Category
n (%)
Gender
Female
68 (39.5)
Male
104 (60.5)
Age (years)
18–24
11 (11.0)
25–44
16 (6.4)
45–64
87 (16.0)
65–84
54 (9.4)
85 and above
3 (1.7)
Population of place of residence
200,000 and above
3 (87.0)
100,000–199,999
9 (5.2)
50,000–99,999
36 (20.9)
20,000–49,999
31 (18.0)
10,000–19,999
22 (12.8)
5,000–9,999
18 (10.5)
2,000–4,999
9 (5.2)
Rural area
44 (21.6)
Education
Primary
24 (14.0)
Vocational
60 (34.9)
Secondary
46 (26.7)
Post-secondary
22 (12.8)
Higher
19 (11.0)
Marital status
Single
15 (8.7)
Married
106 (61.6)
Widowed
25 (14.5)
Separated
13 (7.6)
Divorced
13 (7.6)
All patients underwent spirometry; 37 (21.5 %) of them had FEV1 less than 60 % of predicted value. The highest number of concomitant chronic diseases was eight (median 2.0) and the median healthcare service index was 5.2 (Q1: 2.4, Q3: 26.7; range: 1–113.8). QoL was assessed using a Polish version of WHO Quality of Life Instrument Short Form (WHOQoL-BREF), which measures QoL in four domains: physical, psychological, social relationships, and environmental. Answers to all questions, including two questions on satisfaction with QoL and health status, were given on a five-point Likert-type scale.
Based on the patients’ answers, the feeling of anxiety was assessed as occurring never (37, 21.5 %), seldom (72, 41.9 %), quite often (27, 15.7 %), very often (23, 13.4 %), and always (13, 7.6 %). The reliability of the WHOQoL-BREF questionnaire was verified using Cronbach’s alpha coefficient: values for particular domains ranged from 0.81 to 0.69, and the coefficient for the questionnaire as a whole was 0.90. The patients’ adaptation to life with disease was assessed using the Acceptance of Illness Scale, which contains eight statements on negative consequences of health state, each statement being rated on a five-point Likert-type scale with 1 denoting poor adaptation to disease and 5 its full acceptance. The score for acceptance of illness (AI) is a total of all points and ranges from 8 to 40. Low scores (8–29) indicate a lack of acceptance and adaptation to illness and an intense feeling of mental discomfort. High scores (35–40) indicate the acceptance of illness, manifesting as a lack of negative emotions associated with it. Cronbach’s α was 0.85 for the Polish version and 0.82 for the original version. A somatic index was calculated for each patient. The somatic symptoms reported by the patients were assigned values from 1 (symptoms occurring once a year) to 7 (symptoms present all the time). The index was calculated by adding up the values and dividing the result by 49 (the highest possible result for the frequency of somatic symptoms). The healthcare service index was calculated by adding up the services received and dividing by the number of types of the service provided during visits to a doctor, during nurse interventions, and during hospitalizations over the last 12 months. Higher values of this index correspond with a higher utilization of healthcare services. The number of hospitalizations over 3 years denotes the number of hospital stays in the years 2013–2015.
2.1 Statistical Elaboration
For quantitative variables, the basic descriptive statistics were calculated: mean, standard deviation, median, quartiles, and minimum and maximum values. All quantitative variables, except for body weight, had a normal distribution (p = 0.001), which was tested using the Shapiro–Wilk test of normality. In the next stage of the analysis, Spearman’s rank correlation coefficient was calculated. In the case of qualitative variables, categories were encoded with natural numbers. Correlation analysis was supplemented with the calculation of odds ratios for four field tables formed by pairs of two-categorical variables. These variables emerged from primary variables or were created by encoding values above and below the median in the case of quantitative variables, or by joining categories in cases of qualitative variables. A 95 % confidence interval was calculated for each odds ratio. Additionally, Fisher’s exact test of independence was performed for each four field table. The critical level of significance was set as 0.05 for all tests. Calculations were performed using an Apple MacBook Pro computer with OS X El Capitan ver. 10.11.5. The R statistical software ver. 3.1.3 was employed.
3 Results
3.1 Significant Correlations
QoL levels in the mental domain positively correlated with satisfaction with QoL (in all cases p < 0.001) and satisfaction with health state (in both cases r = 0.65), with physical domain (r = 0.85), social relationship domain (r = 0.68), and the environmental domain (r = 0.82). QoL in the psychological domain was rated higher by patients without coexisting COPD (r = 0.16, p = 0.034) and with high AI levels (r = 0.63).
Lower QoL in the psychological domain was observed among patients over 45 years of age (r = −0.43, p < 0.001), those with BMI > 25 (r = −0.18, p = 0.021), widowed, separated, and divorced (r = −0.24, p = 0.001); those with a high healthcare service index (r = −0.31, p < 0.001) and a high somatic index (r = −0.37, p < 0.001); and those with a high number of concomitant chronic diseases (r = −0.32, p < 0.001). Lower QoL in the psychological domain was also seen in the patients who were hospitalized more frequently in 2013–2015 (r = −0.30, p < 0.001), those receiving higher numbers of home visits (r = −0.22, p = 0.004), phone consultations (r = −0.15, p = 0.046) and district nurse interventions (r = −0.25, p = 0.001). The patients’ QoL in the psychological domain did not correlate with gender, place of residence, or FEV1 < 60 %.
Illness acceptance correlated positively (in all cases p < 0.001) with satisfaction with general QoL (r = 0.52), satisfaction with health state (r = 0.57), physical domain (r = 0.67), social relationship domain (r = 0.68), and the environmental domain (r = 0.68). Negative correlations of AI were observed with marital status, age (r = −0.45, p < 0.001), place of residence (r = −0.17, p = 0.024), and BMI (r = −0.20, p = 0.01). Lower AI levels were observed in widowed, separated, or divorced persons (r = −0.24, p = 0.002), older persons (r = −0.45, p < 0.001), those with BMI > 25 (r = −0.20, p = 0.01), high healthcare service (r = −0.34, p < 0.001) and somatic indices (r = −0.37, p < 0.001), and those having a higher number of concomitant chronic diseases (r = −0.44, p = 0.001).
Low AI levels were observed in the patients with a high number of hospital stays in 2013–2015 (r = −0.44, p = 0.001), those receiving higher numbers of home visits (r = −0.30, p = 0.001), phone consultations (r = −0.21, p = 0.005), and district nurse interventions (r = −0.28, p = 0.001), and those without somatic improvement (r = −0.26, p = 0.002). There was no significant correlation between the psychological domain and the severity of asthma (r = −0.12, p = 0.379).
3.2 Odds Ratios (OR) – Psychological Domain
The odds ratios for selected variables are presented in Table 2. The odds in favor of a low score in the psychological domain (below 14 points) were as follows:
23.91 times higher for patients with low scores in the physical domain (≤ 13.1) than for those with scores > 13.1 in this domain; the proportions of patients with low scores in the psychological domain in these groups were 81.6 and 15.3 %, respectively (p < 0.001);
16.67 times higher for patients with at least one nurse’s intervention at home than for those without such an intervention; the proportions of patients with low scores in the psychological domain in these groups were 93.3 and 44.6 %, respectively (p < 0.001);
12.75 times higher for patients with low scores in the social relationship domain (≤ 14.7) than in those with scores > 14.7; the proportions of patients with low scores in the psychological domain in these groups were 75.0 and 18.0 %, respectively (p < 0.001);
12.23 times higher for patients with low scores in the environmental domain (≤ 13.8) than for those with scores > 13.8; the proportions of patients with low scores in the psychological domain in these groups were 76.7 and 20.9 %, respectively (p < 0.001);
12.20 times higher for patients with low satisfaction with QoL (< 4) than for those with scores ≥ 4; the proportions of patients with low scores in the psychological domain in these groups were 77.4 and 21.6 %, respectively (p < 0.001);
6.54 times higher for patients with poor health state (< 3) than for those with scores ≥ 3); the proportions of patients with low scores in the psychological domain in these groups were 75.8 and 32.1 %, respectively (p < 0.001);
6.38 times higher for patients with low AI levels (< 27) than for those with AI levels ≥ 27; the proportions of patients with low scores in the psychological domain in these groups were 70.2 and 26.7 %, respectively (p < 0.001);
4.55 times higher for patients with at least one home visit of a doctor than for those without such a visit; the proportions of patients with low scores in the psychological domain in these groups were 78.3 and 44.3 %, respectively (p = 0.003).
3.57 times higher for patients with a high somatic index (> 0.4) than for those with a lower somatic index ≤ 0.4; the proportions of patients with low scores in the psychological domain in these groups were 65.1 and 33.7 %, respectively (p < 0.001);
3.45 times higher for patients with a higher number of comorbidities (≥ 2) than for those with fewer comorbidities < 2; the proportions of patients with low scores in the psychological domain in these groups were 63.6 and 33.3 %, respectively (p = 0.001);
3.30 times higher for patients aged over 58 years than for younger ones (18–58 years of age); the proportions of patients with low scores in the psychological domain in these groups were 63.9 and 34.1 %, respectively (p = 0.001);
2.20 times higher for widowed, separated, or divorced patients than for those who were single or married; the proportions of patients with low scores in the psychological domain in these groups were 62.7 and 43.0 %, respectively (p = 0.02);
2.13 times higher for patients with high health care service index (> 5.2) than for those with the index ≤ 5.2; the proportions of patients with low scores in the psychological domain in these groups were 58.1 and 39.5 %, respectively (p = 0.02);
1.96 times higher for patients with a high number of hospitalizations (≥ 2) in the past 3-year period than for those with < 2 hospital stays; the proportions of patients with low scores in the psychological domain in these groups were 56.5 and 40.0 %, respectively (p = 0.03).
Table 2
Odds ratio (OR) for 2 × 2 contingency tables of WHOQoL-BREF psychological domain by other variables
Score of WHOQoL-BREF psychological domain | Score of acceptance of illness | ||||||||
|---|---|---|---|---|---|---|---|---|---|
Variable | <14 | ≥14 | OR | p | <27 | ≥27 | OR | p | |
n (%) | n (%) | CI1 − CI2 | n (%) | n (%) | CI1 − CI2 | ||||
Gender | Male | 57 (46.2) | 56 (53.8) | 0.76 | 0.436 | 48 (46.2) | 56 (53.8) | 0.72 | 0.345 |
Female | 48 (52.9) | 32 (47.1) | 0.39 − 1.47 | 36 (54.5) | 30 (45.5) | 0.37 − 1.39 | |||
Age (year) | ≤58 | 30 (34.1) | 58 (65.9) | 0.30 | 0.001 | 28 (32.6) | 58 (67.4) | 0.25 | 0.001 |
>58 | 53 (63.9) | 30 (36.1) | 0.15 − 0.57 | 55 (66.3) | 28 (33.7) | 0.12 − 0.49 | |||
Height (cm) | ≤168 | 46 (53.5) | 40 (46.5) | 1.53 | 0.171 | 46 (54.1) | 39 (45.9) | 1.46 | 0.222 |
>168 | 36 (42.9) | 48 (57.1) | 0.80 − 2.94 | 37 (44.6) | 46 (55.4) | 0.76 − 2.82 | |||
Weight (kg) | ≤72 | 41 (46.6) | 47 (53.4) | 0.87 | 0.759 | 36 (41.9) | 50 (58.1) | 0.54 | 0.063 |
>72 | 41 (50.0) | 41 (50.0) | 0.46 − 1.66 | 47 (57.3) | 35 (42.7) | 0.28 − 1.03 | |||
Marital status | Single/married | 52 (43.0) | 69 (57.0) | 0.45 | 0.020 | 51 (42.9) | 68 (57.1) | 0.41 | 0.011 |
Others | 32 (62.7)
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