Longitudinal changes in physical and mental health of older adults with chronic hepatitis B infection: Trajectories and predictors

Chang-Hua Chen; Ming-Shiang Wu; Yu-Wen Yang; Yen-Tze Liu; Yen-Feng Chiu; Chih-Cheng Hsu; Shu-Chun Chuang; Tieh-Chi Chung; Tsung-Lung Tsai; Wen-Hao Huang; Wei-Lin Huang; Chung-Chou Juan; Li-Ming Lien; Chao A Hsiung; I-Chien Wu

doi:10.1016/j.pmedr.2021.101432

Longitudinal changes in physical and mental health of older adults with chronic hepatitis B infection: Trajectories and predictors

Prev Med Rep. 2021 Jun 2:23:101432. doi: 10.1016/j.pmedr.2021.101432. eCollection 2021 Sep.

Authors

Chang-Hua Chen^{1

2}, Ming-Shiang Wu³, Yu-Wen Yang^{2

4}, Yen-Tze Liu^{2

4}, Yen-Feng Chiu³, Chih-Cheng Hsu³, Shu-Chun Chuang³, Tieh-Chi Chung⁵, Tsung-Lung Tsai⁶, Wen-Hao Huang⁷, Wei-Lin Huang⁸, Chung-Chou Juan⁹, Li-Ming Lien^{10

11}, Chao A Hsiung³, I-Chien Wu^{3

12}

Affiliations

¹ Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
² Center for Aging and Health, Changhua Christian Hospital, Changhua City, Taiwan.
³ Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.
⁴ Department of Family Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
⁵ Hope Doctors Hospital, Miaoli County, Taiwan.
⁶ Puzi Hospital, Ministry of Health and Welfare, Chiayi County, Taiwan.
⁷ Yeezen General Hospital, Taoyuan, Taiwan.
⁸ Mennonite Christian Hospital, Hualien, Taiwan.
⁹ Yuan's General Hospital, Kaohsiung, Taiwan.
¹⁰ Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
¹¹ Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹² Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.

Abstract

Despite the increasing health burden of chronic hepatitis B (CHB) in aging populations, little is known about the course of health-related quality of life (HRQoL) changes. We aimed to assess individual-level longitudinal HRQoL changes in elderly patients with CHB and to examine their correlates. A prospective 5.1 years-cohort study was conducted in community-dwelling adults aged 55 years with hepatitis B surface antigen-positive. Participants underwent serial measurement of HRQoL using the short-form (12) health survey version 2. Of 503 participants, 82.7% remained in good physical health throughout the study period, whereas 9.1% had declining physical health and 8.2% were in poor physical health. We likewise identified three trajectories of mental health changes ("good mental health" [86.9%], "declining mental health" [6.8%], and "poor mental health" [6.4%]). Three baseline characteristics were independently associated with a lower likelihood of remaining physically or mentally healthy: sarcopenic obesity (odds ratio [OR] with 95% confidence interval [95% CI] of 7.5 [2.8-20.5] for poor physical health, 3.1 [1.1-8.4] for declining physical health, 4.3 [1.4-13.0] for poor mental health), a higher number of metabolic abnormalities (OR [95% CI] of 3.6 [1.6-8.0] for poor physical health) and depressed mood (OR [95% CI] of 21.7 [5.8-81.0] for poor physical health, 5.3 [1.4-19.9] for declining physical health, 83.1 [19.7-350.2] for poor mental health, 13.6 [2.9-64.8] for declining mental health). In conclusion, in a cohort of elderly patients with CHB, we demonstrated the heterogeneity and nonlinearity of HRQoL changes and their associations with variations in specific extrahepatic organs/systems.

Keywords: 95% CI, 95% confidence interval; ALT, alanine aminotransferase; AST, aspartate aminotransferase; Aging; BIC, Bayesian information criterion; BMI, body mass index; BP, blood pressure; CES-D, Center for Epidemiological Studies Depression; CHB, chronic hepatitis B; CV, coefficient of variation; FIB-4, Fibrosis-4 Index for Liver Fibrosis; Geriatric assessment; Group-based trajectory modeling; HALST, Healthy Aging Longitudinal Study in Taiwan; HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; HOMA-IR, Homeostasis Model Assessment of Insulin Resistance; HRQoL, health-related quality of life; Health-related quality of life; Healthy Aging Longitudinal Study in Taiwan (HALST); MCS, Mental Component Summary; MMSE, Mini-Mental State Examination; OR, odds ratio; PCS, Physical Component Summary; SF-12v2, the Short Form (12) Health Survey version 2; hsCRP, high-sensitivity C-reactive protein.