n
%
Mean ± SD
Chi2
Q1–Q3
p
Gender
Women
123
46.8
1.1
Men
140
53.2
0.29
Age
24 and below
4
1.5
25–44
20
7.6
60.2 ± 13.2
298.7
45–64
151
57.6
53.0–70.0
<0.0001
65–84
78
29.8
85 and above
9
3.4
Place of residence
Village
136
51.7
Below 5,000*
56
21.3
5,000–10,000*
7
2.6
466.1
10,000–50,000*
35
13.3
<0.0001
50,000–100,000*
19
7.2
100,000–200,000*
4
1.5
Over 200,000*
6
2.3
Education
Incomplete primary – below 8 years
1
0.4
Primary – 8 years
60
22.8
336.2
Vocational – 10 years
85
32.3
<0.0001
Secondary – 12 or 14 years
96
36.5
Higher – 17 or above 17 years
21
8.0
Marital status
Single
21
8.0
Married
185
70.3
431.0
Separated
4
1.5
<0.0001
Divorced
12
4.6
Widowed
41
15.6
Smoking
Non-smokers
75
28.4
Smokers
53
20.1
The QoL profile was investigated with the Polish version of the World Health Organization Quality of Life Instrument Short Form (WHOQOL-BREF). This is an instrument which conceptually derives from the QoL definition proposed by WHO. It contains 26 questions, the two first of which provide information on how individuals perceive their health and general quality of life. Other questions evaluate four QoL domains: physical, psychological, social relationships, and environmental (Wolowicka and Jaracz 2001; WHOQOL Group 1998).
The answers to all WHOQOL-BREF questions, including the first two concerning the satisfaction with QoL and health status, are weighed on a five point Likert-type scale, ranging from 1- ‘does not occur at all’ to 5 – ‘it does occur’. A maximum of 5 points could be obtained for questions 1 and 2, 4–20 points for each domain. The total QoL score is the arithmetic sum of the scores obtained in the four WHOQOL-BREF domains: the higher the score, the higher the QoL level. The final results were interpreted as follows: the score ≥ 75 % of the total score = very high QOL, 50–74.9 % = high QOL, and <50 % = low QoL. The reliability of the WHOQOL-BREF Polish version, measured with the α-Cronbach coefficient, is in a range of 0.81–0.69 for individual domains and 0.90 for the whole questionnaire.
The AI was investigated with the Acceptance of Illness Scale consisting of eight questions about consequences of bad health status. The questions concerned limitations caused by disease, lack of self-sufficiency, feeling of dependence on others, and low self-esteem. Each question was weighed on a five point Likert-type scale. Resolute agreement with a particular statement corresponded with the weak adaptation to disease (1 point), while resolute disagreement indicated acceptance of illness (5 points). The possible score ranged from 8 to 40 points and reflected the degree of general acceptance of disease. A low score (8–18 points) denoted lack of acceptance and adaptation as well as a strong feeling of psychological discomfort. A high score (30–40 points) suggested acceptance of disease together with lack of negative emotions associated with it. A score of 19–29 demonstrated that the patient had managed to partially adapt to disease. The α-Cronbach coefficient of the Polish version of the scale is 0.85 (Nowicki and Ostrowska 2008).
The socioeconomic measure was based on the patients’ answers concerning the education defined by the number of schooling years (Laurent et al. 2008; Krieger et al. 1997), place of residence, marital status, gender, and age. Lung function was assessed from the forced expired volume in 1 s (FEV1) measurements taken during the preceding year, expressed in percent predicted values.
To unify the results, a somatic index was used in the study. Somatic symptoms reported by the patients were assigned to values from one (symptoms occurring once a year) to seven (permanent symptoms). The index was calculated by summing up values assigned to somatic symptoms and then dividing this sum by 49 (the highest possible score).
Means ± SD, medians, min-max values were calculated for measurable (quantitative) variables, while for qualitative variables the frequency (percentage) was determined. Spearman’s rank correlation coefficient was used to assess associations between variables. Data were not normally distributed as assessed with the Shapiro-Wilk test. Analysis of logistic regression was used to examine the impact of explanatory variables on QoL and AI levels. The critical level of significance was assumed at p < 0.05. Statistical analysis was performed using R2.10.1 (for Mac OS X Cocoa GUI).
3 Results
The mean age of rural patients was higher than that of urban patients (63.5 ± 11.8 vs. 56.6 ± 14.1 years, p < 0.0001). There were also significant differences in the percentage of the post-working age population between urban and rural areas: the percentage of people aged 65–85 years or more was higher in rural than urban areas – 40.0 % (54 persons) and 26.0 % (33 persons), respectively (p = 0.002).
The level of education depended on the place of residence (p ≤ 0.001). In rural areas, the percentage of patients with primary education was higher than in urban areas (35.3 %, 48 persons and 9.4 %, 12 persons, respectively). Furthermore, patients with vocational education were more numerous in rural areas (39.7 %, 54 persons and 24.4 %, 31 persons, respectively). More urban residents had secondary education (52.7 %, 67 persons and 21.3 %, persons) and higher education (8.6 %, 11 persons and 7.4 %, 10 persons, respectively) than was the case in rural areas.
The patients suffered from COPD for 9.0 ± 6.0 years (range 2.0–35.0 years). The duration of the disease was significantly shorter in rural (8.4 ± 5.3 years) than urban areas (13.4 ± 7.6 years, p < 0.0001). The severity of COPD was determined on the basis of spirometry. A mild form of the disease (A) was diagnosed in 53.4 % (141 patients), moderate (B) in 36.4 % (96 patients), and severe (C) in 1.1 % (3 patients). Less than every tenth patient (9.1 %, 24 patients) had no spirometry done in the year preceding the study. Most patients (28.0 %, 74 persons) reported three diseases, (25.8 %, 68 persons) two diseases, and 47 (17.8 %, 47 persons) four diseases. The average number of diseases was 3.2 ± 1.6 (range 1–9 diseases).
The average value of the somatic index was 0.4 ± 0.2. Somatic improvement during the previous 12 months was reported by 37.8 % of patients (100 persons) and psychological improvement by 40.2 % of patients (106 persons) (p > 0.05). There were no significant differences in the index of health services between residents of urban and rural areas (p = 0.06). During the 12 months prior to the study, the average number of health services was 5.2 ± 5.2 (range 0–30).
Patients’ overall satisfaction with QoL was at a reasonably good level (3.5 ± 0.9). However, patients were dissatisfied with their health status; the average score being 2.9 ± 0.9 (Table 2). Patients with higher education were more satisfied with QoL and health status (Chi2 = 34.4, p < 0.0001 and Chi2 = 34.1, p < 0.0001, respectively).
Table 2
Quality of life according to the WHOQOL-BREF questionnaire and acceptance of illness according to Acceptance of Illness Scale
QoL domains and AI | n | M | SD | Q.25 % | Q.50 % | Q.75 % | Min | Max |
|---|---|---|---|---|---|---|---|---|
Satisfaction with QoL | 263 | 3.4 | 0.8 | 3.0 | 4.0 | 4.0 | 1.0 | 5.0 |
Satisfaction with health status | 264 | 2.9 | 0.9 | 2.0 | 3.0 | 4.0 | 1.0 | 5.0 |
D1 – Physical domain | 264 | 13.1 | 2.9 | 11.4 | 13.1 | 15.4 | 4.6 | 19.4 |
D2 – Psychological domain | 264 | 13.0 | 2.8 | 10.6 | 12.6 | 15.3 | 6.6 | 18.6 |
D3 – Social relationships domain | 264 | 14.2 | 2.8 | 12.0 | 14.6 | 16.0 | 6.6 | 20.0 |
D4 – Environmental domain | 263 | 13.4 | 2.4 | 12.0 | 13.5 | 15.0 | 7.0 | 18.5 |
Total QoL | 263 | 53.8 | 9.8 | 47.2 | 52.2 | 60.0 | 29.1 | 76.6 |
AI | 258 | 25.9 | 6.9 | 21.0 | 25.0 | 31.0 | 8.0 | 40.0 |
There were differences in satisfaction with QoL and health status measured with reference to the indicators of socioeconomic status. Patients with higher education had higher QoL than those worse educated (Chi2 = 34.4, p < 0.0001), younger patients had higher QoL than older ones (Chi2 = 34.4, p < 0.0001), and patients from towns/cities with a population of over 50,000 had higher QoL than those from rural areas and towns/cities with a population up to 2,000 (Chi2 = 18.1, p = 0.02). Satisfaction with health status depended on education (Chi2 = 34.1, p < 0.0001), age (Chi2 = 20.5, p < 0.001), and gender (Chi2 = 5.2, p = 0.02).
The overall QoL score was 53.8 ± 9.8, which implied very good and good QoL. The social relationships domain scored high (14.2 ± 2.8) and the psychological domain scored low (13.0 ± 2.8), while in the physical and environmental domains the results were similar. There were statistically significant differences in QoL depending on education, age, and place of residence; very good QoL was observed in patients with education of 14 years of schooling or more, patients aged up to 44 years, and residents of towns and cities (Chi2 = 104.5, p < 0.0001).
There were significant QoL differences in the physical domain depending on education, age, and gender (Chi2 = 93.4, p < 0.0001). In this domain, QoL was more often assessed as very good in patients with higher education, younger patients, and in women. Worse QoL (score below 13.99 points) was noted in poorly educated and older patients, and men (Chi2 = 93.4, p < 0.0001). QoL also differed in the social relationships domain, depending on education, age, and the place of residence (Chi2 = 88.5, p < 0.0001). Patients with higher education, younger patients, and rural residents evaluated QoL in this domain as very good and good. In the environmental domain, QoL depended on education, age, the place of residence, and gender (Chi2 = 107.2, p < 0.0001). QoL was more often assessed as very good and good by well-educated and younger patients, residents of towns/cities, and by women.
The average AI result amounted to 25.9 ± 6.9, which may suggest problems with adaptation to life with the disease, a feeling of discomfort, and self-care difficulties among COPD patients. There were significant differences in AI depending on education, the place of residence, age, and gender (Chi2 = 70.20, p < 0.0001). Patients with higher education, patients aged up to 44 years, urban patients, and women were prone to better accept their health status.
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