthcare needs (Yes=0)
 Not unmet healthcare needs 0.01 0.31 .754 0.05 5.15 <.001
R2=.24, Adj. R2=.17, F=3.30, p<.001 R2=.19, Adj. R2=.17, F=11.33, p<.001

NHI=national health insurance; NMC=not included musculoskeletal condition; †Missing data excluded.

Dependent variable : health-related quality of life (EQ-5D index)

Note. Predictors : (constant), gender, educational level, annual income of household (million won), occupational type, smoking, drinking, moderate physical activity, type of health insurance, number of chronic disease, type of multimorbidity, unmet healthcare needs.

Notes

This research is financially supported by Changwon National University in 2015~2016.

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