Aging
Health-Related Quality of Life Association with Chronic Disease Burden in Missouri Sueny Paloma Lima dos Santos* Sueny Paloma Lima dos Santos Lima dos Santos University of Missouri – Columbia
Background:
Multimorbidity is increasingly common in primary care, yet population-based evidence on how chronic disease burden translates into health-related quality of life (HRQoL) remains limited at the state level. Identifying which HRQoL domains are most affected—and by which conditions—can inform prevention and care strategies, particularly in states with large rural populations such as Missouri.
Methods:
We analyzed cross-sectional data from the 2024 Center for Medical Epidemiology and Population Health Adult Health Survey (N = 547). HRQoL was measured using the SF-36 (eight domains) and Physical and Mental Component Summary scores (PCS, MCS). Chronic disease burden was defined by comorbidity count (0, 1, ≥2 conditions) and by specific conditions (CVD, arthritis, COPD/asthma, diabetes, depressive disorder, cancer, kidney disease). Multivariable linear regression estimated adjusted mean differences in HRQoL scores, controlling for age, sex, race/ethnicity, education, income, and rurality. False discovery rate (FDR) correction was applied across HRQoL outcomes for Aim 1.
Results:
Fifty-four percent of participants reported ≥2 chronic conditions. Compared with adults with no chronic conditions, those with ≥2 conditions had substantially lower physical HRQoL: Physical Functioning (β = −21.6, p<0.001), Role-Physical (β = −30.7, p<0.001), and General Health (β = −10.6, p<0.001), and worse Bodily Pain (β = +23.0, p<0.001). The PCS was lower among adults with ≥2 conditions (β = −4.3, p < 0.001), whereas differences in the mental and social domains were small and not statistically significant, including Mental Health (β = −0.2, p = 0.846) and MCS (β = −0.1, p = 0.85). Adults with one condition showed modest differences, including Bodily Pain (β = 8.3, p = 0.007). In condition-specific models, arthritis, CVD, and COPD/asthma were the largest drivers of physical HRQoL deficits, while depressive disorder showed the strongest associations with mental health and role-emotional functioning.
Conclusions:
Among Missouri adults, multimorbidity is associated primarily with declines in physical functioning, role performance, and pain, with comparatively limited differences in mental health by comorbidity count. Primary care approaches should prioritize functional status and pain management alongside chronic disease control, particularly in working-age and rural populations. Building on these results, future work will inform the development of a longitudinal, population-based cohort of Missouri adults to examine multimorbidity trajectories and their impact on functional and quality-of-life outcomes across the life course.