Health-related quality of life and survival of older adults in Campinas, São Paulo, Brazil: A retrospective analysis from 2008 to 2018

Abstract

As the average life expectancy continues to rise, the prevalence of multimorbidity is also expected to increase, potentially leading to outcomes such as functional decline, a higher risk of premature death, and adverse effects on overall health and well-being. This study aimed to estimate the survival rates of older adults with varying levels of health-related quality of life (HRQoL) and to assess the association between the domains and components of the 36-item Short Form Health Survey and all-cause mortality over a 10-year period in Brazil. We conducted a retrospective longitudinal study using baseline data from 1,520 elders (aged 60 years and older) who participated in the Health Care Survey of the Municipality of Campinas, São Paulo, Brazil (ISACamp 2008/2009). A linkage was established between the ISACamp databases and the Mortality Information System. An active search was performed for individuals whose data could not be paired to confirm the death status. Survival functions were calculated using the Kaplan-Meier method, while hazard ratios (with 95% confidence intervals) were determined using Cox regression analysis. All HRQoL domains showed proportional hazards and statistically significant differences (p < 0.05) between survival curves, except for the bodily pain domain. In the multivariate analysis, lower scores in physical functioning and role-physical were associated with a 74% and 42% increased risk of death, respectively. In addition, impairments in role-emotional, mental health, and general health heightened the risk of mortality by approximately 36%. Notably, the lowest score in the physical component emerged as a significant predictor of mortality, increasing the probability of death by 47%, while the mental component showed no significant association. Our findings provide compelling evidence of the predictive capacity of HRQoL in evaluating mortality risk among older people in low- and middle-income countries.

Keywords

Quality of life / Health-related quality of life / Mortality / Survival analysis / Cohort studies / Elderly

Funding

The 2008 ISACamp survey was financed by the National Council for Scientific and Technological Development (CNPq; process number 409747/2006-8) and had complementary funding from the Municipal Health Department of Campinas and the Health Surveillance of the Ministry of Health (in partnership with UNICAMP/ FUNCAMP/SMS number 4300). The ISACamp-Cohort project was funded by the National Council for Scientific and Technological Development (CNPq) under process number 423934/2016. Donatila Barbieri de Oliveira Souza received a doctoral grant from the Coordination for the Advancement of Higher Education Personnel (CAPES) (grant number 88887.498920/2020-00). Marilisa Berti de Azevedo Barros (grant number 303241/2019-5) and Luciana Correia Alves (grant number 304871/2020-6) received productivity scholarships from CNPq.

Conflict of interest

The authors declare that they have no competing interests related to the conduct of this research.

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