Background
Methods
Study design
Data collection
Abbreviation of the instrument | Function and interpretation |
---|---|
AUDIT-C | Alcohol Use Disorders Identification Test [20]; 3 items with 5 possible response categories (0 to 4 points); interpretation: total score (max. 12 points): ≤ 7 points no suspicion of an alcohol related disorder, ≥ 8 points: suspicion of an alcohol related disorder |
Barthel-Index | Measures performance in basic activities of daily living [26]; 10 items with 3 categories each (0, 5 and 10 points); interpretation: total score (max. 100 points); 0 to 30 points: largely dependent from others, 35 to 80 points: need of care, 85 to 95: punctual need of care, 100: independent from others |
BMI | Body-Mass-Index (weight (kg)/height (m2)); interpretation: BMI < 18.5: underweight, 18.5 to < 25: normal weight, 25 to < 30: overweight and > 30: obesity |
VAS of EQ-5D | Visual analogous scale of the EuroQoL-5D (EQ-5D) [16] measures subjective health related quality of life on a scale from “0” representing the worst to “100” representing the best possible health status; interpretation: higher scores represent higher rates of subjective health |
F-SOZU K-14 | Social support questionnaire [21]; 14 items; 5 point scale; mean of the sum of all items; interpretation: high scores indicate high social support |
GCPS | Graded chronic pain scale [25]; 8 items, scale 0 to 10; 2 total scores: Characteristic pain intensity and Disability score; interpretation: higher scores represent higher pain intensity and higher disability caused by pain respectively |
GDS | Geriatric Depression Scale [23]; 15 items; 0 vs. 1 point per item; max. 15 points; interpretation: 0 to 5 points: unsuspicious, ≥ 6 points: depressive episode likely |
IADL | Instrumental Activities of Daily Living [27]; 8 items; 0 vs. 1 point per item; total score: men: item 1–2 and 6–8 (max. 5 points), women: item 1–8 (max. 8 points); interpretation: males: score < 5: with limitations, females: score < 8: with limitations |
IPAQ-7 | International Physical Activity Questionnaire [19]; 6 items buildup 3 scores: time spent on vigorous activity (weighting coefficient 8.0), on moderate activity (weighting coefficient 4.0) and on walking (weighting coefficient 3.3); “Total Metabolic Equivalent Task (MET)-minutes/week” calculated as follows: minutes x weighting coefficient; interpretation: low scores indicating low and high scores indicating high physical activity |
SWE | Self-Efficacy Scale [22]; 10 items on a four-point scale (1 to 4 points); total score: sum of the 10 items divided by 10; interpretation: high scores indicating high self-efficacy expectation |
4 DBL | Four-dimensional symptom questionnaire [24]; 50 items with 5 point scale; 4 sub scores reflecting the factors “somatization” (16 items), “anxiety” (12 items), “depression” (6 items) and “distress” (16 items); interpretation: somatization >10: moderate, >20 high; anxiety: >8: moderate, >12: high; depression: >2: moderate, >5: high; general distress: >10: moderate, >20: high |
Self-rated health
Socio-demographic variables
Lifestyle variables
Psychological characteristics
Illness related factors
Diagnosis group | Total (n = 3189) | Men (n = 1298) | Women (n = 1891) |
p value
3
|
---|---|---|---|---|
Hypertension | 2307 (72.3%) | 939 (72.3%) | 1368 (72.3%) | n.s. |
Joint arthrosis | 2115 (66.4%) | 718 (55.4%) | 1397 (73.9%) | < 0.001 |
Chronic low back pain | 1975 (62.0%) | 700 (54.1%) | 1275 (67.5%) | < 0.001 |
Lipid metabolism disorders | 1460 (45.9%) | 617 (47.6%) | 843 (44.7%) | n.s. |
Chronic ischemic heart disease | 963 (30.3%) | 549 (42.3%) | 414 (22.0%) | < 0.001 |
Severe vision reduction | 1396 (43.9%) | 515 (39.7%) | 881 (46.8%) | < 0.001 |
Prostatic hyperplasia | 511 (20.8%) | 511 (39.6%) | -- | -- |
Diabetes mellitus | 992 (31.2%) | 479 (37.0%) | 513 (27.2%) | < 0.001 |
Cardiac arrhythmia | 1044 (32.8%) | 451 (34.8%) | 595 (31.5%) | n.s. |
Neuropathies | 1114 (34.9%) | 426 (32.8%) | 688 (36.4%) | 0.041 |
Dizziness | 1109 (34.8%) | 381 (29.4%) | 728 (38.5%) | < 0.001 |
Lower limb varicosis | 1148 (36.0%) | 321 (24.8%) | 827 (43.8%) | < 0.001 |
Asthma/COPD1
| 696 (21.8%) | 280 (21.6%) | 416 (22.0%) | n.s. |
Purine/pyrimidine metabolism disorders/Gout | 536 (16.9%) | 269 (20.8%) | 267 (14.2%) | < 0.001 |
Haemorrhoids | 727 (22.8%) | 246 (19.0%) | 481 (25.5%) | < 0.001 |
Cerebral ischemia/Chronic stroke | 444 (13.9%) | 225 (17.4%) | 219 (11.6%) | < 0.001 |
Cardiac insufficiency | 548 (17.2%) | 214 (16.5%) | 334 (17.7%) | n.s. |
Atherosclerosis/PAOD2
| 347 (10.9%) | 193 (14.9%) | 154 (8.2%) | < 0.001 |
Thyroid dysfunction | 991 (31.1%) | 192 (14.8%) | 799 (42.3%) | < 0.001 |
Cancer | 332 (10.4%) | 171 (13.2%) | 161 (8.8%) | < 0.001 |
Noninflammatory gynaecological problems | 246 (9.1%) | -- | 246 (13.1%) | -- |
Renal insufficiency | 307 (9.6%) | 150 (11.6%) | 157 (8.3%) | 0.003 |
Cardiac valve disorders | 314 (9.9%) | 139 (10.7%) | 175 (9.3%) | n.s. |
Intestinal diverticulosis | 435 (13.7%) | 138 (10.6%) | 297 (15.7%) | < 0.001 |
Psoriasis | 213 (6.7%) | 117 (9.0%) | 96 (5.1%) | < 0.001 |
Rheumatoid arthritis/Chronic polyarthritis | 410 (12.9%) | 112 (8.7%) | 298 (15.8%) | < 0.001 |
Osteoporosis | 690 (21.7%) | 97 (7.5%) | 593 (31.4%) | < 0.001 |
Chronic cholecystitis/Gallstones | 271 (8.5%) | 78 (6.0%) | 193 (10.2%) | < 0.001 |
Urinary tract stones | 124 (3.9%) | 63 (4.9%) | 61 (3.2%) | 0.025 |
Anemia | 169 (5.3%) | 54 (4.2%) | 115 (6.1%) | 0.019 |
Migraine/chronic headache | 166 (5.2%) | 37 (2.9%) | 129 (6.8%) | < 0.001 |
Parkinson’s disease | 67 (2.1%) | 36 (2.8%) | 31 (1.6%) | 0.032 |
Missing values
Data analysis
Ethical considerations
Results
Characterization of the study population
Total (n = 3189) | Men (n = 1298) | Women (n = 1891) | P value2
| ||
---|---|---|---|---|---|
Self-rated health (SRH) (Mean (SD)) | 62.4 (18.2) | 63.6 (18.4) | 61.6 (18.0) | 0.003 | |
Demographic variables
| |||||
Age, in years (Mean (SD)) | 74.4 (5.2) | 74.0 (5.1) | 74.7 (5.3) | 0.001 | |
Marital status (N (%)) | |||||
Married
| 1863 (58.4%) | 1026 (79.0) | 837 (44.3) | ||
Single
| 188 (5.9%) | 56 (4.3) | 132 (7.0) | ||
Divorced
| 256 (8.0%) | 74 (5.7) | 182 (9.6) | ||
Widowed
| 882 (27.7%) | 142 (10.9) | 740 (39.1) | < 0.001 | (df = 3) |
Living conditions (N (%)) | |||||
One person household
| 1128 (35.4%) | 229 (17.6) | 899 (47.5) | ||
Living with partner/spouse
| 1847 (57.9%) | 1021 (78.7) | 826 (43.7) | ||
Living with others
1
| 214 (6.7%) | 48 (3.7) | 166 (8.8) | < 0.001 | (df = 2) |
Education (N (%)) | |||||
Low
| 1986 (62.3%) | 753 (58.0) | 1233 (65.2) | ||
Intermediate
| 856 (26.8%) | 306 (23.6) | 550 (29.1) | ||
High
| 347 (10.9%) | 239 (18.4) | 108 (5.7) | < 0.001 | (df = 2) |
Monthly income (in Euro) (Mean (SD)) | 1412.2 (705.9) | 1517.0 (833.0) | 1340.3 (593.0) | < 0.001 | |
Lifestyle variables
| |||||
Smoking behavior (N (%)) | |||||
Current smoker
| 292 (9.2%) | 153 (11.8) | 139 (7.3) | ||
Former smoker
| 1361 (42.7%) | 819 (63.1) | 542 (28.7) | ||
Non smoker
| 1532 (48.0%) | 324 (25.0) | 1208 (63.9) | < 0.001 | (df = 2) |
Body mass index (Mean (SD)) | 28.2 (4.9) | 28.1 (4.0) | 28.3 (5.4) | n.s. | |
Alcohol habits score (Mean (SD)) | 2.2 (1.9) | 3.0 (2.2) | 1.6 (1.5) | < 0.001 | |
Physical activity (in 1000 MET minutes/week) (Mean (SD)) | 2.2 (2.5) | 2.6 (2.8) | 1.9 (2.2) | < 0.001 | |
Psychological variables
| |||||
Self-efficacy (SWE) (Mean (SD)) | 3.3 (0.6) | 3.4 (0.5) | 3.2 (0.6) | < 0.001 | |
Social support (F-SOZU) (Mean (SD)) | 4.1 (0.7) | 4.1 (0.7) | 4.1 (0.7) | n.s. | |
Depression (GDS) (Mean (SD)) | 2.6 (2.6) | 2.3 (2.5) | 2.8 (2.7) | < 0.001 | |
Somatization (4DBL) (Mean (SD)) | 7.0 (5.1) | 5.7 (4.7) | 7.8 (5.2) | < 0.001 | |
Anxiety (4DBL) (Mean (SD)) | 1.0 (2.2) | 0.6 (1.7) | 1.3 (2.4) | < 0.001 | |
Depression (4DBL) (Mean (SD)) | 0.8 (2.0) | 0.7 (1.8) | 1.0 (2.1) | < 0.001 | |
Distress (4DBL) (Mean (SD)) | 5.9 (5.3) | 4.7 (4.7) | 6.8 (5.5) | < 0.001 | |
Disease-related variables
| |||||
Characteristic pain intensity (GCPS) (Mean (SD)) | 34.5 (25.5) | 28.1 (24.7) | 39.0 (25.2) | < 0.001 | |
Disability score (GCPS) (Mean (SD)) | 26.0 (29.2) | 20.2 (27.3) | 30.0 (29.2) | < 0.001 |
Variables | Mean (N) | SD | Mean (N) | SD |
pvalue | Effect size |
---|---|---|---|---|---|---|
Self-reported diseases | Present | Absent | ||||
Hypertension | 61.7 (2307) | 18.0 | 64.3 (882) | 18.5 | <0.001 | 0.14 |
Joint arthrosis | 60.0 (2115) | 17.9 | 67.2 (1072) | 17.8 | <0.001 | 0.40 |
Chronic low back pain | 59.1 (1975) | 18.2 | 68.0 (1208) | 16.9 | <0.001 | 0.49 |
Chronic ischemic heart disease | 59.4 (963) | 18.8 | 63.7 (2220) | 17.8 | <0.001 | 0.24 |
Severe vision reduction | 60.8 (1396) | 18.3 | 63.7 (1786) | 18.0 | <0.001 | 0.12 |
Diabetes mellitus | 61.0 (992) | 18.0 | 63.1 (2188) | 18.3 | 0.004 | 0.12 |
Cardiac arrhythmia | 59.0 (1046) | 18.2 | 64.1 (2139) | 18.0 | <0.001 | 0.28 |
Neuropathies | 57.1 (1114) | 18.2 | 65.2 (2075) | 17.6 | <0.001 | 0.45 |
Dizziness | 57.1 (1109) | 17.9 | 65.3 (2078) | 17.7 | <0.001 | 0.45 |
Lower limb varicosis | 61.1 (1148) | 18.4 | 63.2 (2037) | 18.0 | 0.002 | 0.12 |
Asthma/COPD1
| 58.0 (696) | 18.5 | 63.7 (2491) | 17.9 | <0.001 | 0.31 |
Purine/pyrimidine metabolism disorders/Gout | 57.7 (536) | 18.1 | 63.4 (2643) | 18.1 | <0.001 | 0.31 |
Hemorrhoids | 59.9 (727) | 18.4 | 63.2 (2459) | 18.1 | <0.001 | 0.18 |
Cerebral ischemia/Chronic stroke | 59.3 (444) | 18.4 | 62.9 (2742) | 18.1 | <0.001 | 0.20 |
Cardiac insufficiency | 55.7 (548) | 18.4 | 63.8 (2632) | 17.8 | <0.001 | 0.45 |
Atherosclerosis/PAOD2
| 54.6 (347) | 19.9 | 63.4 (2835) | 17.8 | <0.001 | 0.48 |
Renal insufficiency | 55.1 (307) | 19.1 | 63.2 (2875) | 17.9 | <0.001 | 0.45 |
Intestinal diverticulosis | 60.8 (435) | 17.7 | 62.7 (2751) | 18.3 | 0.046 | 0.10 |
Rheumatoid arthritis | 55.0 (410) | 18.8 | 63.5 (2768) | 17.8 | <0.001 | 0.47 |
Osteoporosis | 57.4 (690) | 18.7 | 63.8 (2496) | 17.8 | <0.001 | 0.35 |
Chronic cholecystitis/Gallstones | 59.1 (271) | 18.4 | 62.7 (2917) | 18.2 | 0.002 | 0.20 |
Anemia | 55.2 (169) | 18.1 | 62.8 (3017) | 18.1 | <0.001 | 0.42 |
Migraine | 58.8 (166) | 18.6 | 62.6 (3022) | 18.2 | 0.008 | 0.21 |
Parkinson’s disease | 49.5 (67) | 18.4 | 62.7 (3121) | 18.1 | <0.001 | 0.73 |
Lipid metabolism disorders | 61.8 (1460) | 17.9 | 62.9 (1721) | 18.4 | 0.10 | 0.06 |
Thyroid dysfunction | 61.7 (991) | 18.2 | 62.7 (2196) | 18.2 | 0.15 | 0.05 |
Prostate hyperplasia | 63.3 (510) | 17.7 | 63.8 (779) | 18.8 | 0.63 | 0.03 |
Non-inflammatory gynecological problems | 60.8 (245) | 19.7 | 61.7 (1631) | 17.8 | 0.45 | 0.05 |
Cardiac valve disorders | 61.4 (314) | 18.4 | 62.5 (2872) | 18.2 | 0.31 | 0.06 |
Kidney stones | 60.7 (124) | 18.5 | 62.5 (3063) | 18.2 | 0.29 | 0.10 |
Psoriasis | 61.4 (213) | 19.2 | 62.5 (2976) | 18.1 | 0.39 | 0.06 |
Malignant tumors | 60.9 (332) | 18.0 | 62.6 (2850) | 18.2 | 0.11 | 0.09 |
Sex
|
Males
|
Females
| ||||
63.6 (1298) | 18.4 | 61.6 (1891) | 18.0 | 0.003 | 0.11 | |
Marital status
|
Married
|
Non married
| ||||
63.3 (1863) | 18.2 | 61.2 (1326) | 18.2 | 0.001 | 0.12 | |
Household type
|
With others
|
Living alone
| ||||
63.0 (2061) | 18.2 | 61.3 (1128) | 18.2 | 0.011 | 0.09 | |
Education
|
High
|
Low/Intermediate
| ||||
67.1 (347) | 18.7 | 61.8 (2842) | 18.1 | <0.001 | 0.29 | |
Smoking behavior
|
Smoker
|
Non-smoker
| ||||
61.5 (237) | 18.4 | 62.5 (2948) | 18.2 | 0.42 | 0.05 |
Bivariate analyses
Characteristics | Men (n = 1298) | Women (n = 1891) | Total (n = 3189) |
---|---|---|---|
Socioeconomic variables
| |||
Age | −0.08 ** | −0.13 *** | −0.11 *** |
Income | 0.12 *** | 0.13 *** | 0.13 *** |
Lifestyle variables
| |||
Body mass index (BMI) | −0.13 *** | −0.16 *** | −0.15 *** |
Alcohol habit score (AUDIT-C) | 0.10 ** | 0.13 *** | 0.12 *** |
Physical activity (IPAQ-7) | 0.26 *** | 0.22 *** | 0.24 *** |
Psychological variables
| |||
Self-efficacy (SWE) | 0.24 *** | 0.20 *** | 0.22 *** |
Social support (F-SOZU) | 0.15 *** | 0.20 *** | 0.18 *** |
Depression (GDS) | −0.42 *** | −0.40 *** | −0.41 *** |
Somatization (4DBL) | −0.42 *** | −0.43 *** | −0.43 *** |
Anxiety (4DBL) | −0.26 *** | −0.22 *** | −0.23 *** |
Depression (4DBL) | −0.27 *** | −0.30 *** | −0.29 *** |
Distress (4DBL) | −0.36 *** | −0.37 *** | −0.37 *** |
Disease-related variables
| |||
Basic activities of daily living (Barthel) | 0.29 *** | 0.23 *** | 0.25 *** |
Instrumental activities (IADL) | 0.29 *** | 0.27 *** | -- 1
|
Characteristic pain intensity (GCPS) | −0.39 *** | −0.42 *** | −0.41 *** |
Pain Disability score (GCPS) | −0.43 *** | −0.47 *** | −0.46 *** |
Multiple regression analyses
Regression coefficient B (95% CI) | Standardized coefficient (beta) |
p value
| |
---|---|---|---|
Disability score (GCPS) | −0.11 (−0.15/-0.08) | −0.18 | <0.001 |
Depression (GDS) | −0.96 (−1.31/-0.60) | −0.14 | <0.001 |
Somatization (4DBL) | −0.61 (−0.79/-0.43) | −0.17 | <0.001 |
Physical activity (IPAQ-7) (in 1000 MET minutes/week) | 1.00 (0.38/0.97) | 0.09 | <0.001 |
Instrumental activities (IADL) | 1.11 (0.70/1.51) | 0.11 | <0.001 |
Characteristic pain intensity (GCPS) | −0.07 (−0.11/-0.03) | −0.09 | <0.001 |
Monthly income (in 1000 Euro) | 2.00 (0.56/2.51) | 0.06 | <0.001 |
BMI | −0.24 (−0.38/-0.09) | −0.06 | <0.001 |
Age | −0.18 (−0.32/-0.05) | −0.05 | 0.001 |
Self-efficacy (SWE) | 1.60 (0.27/2.94) | 0.05 | 0.002 |
Parkinson’s disease | −5.72 (−10.63/-0.80) | −0.04 | 0.003 |
Neuropathies | −1.58 (−3.12/-0.04) | −0.04 | 0.008 |
Distress (4DBL) | −0.19 (−0.37/0.00) | −0.05 | 0.010 |
Men | Women | |||||
---|---|---|---|---|---|---|
Regression coefficient B (95% CI) | Standar-dized coefficient (beta) |
p value
| Regression coefficient B (95% CI) | Standar-dized coefficient (beta) |
p value
| |
Somatization (4DBL) | −0.79 (−1.00/-0.59) | −0.20 | <0.001 | −0.54 (−0.72/-0.37) | −0.16 | <0.001 |
Disability score (GCPS) | −0.14 (−0.18/-0.11) | −0.21 | <0.001 | −0.10 (−0.14/-0.07) | −0.17 | <0.001 |
Depression (GDS) | −1.51 (−1.90/-1.12) | −0.20 | <0.001 | −0.91 (−1.24/-0.58) | −0.13 | <0.001 |
Physical activity (in 1000 MET minutes/week) (IPAQ-7) | 1.00 (0.53/1.14) | 0.13 | <0.001 | 1.00 (0.28/0.94) | 0.07 | <0.001 |
Activities of daily living (Barthel) | 0.30 (0.16/0.44) | 0.10 | <0.001 | n.s. | ||
Low or intermediate education | −4.43 (−6.57/-2.29) | −0.09 | <0.001 | n.s. | ||
Cardiac arrhythmia | −2.57 (−4.34/-0.80) | −0.07 | 0.004 | n.s. | ||
Characteristic pain intensity (GCPS) | n.s. | −0.07 (−0.11/-0.03) | −0.10 | <0.001 | ||
Instrumental activities (IADL) | n.s. | 1.09 (0.42/1.75) | 0.07 | 0.001 | ||
BMI | n.s. | −0.24 (−0.37/-0.11) | −0.07 | <0.001 | ||
Distress (4DBL) | n.s. | −0.30 (−0.47/-0.14) | −0.09 | <0.001 | ||
Age | n.s. | −0.24 (−0.38/-0.11) | −0.07 | 0.001 | ||
Chronic low back pain | n.s. | −2.36(−3.97/-0.74) | −0.06 | 0.004 | ||
Monthly income (in 1000 Euro) | n.s. | 2.00 (0.39/0.27) | −0.05 | .009 |