The objectives of the analysis were to ( 1) assess the magnitude of HRQL deficits associated with determinants of health and type 2 diabetes, and ( 2) assess the contribution of Hertzman et al.'s domains to explaining the variance in HRQL associated with type 2 diabetes.
SubjectsThe analysis included respondents from the Canadian Community Health Survey Cycle 1.1 (2000-2001) who were aged 18 years and older and who were identified as having type 2 diabetes. The study used regression analyses to assess the associations between the Health Utilities Index Mark 3 and determinants of health.
MethodThe study used multiple regression analysis to assess the clinical importance (i.e., magnitude of the unstandardized regression coefficients) and the statistical significance of each determinant of health in a single overall model. Normalized sampling weights[ 14] and bootstrap variance estimates[ 25] were used to account for the multistage stratified cluster design. The statistical significance of each determinant of health was derived from the 95% confidence intervals (on the basis of the bootstrap variance estimate) of the regression coefficients.
Collinearity in the regression model was assessed from the tolerance of each independent variable and was not problematic.[ 26] All analyses were conducted with SPSS Version 12.0 software (SPSS Inc, Chicago, Ill) and with a bootstrap algorithm designed by Statistics Canada.
ResultsComorbidities had the largest impact on HRQL, with stroke (-0.11; 95% confidence interval [CI] = -0.17, -0.06) and depression (-0.11; 95% CI = -0.15, -0.06) being associated with the largest deficits. Large differences in HRQL were observed for 2 markers of socioeconomic status: social assistance (-0.07; 95% CI =-0.12,-0.03) and food insecurity (-0.07; 95% CI =-0.10,-0.04). Stress, physical activity, and sense of belonging also were important determinants. Overall, 36% of the variance in the Health Utilities Index Mark 3 was explained.
Critical EvaluationThe study might not...