Predictors of Reduced Health-related Quality of Life in Celiac Disease
Predictors of Reduced Health-related Quality of Life in Celiac Disease
Background: Data available on predictors of reduced health-related quality of life in coeliac disease are not consistent.
Aim: To test predictors of reduced health-related quality of life, described in the literature, by a multivariate approach.
Methods: 1000 adult coeliacs of the German Coeliac Society completed a medical and a sociodemographic questionnaire, the Short-Form Health Survey (SF-36), the Coeliac Disease Questionnaire and the Hospital Anxiety and Depression Scale within a postal survey. Predictors of reduced health-related quality of life were tested for by logistic regression analysis.
Results: Physical comorbidities (β = −0.41; OR = 0.66, P < 0.001) and mental disorder (β = 0.88; OR = 2.4, P = 0.03) were associated with a reduced physical summary score of the SF-36. Mental disorder (β = 2.5; OR = 11.9, P < 0.001), physical comorbidities (β = −0.26; OR = 0.77, P = 0.004) and younger age at diagnosis (β = −0.10; OR = 0.91, P = 0.05) predicted a reduced mental summary score of the SF-36. Mental disorder (β = 0.90; OR = 2.5, P = 0.03), non-compliance with gluten-free diet (β = 0.44; OR = 1.6, P = 0.009), active medical comorbidities (β = −0.28; OR = 0.76, P = 0.007) and dissatisfaction with doctor–patient communication (β = 0.55; OR = 1.7, P = 0.03) were associated with reduced Coeliac Disease Questionnaire scores.
Conclusions: Reduced health-related quality of life in coeliac disease is associated not only with physical and mental comorbidities, but also with non-compliance with gluten-free diet and dissatisfaction with doctor–patient communication.
Health-related quality of life (HRQOL) has become an important primary or secondary end point of clinical studies in gastroenterology. There is a growing interest in the identification of potentially modifiable determinants of HRQOL in given diseases in order to derive specific treatments to improve the health status of the patients.
Coeliac disease (CD) can be defined as an inflammatory disease of the small intestine characterized by a persistent intolerance to gluten proteins contained in wheat, barley and rye. Serological screening studies demonstrated a prevalence of CD between 1:125 and 500 in the general US-American and European population. By removing gluten from the diet – which goes along with a major change in diet with a complete avoidance of wheat-based foods which are a major part of nutrition in western countries such as sandwiches, pasta, pizza, pancakes or cookies – full histological and serological remission and an improvement of HRQOL can be attained.
Studies on the impact of CD and gluten-free diet (GFD) on HRQOL led to conflicting results. Whereas US-American, Canadian studies and Swedish studies reported an average HRQOL of adult coeliac patients comparable with the general population, studies conducted in Italy, Northern Ireland and Germany demonstrated a reduced HRQOL compared with the general population healthy controls, respectively. The results of the studies on HRQOL in CD are not fully comparable because they partially used different health measures. Moreover, the scope of demographic (socioeconomic factors, for example) and disease-related factors (somatic and mental comorbidities) assessed within these studies was different.
From a clinical point of view it is more relevant to identify subgroup of coeliac patients with a reduced HRQOL and its potentially modifiable determinants than to look at average HRQOL values of the total coeliac sample under study. The following factors, measured by generic instruments, had been identified by univariate statistical analysis to be associated with a reduced HRQOL in adult coeliacs: female sex, younger age at diagnosis, newly diagnosed patients, latency of diagnosis, poor adherence to GFD, anxiety and somatic as well as psychiatric comorbidity. The relative predictive value of these variables for a reduced HRQOL in CD had not been assessed up to now. Moreover, the studies on health status in CD used generic HRQOL instruments, but not validated disease-specific instruments.
The aims of our study therefore were to test by a multivariate approach the relative predictive value of variables hitherto identified by univariate analysis to be associated with a reduced HRQOL measured by a generic and by a disease-specific instrument in adult coeliacs.
Summary and Introduction
Summary
Background: Data available on predictors of reduced health-related quality of life in coeliac disease are not consistent.
Aim: To test predictors of reduced health-related quality of life, described in the literature, by a multivariate approach.
Methods: 1000 adult coeliacs of the German Coeliac Society completed a medical and a sociodemographic questionnaire, the Short-Form Health Survey (SF-36), the Coeliac Disease Questionnaire and the Hospital Anxiety and Depression Scale within a postal survey. Predictors of reduced health-related quality of life were tested for by logistic regression analysis.
Results: Physical comorbidities (β = −0.41; OR = 0.66, P < 0.001) and mental disorder (β = 0.88; OR = 2.4, P = 0.03) were associated with a reduced physical summary score of the SF-36. Mental disorder (β = 2.5; OR = 11.9, P < 0.001), physical comorbidities (β = −0.26; OR = 0.77, P = 0.004) and younger age at diagnosis (β = −0.10; OR = 0.91, P = 0.05) predicted a reduced mental summary score of the SF-36. Mental disorder (β = 0.90; OR = 2.5, P = 0.03), non-compliance with gluten-free diet (β = 0.44; OR = 1.6, P = 0.009), active medical comorbidities (β = −0.28; OR = 0.76, P = 0.007) and dissatisfaction with doctor–patient communication (β = 0.55; OR = 1.7, P = 0.03) were associated with reduced Coeliac Disease Questionnaire scores.
Conclusions: Reduced health-related quality of life in coeliac disease is associated not only with physical and mental comorbidities, but also with non-compliance with gluten-free diet and dissatisfaction with doctor–patient communication.
Introduction
Health-related quality of life (HRQOL) has become an important primary or secondary end point of clinical studies in gastroenterology. There is a growing interest in the identification of potentially modifiable determinants of HRQOL in given diseases in order to derive specific treatments to improve the health status of the patients.
Coeliac disease (CD) can be defined as an inflammatory disease of the small intestine characterized by a persistent intolerance to gluten proteins contained in wheat, barley and rye. Serological screening studies demonstrated a prevalence of CD between 1:125 and 500 in the general US-American and European population. By removing gluten from the diet – which goes along with a major change in diet with a complete avoidance of wheat-based foods which are a major part of nutrition in western countries such as sandwiches, pasta, pizza, pancakes or cookies – full histological and serological remission and an improvement of HRQOL can be attained.
Studies on the impact of CD and gluten-free diet (GFD) on HRQOL led to conflicting results. Whereas US-American, Canadian studies and Swedish studies reported an average HRQOL of adult coeliac patients comparable with the general population, studies conducted in Italy, Northern Ireland and Germany demonstrated a reduced HRQOL compared with the general population healthy controls, respectively. The results of the studies on HRQOL in CD are not fully comparable because they partially used different health measures. Moreover, the scope of demographic (socioeconomic factors, for example) and disease-related factors (somatic and mental comorbidities) assessed within these studies was different.
From a clinical point of view it is more relevant to identify subgroup of coeliac patients with a reduced HRQOL and its potentially modifiable determinants than to look at average HRQOL values of the total coeliac sample under study. The following factors, measured by generic instruments, had been identified by univariate statistical analysis to be associated with a reduced HRQOL in adult coeliacs: female sex, younger age at diagnosis, newly diagnosed patients, latency of diagnosis, poor adherence to GFD, anxiety and somatic as well as psychiatric comorbidity. The relative predictive value of these variables for a reduced HRQOL in CD had not been assessed up to now. Moreover, the studies on health status in CD used generic HRQOL instruments, but not validated disease-specific instruments.
The aims of our study therefore were to test by a multivariate approach the relative predictive value of variables hitherto identified by univariate analysis to be associated with a reduced HRQOL measured by a generic and by a disease-specific instrument in adult coeliacs.