Impact of nine chronic conditions for US adults aged 65 years and older: an application of a hybrid estimator of quality-adjusted life years throughout remainder of lifetime

Purpose: To estimate quality-adjusted life years (QALY) loss due to each of the following nine chronic conditions-depression, diabetes mellitus, hypertension, heart disease, stroke, emphysema, asthma, arthritis, and cancer.

Methods: We ascertained respondents' health-related quality of life scores and mortality status from the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES) with mortality follow-up data through December 31, 2011. We included respondents aged 65 years and older (n = 2380). A hybrid estimator was used to calculate QALY from two parts: QALY during the follow-up period and QALY beyond the follow-up period. We calculated QALY by each of the nine chronic conditions.

Results: For persons aged 65 and older, QALY throughout the reminder of lifetime was 12.3 years. After adjusting for age- and sex-related differences, depression had an associated 8.2 years of QALY loss; diabetes, 5.6 years; hypertension, 2.5 years; heart disease, 5.4 years; stroke, 6.4 years; emphysema, 8.0 years; asthma, 4.8 years; arthritis, 0.3 years; and cancer, 2.5 years. Compared to persons without any chronic conditions, persons with one condition had an associated 4.7 years of QALY loss; persons with two conditions, 7.9 years; and persons with three or more conditions, 10.8 years.

Conclusions: This study presents a QALY estimator for respondents in the NHANES-Linked Mortality File and demonstrates the utility of this method to other follow-up data. Continued application of our method would enable the burden of disease to be compared for a range of health conditions and risk factors in the ongoing effort to improve population health.