Four-Year Trajectories of Health-Related Quality of Life in People Living with HIV: Impact of Unmet Basic Needs across Age Groups in Positive Spaces, Healthy Places
Abstract
:1. Introduction
2. Materials and Methods
2.1. Positive Spaces, Healthy Places (PSHP) Cohort
2.2. Sample and Data Analyses
2.3. Measures
2.4. Statistical Analysis
3. Results
3.1. Sample Characteristics
3.2. Unmet Basic Needs
3.3. Physical and Mental Health-Related Quality of Life
3.4. Individual Growth Curve Models in Physical and Mental Health-Related Quality of Life
3.5. The Trajectories of Physical and Mental Health-Related Quality of Life
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Total n = 538 | Unmet Basic Needs n = 537 | |||||
---|---|---|---|---|---|---|---|
0-Unmet (Met) n = 79 (14.71) | 1-Unmet n = 134 (24.95) | 2-Unmet n = 118 (21.97) | 3-Unmet n = 115 (21.42) | 4-Unmet n = 91 (16.95) | p Value ǂ | ||
n (%)/ Median (IQR) | n (%)/ Median (IQR) | n (%)/ Median (IQR) | n (%)/ Median (IQR) | n (%)/ Median (IQR) | n (%)/ Median (IQR) | ||
Physical HRQoL summary ‡ | 42.36 (34.30, 51.66) | 50.0 (39.58, 56.70) | 47.26 (36.0, 54.88) | 40.98 (33.28, 49.86) | 40.26 (33.91, 46.89) | 38.98 (29.69, 47.34) | <0.0001 |
Mental HRQoL summary ‡ | 43.39 (35.89, 53.42) | 52.07 (42.22, 59.24) | 50.25 (39.40, 55.90) | 42.65 (34.68, 53.13) | 41.73 (35.04, 49.64) | 37.90 (30.94, 44.27) | <0.0001 |
Demographics | |||||||
Non-greater Toronto residents | 213 (39.59) | 19 (24.05) | 49 (36.57) | 49 (41.53) | 56 (48.70) | 40 (43.96) | 0.002 |
Age (n = 507) | |||||||
Young, 20–34 † | 75 (14.79) | 9 (12.16) | 16 (12.40) | 14 (12.73) | 15 (13.64) | 20 (24.10) | 0.136 |
Middle-aged, 35–49 | 304 (59.96) | 40 (54.05) | 77 (59.69) | 67 (60.91) | 71 (64.55) | 49 (59.04) | |
Old, 50+ | 128 (25.25) | 25 (33.78) | 36 (27.91) | 29 (26.36) | 24 (21.82) | 14 (16.87) | |
Female | 134 (24.91) | 16 (20.25) | 23 (17.16) | 24 (20.34) | 33 (28.70) | 38 (41.76) | <0.0001 |
Caucasian | 394 (73.23) | 57 (72.15) | 103 (76.87) | 89 (75.42) | 79 (68.70) | 66 (72.53) | 0.473 |
Heterosexual (n = 530) | 195 (36.79) | 25 (32.05) | 30 (22.73) | 36 (30.51) | 53 (46.90) | 50 (56.82) | <0.0001 |
SES/living and support conditions | |||||||
No high school degree (n = 536) | 116 (21.64) | 10 (12.66) | 25 (18.80) | 30 (25.42) | 25 (21.74) | 26 (28.89) | 0.013 |
Low income < 1150 CAD/m (n = 515) | 261 (50.68) | 37 (50.00) | 56 (43.75) | 59 (53.64) | 63 (55.75) | 46 (51.11) | 0.274 |
Unemployed (n = 537) | 424 (78.96) | 55 (69.62) | 95 (70.90) | 102 (87.18) | 93 (80.87) | 78 (85.71) | 0.001 |
Living alone (n = 486) | 259 (53.29) | 41 (60.29) | 66 (54.55) | 63 (60.00) | 51 (48.11) | 38 (44.19) | 0.026 |
Low social support < 43 (n = 525) | 255 (48.57) | 36 (45.57) | 55 (41.67) | 59 (51.75) | 59 (53.64) | 46 (51.69) | 0.987 |
HIV status | |||||||
A history of AIDS diagnosis (n = 527) | 271 (51.41) | 35 (46.05) | 74 (56.06) | 61 (53.04) | 56 (49.12) | 45 (50.56) | 0.888 |
CD4 T-cells < 200/mL (n = 454) | 256 (56.39) | 39 (54.93) | 72 (64.29) | 54 (51.92) | 52 (53.06) | 39 (57.35) | 0.526 |
Health behavior risks | |||||||
Depressive symptoms (n = 481) | 195 (40.54) | 9 (13.24) | 34 (28.57) | 49 (45.79) | 54 (52.94) | 49 (57.65) | <0.0001 |
Drug abuse (n = 532) | 102 (19.17) | 7 (8.97) | 25 (18.66) | 26 (22.81) | 23 (20.00) | 21 (23.33) | 0.036 |
Alcohol use disorder (n = 536) | 90 (16.79) | 9 (11.54) | 19 (14.29) | 26 (22.03) | 23 (20.00) | 12 (13.19) | 0.444 |
A history of homelessness | 213 (39.59) | 27 (34.18) | 47 (35.07) | 50 (42.37) | 52 (45.22) | 36 (39.56) | 0.158 |
A history of incarceration (n = 533) | 158 (29.64) | 18 (23.08) | 30 (22.56) | 45 (38.14) | 39 (34.51) | 26 (28.89) | 0.085 |
Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | Model 6 | |
---|---|---|---|---|---|---|
Fixed effects | ||||||
Intercept | 43.30 (0.40) a | 42.69 (0.45) a | 46.19 (0.67) a | 50.98 (1.14) a | 54.63 (1.26) a | 52.50 (1.78) a |
Time | 0.51 (0.15) b | 0.43 (0.15) b | 0.38 (0.15) c | 0.39 (0.16) c | 0.40 (0.16) c | |
Unmet basic needs (met = ref.) | ||||||
1-unmet | −1.42 (0.67) c | −1.47 (0.68) c | −1.29 (0.70) d | 2.02 (1.87) | ||
2-unmet | −4.09 (0.71) a | −4.11 (0.72) a | −3.75 (0.75) a | −1.06 (1.96) | ||
3-unmet | −5.63 (0.75) a | −5.71 (0.76) a | −5.30 (0.78) a | −3.78 (1.91) c | ||
4-unmet | −6.69 (0.84) a | −6.78 (0.85) a | −6.40 (0.87) a | −3.21 (2.15) | ||
Age groups (20–34 = ref.) | ||||||
Middle-aged, 35–49 | −4.17 (1.10) a | −4.10 (1.07) b | −1.72 (1.88) | |||
Old, 50+ | −8.85 (1.23) a | −8.21 (1.22) a | −4.98 (2.07) c | |||
Non-greater Toronto resident | −3.43 (0.76) a | −3.34 (0.76) a | ||||
Caucasian | −2.37 (0.84) b | −2.61 (0.84) b | ||||
Low social support < 43 | −1.60 (0.60) b | −1.68 (0.55) b | ||||
Drug abuse ≥ 6 DAST scores | −1.67 (0.73) c | −1.58 (0.73) c | ||||
Interactions | ||||||
1-unmet × middle-aged | −4.21 (2.08) c | |||||
1-unmet × old | −3.06 (2.29) | |||||
2-unmet × middle-aged | −2.38 (2.18) | |||||
2-unmet × old | −5.03 (2.48) c | |||||
3-unmet × middle-aged | −1.52 (2.15) | |||||
3-unmet × old | −2.24 (2.49) | |||||
4-unmet × middle-aged | −2.91 (2.42) | |||||
4-unmet × old | −6.21 (2.83) c | |||||
Random variance | ||||||
Intercepts (1,1) | 70.27 a | 79.52 a | 71.19 a | 64.42 a | 57.53 a | 57.10 a |
Intercepts-slopes (2,1) | - | −4.32 c | −3.97 c | −3.78 c | −3.46 c | −3.32 d |
Linear slopes (2,2) | - | 1.88 c | 1.56 c | 1.51 c | 1.59 c | 1.67 c |
Residuals | 44.60 a | 39.93 a | 39.18 a | 39.01 a | 38.67 a | 37.30 a |
Observations used | 1482 | 1482 | 1481 | 1395 | 1319 | 1319 |
Fit statistics and model tests | ||||||
-2LL | 10,730.4 | 10,713.8 | 10,614.4 | 9943.4 | 9357.6 | 9321.9 |
AIC | 10,736.4 | 10,721.8 | 10,622.4 | 9951.4 | 9365.6 | 9329.9 |
BIC | 10,749.3 | 10,739.0 | 10,639.5 | 9968.3 | 9382.5 | 9346.8 |
Chi-square | 508.42 a | 521.67 a | 470.48 a | 400.39 a | 328.23 a | 329.43 a |
Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | Model 6 | |
---|---|---|---|---|---|---|
Fixed effects | ||||||
Intercept | 45.14 (0.42) a | 44.20 (0.48) a | 48.61 (0.74) a | 48.56 (1.25) a | 55.03 (1.36) a | 52.48 (2.08) a |
Time | 0.78 (0.18) a | 0.68 (0.18) a | 0.65 (0.18) b | 0.41 (0.20) c | 0.43 (0.20) c | |
Unmet basic needs (met = ref.) | ||||||
1-unmet | −1.68 (0.78) c | −1.65 (0.81) c | −1.49 (0.80) d | 0.72 (2.23) | ||
2-unmet | −4.41 (0.83) a | −4.34 (0.85) a | −2.98 (0.86) a | −0.41 (2.41) | ||
3-unmet | −7.20 (0.86) a | −7.08 (0.89) a | −5.89 (0.89) a | −2.18 (2.32) | ||
4-unmet | −9.60 (0.96) a | −9.44 (0.99) a | −7.39 (1.00) a | −4.01 (2.51) | ||
Age groups (20–34 = ref.) | ||||||
Middle-aged, 35–49 | −0.40 (1.17) | −0.23 (1.12) | 2.33 (2.84) | |||
Old, 50+ | −0.92 (1.32) | −1.00 (1.25) | 2.84 (2.39) | |||
Female | −1.97 (0.90) c | −1.81 (0.90) c | ||||
Low income < 1150 CAD/m | −1.31 (0.60) c | −1.25 (0.61) c | ||||
Unemployed | −2.88 (0.73) a | −3.10 (0.74) a | ||||
Low social support < 43 | −5.23 (0.61) a | −5.24 (0.61) a | ||||
Drug abuse ≥ 6 DAST scores | −5.43 (0.80) a | −5.32 (0.80) a | ||||
Interactions (20–34 [ref.]) | ||||||
1-unmet × middle-aged | −2.47 (2.46) | |||||
1-unmet × old | −2.52 (2.70) | |||||
2-unmet × middle-aged | −2.53 (2.63) | |||||
2-unmet × old | −3.70 (2.95) | |||||
3-unmet × middle-aged | −3.93 (2.57) | |||||
3-unmet × old | −5.19 (2.95) d | |||||
4-unmet × middle-aged | −2.45 (2.79) | |||||
4-unmet × old | −8.44 (3.25) b | |||||
Random variance | ||||||
Intercepts (1,1) | 71.70 a | 79.72 a | 68.31 a | 67.38 a | 55.10 a | 55.20 a |
Intercepts-slopes (2,1) | - | −3.83 | −4.67 c | −3.83 c | −5.64 c | −5.67 c |
Linear slopes (2,2) | - | 2.73 c | 2.32 c | 2.03 c | 3.70 b | 3.65 b |
Residuals | 65.09 a | 57.70 a | 56.55 a | 57.40 a | 49.40 a | 49.31 a |
Observations used | 1482 | 1482 | 1481 | 1395 | 1274 | 1274 |
Fit statistics and model tests | ||||||
-2 LL | 11,140.5 | 11,117.4 | 10,982.7 | 10,348.7 | 9276.9 | 9240.9 |
AIC | 11,146.5 | 11,125.4 | 10,990.7 | 10,356.7 | 9284.9 | 9248.9 |
BIC | 11,159.3 | 11,142.6 | 11,007.8 | 10,373.6 | 9301.7 | 9265.8 |
Chi-square | 354.41 a | 370.52 a | 296.42 a | 280.22 a | 189.23 a | 187.68 a |
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Sok, P.; Seeman, M.V.; Nisenbaum, R.; Watson, J.; Rourke, S.B.; on behalf of the PSHP Team. Four-Year Trajectories of Health-Related Quality of Life in People Living with HIV: Impact of Unmet Basic Needs across Age Groups in Positive Spaces, Healthy Places. Int. J. Environ. Res. Public Health 2021, 18, 12256. https://doi.org/10.3390/ijerph182212256
Sok P, Seeman MV, Nisenbaum R, Watson J, Rourke SB, on behalf of the PSHP Team. Four-Year Trajectories of Health-Related Quality of Life in People Living with HIV: Impact of Unmet Basic Needs across Age Groups in Positive Spaces, Healthy Places. International Journal of Environmental Research and Public Health. 2021; 18(22):12256. https://doi.org/10.3390/ijerph182212256
Chicago/Turabian StyleSok, Phan, Mary V. Seeman, Rosane Nisenbaum, James Watson, Sean B. Rourke, and on behalf of the PSHP Team. 2021. "Four-Year Trajectories of Health-Related Quality of Life in People Living with HIV: Impact of Unmet Basic Needs across Age Groups in Positive Spaces, Healthy Places" International Journal of Environmental Research and Public Health 18, no. 22: 12256. https://doi.org/10.3390/ijerph182212256