Impact of chronic disease on quality of life in the Bella Coola Valley

INTRODUCTION: North American rural residents have higher rates of chronic disease and they report being ill more frequently compared to their urban counterparts. We recently studied health-related quality in residents living in the isolated, rural community of Bella Coola, Canada. OBJECTIVE: To assess health-related quality of life parameters in adults suffering from chronic disease and living in the rural, remote community of Bella Coola. METHODS: Design, mixed methods: (1) mailed health-related survey; (2) retrospective chart review. STUDY POPULATION: people aged 17 years and older living in the Bella Coola Valley and having a chart at the Bella Coola Medical Clinic as of September 2001 were asked to complete a detailed health-related quality of life survey during the period August to December 2001. MAIN OUTCOME MEASURES: demographics (age, sex, weight BMI, ethnicity). Health-related quality of life was measured using the MOS 36-item Short Form Health Survey (SF-36), and the US Centers for Disease Control healthy day's items. Chronic diseases studied included diabetes mellitus, hypertension, chronic obstructive lung disease, coronary artery disease, hyperlipidemia, depression/anxiety, cancer, osteoarthritis, inflammatory arthritis and chronic back/neck pain. RESULTS: Response rate to the survey was 38% (675/1770). Compared to total clinic population relatively more female (57% vs 49%), non-Aboriginal (63% vs 57%) and older people (48.9 vs 43.5 years) answered the survey. The most prevalent chronic diseases among the survey respondents were hypertension (17%), depression/anxiety (13%), hyperlipidemia (11%), chronic back/neck pain (11%), and osteoarthritis (9%). Linear regression analysis was performed for each of the SF-36 domains and CDC healthy day items. The presence of chronic disease is associated with significant differences in HRQOL item scores and the greater the number chronic diseases present the worse the HRQOL item scores. CONCLUSION: People living in the rural remote community of Bella Coola who have chronic disease experience significant impairment in their health-related quality of life. The greater the number of coexisting chronic diseases a person has, the more likely that poor HRQOL scores will be reported.