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|Title:||MEASUREMENT OF QUALITY OF LIFE OF PATIENTS WITH TYPE 2 DIABETES IN CHINA|
|Department:||Health Research Methodology|
|Abstract:||Background: As one of the major global chronic diseases, diabetes mellitus (DM) places substantial humanistic and economic burdens on patients and their families, healthcare systems and society. Type 2 DM (T2DM) accounts for about 90% of cases of diabetes, and it causes heavier impairment on patients’ quality of life (QoL) compared to type 1 DM. China has the world's largest type 2 diabetic patient (T2DP)population. However, little is known about the determinants of long-term QoL of Chinese T2DP. The Chinese Diabetes Quality-of-life (DQOL) measure is one of the most commonly used diabetes-specific QoL measures in Chinese clinical research. Patients have identified the long length of the DQOL a challenge for its implementation. In addition, since it is not a preference-based measure, the Chinese DQOL measured QoL data also cannot be employed in cost-utility analysis, which can achieve a broader economical comparison of interventions across different disease areas in the medical decision-making process. Therefore, this thesis aimed to 1) identify both statistically significant and clinically relevant determinants of long-term QoL of Chinese T2DPs, 2) develop a short version for the Chinese DQOL, and 3) map the Chinese DQOL onto the generic preference-based QoL instrument, EuroOoL5 dimensions 3-level (EQ-5D-3L). Methods: Data from a longitudinal observational study which recruited clinically diagnosed T2DPs (n=2,886) from community health centers in five Chinese cities was used. The Chinese DQOL and EQ-5D-3L were administered, and demographics, diabetes-related, and other health-related information was collected at baseline and at the end of 12 months. We used anchor-based approach to estimate the minimally important difference (MID) of the Chinese EQ-5D-3L for T2DP. The MID was used to identify the clinically relevant change in QoL over a one-year period for this patient population. Then logistic and ordered logistic regression models were fitted to identify statistically significant factors that explain these clinically relevant changes. Both the classical test theory and item response theory, each combined with exploratory factor analysis, were applied to reduce the number of items of the Chinese DQOL. Using the same data set, we also estimated the mapping algorithm between the Chinese DQOL (and its short version) and the Chinese EQ-5D-3L index by exploring different estimators and model specifications. Results and conclusions: This thesis estimated the MID of the EQ-5D-3L index was 0.0262 for Chinese T2DP and found that age, gender, education, income, exercise, and glycosylated hemoglobin level were the statistically significant and clinically relevant factors predicting a change in QoL for ChineseT2DP over a one year period. We provided a 24-item short version for the 46-item Chinese DQOL to reduce the patients’ burden in future clinical research. Mapping algorithms using age, gender, and domain scores were also established to map the original Chinese DQOL and the short version onto the EQ-5D-3L index.|
|Appears in Collections:||Open Access Dissertations and Theses|
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