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Impaired health‐related quality of life in Addison's disease – impact of replacement therapy, comorbidities and socio‐economic factors
Author(s) -
Kluger Nicolas,
Matikainen Niina,
Sintonen Harri,
Ranki Annamari,
Roine Risto P.,
SchalinJäntti Camilla
Publication year - 2014
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12484
Subject(s) - medicine , comorbidity , quality of life (healthcare) , population , cohort , disease , cross sectional study , endocrinology , physical therapy , pathology , nursing , environmental health
Summary Objective Patients with Addison's disease ( AD ) on conventional replacement therapy have impaired health‐related quality of life ( HRQ oL). It is possible that lower hydrocortisone ( HC ) doses recommended by current guidelines could restore HRQ oL. We compared HRQ oL in AD patients treated according to current HC recommendations to that of the age‐ and gender‐standardized general population. Subjects, design and measurement We assessed HRQ oL in a cross‐sectional setting with the 15D instrument in a Finnish AD cohort ( n = 107) and compared the results with those of a large sample of general population ( n = 5671). We examined possible predictors of HRQ oL in AD . Within the patient group, HRQ oL was also assessed by SF ‐36. Results Mean HC dose was 22 mg/d, corresponding to 12 ± 4 mg/m2. HRQ oL was impaired in AD compared with the general population (15D score; 0·853 vs 0·918, P < 0·001). Within single 15D dimensions, discomfort and symptoms, vitality and sexual activity were most affected. Stepwise regression analysis demonstrated that Patient's Association membership ( P = 0·02), female gender ( P < 0·01), presence of other autoimmune or inflammatory comorbidity ( P < 0·02), lower education ( P < 0·02) and longer disease duration ( P < 0·05) independently predicted impaired HRQ oL, whereas replacement regimens, autoimmune‐related comorbidities, total number of comorbidities or level of healthcare follow‐up did not. In AD , HRQ oL was impaired also as assessed by SF ‐36. Conclusions HRQ oL is significantly impaired in AD compared with the general population despite use of recommended HC doses. Patient's Association membership was the most significant predictor of impaired HRQ oL. This finding should be explored in more detail in the future.