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Health-related quality of life in French adolescents and adults: norms for the DUKE Health Profile

  • Cédric Baumann1, 2,
  • Marie-Line Erpelding2,
  • Christine Perret-Guillaume1, 3,
  • Arnaud Gautier4,
  • Stéphanie Régat1,
  • Jean-François Collin1, 2,
  • Francis Guillemin1, 2 and
  • Serge Briançon1, 2Email author
BMC Public Health201111:401

DOI: 10.1186/1471-2458-11-401

Received: 30 July 2010

Accepted: 27 May 2011

Published: 27 May 2011

Abstract

Background

The continual monitoring of population health-related quality of life (HRQoL) with validated instruments helps public health agencies assess, protect, and promote population health. This study aimed to determine norms for the French adolescent and adult general population for the Duke Health Profile (DUKE) questionnaire in a large representative community sample.

Methods

We randomly selected 17,733 French people aged 12 to 75 years old in 2 steps, by households and individuals, from the National Health Barometer 2005, a periodic population study by the French National Institute for Prevention and Health Education. Quality of life and other data were collected by computer-assisted telephone interview.

Results

Normative data for the French population were analyzed by age, gender and self-reported chronic disease. Globally, function scores (best HRQoL=100) for physical, mental, social, and general health, as well as perceived health and self-esteem, were 72.3 (SEM 0.2), 74.6 (0.2), 66.8 (0.1), 71.3 (0.1), 71.3 (0.3), 76.5 (0.1), respectively. Dysfunction scores (worst HRQoL=100) for anxiety, depression, pain and disability domains were 30.9 (0.1), 27.6 (0.2), 34.3 (0.3), 3.1 (0.1), respectively.

Conclusion

The French norms for adolescents and adults for the DUKE could be used as a reference for other studies assessing HRQoL, for specific illnesses, in France and for international comparisons.

Keywords

Health-related quality of life Duke Health Profile norms adolescent adult French population

Background

Quality of life (QoL) is defined by the World Health Organization (WHO) as ''the perception that an individual has of his or her place in life, within the context of the culture and system values in which he or she lives, and in relation to the objectives, expectations, standards and concerns of this individual'' [1]. Health-related quality of life' (HRQoL) [2, 3] can be defined ''as an integrative measure of physical and emotional well-being, level of independence, social relationships and their relationship to salient features of their environment'' [1]. The conceptualization of HRQoL is both objective and subjective, so its measurement requires reference to varied and complex areas, depending on the perspective. For example, social workers will assess QoL from a different perspective than medical workers. HRQoL measurement can also be very personal because experiences, beliefs, and expectations and perceptions influence how individuals think and behave [4].

HRQoL is a multidimensional concept that relates specifically to a person's health, to the measure of its functioning, well-being and general health perception in physical, psychological, and social domains [2]. HRQoL measures are used to determine the burden of disease in economic analyses [5, 6] and have become an important target in medical care for assessing treatment outcomes in chronic disease and an important outcome criterion in randomised clinical trials, especially oncology [1]. In addition, HRQoL instruments can be used in medical practice to improve the physician-patient relationship, in health services evaluation, in research and in policy making.

Many HRQOL instruments, both generic and specific for various illnesses, have been developed to survey the various domains of life that ill health can affect [7].

Most generic instruments are for adults, such as the WHOQOL [8], the Sickness Impact Profile [9], the Nottingham Health Profile [10], the SF-36 [11], and the Duke Health Profile (DUKE) [1214]. However, whether such generic instruments are suitable for young French people is unknown. To compare the adolescent and adult quality of life, the French Committee for Health Promotion, in 1998, 2000 and in 2005 [15], used a version of the DUKE suited to assess quality of life in the 12-19 age group.

The DUKE is a cross-culturally adapted, valid and useful measure of perceived health in adolescents and adults [12]. One of the obstacles to the success of large surveys is the extensive time needed to complete them (by phone conversations or self-administered). The DUKE is a 17-item short questionnaire, self-administered or interviewer-administered, developed and validated in primary care to measure patient-reported HRQoL, or functional health status, during 1 week [13, 14] and may be more suitable than the SF-36 for older inpatients [1618]. Its feasibility and acceptability were reported to be good for patients with dementia [19]. As well, another study found the DUKE significantly better accepted than the SF-36 by young patients [20]. Finally, the DUKE allows for briefly exploring dimensions of self-perceived health such as self-esteem, anxiety and depression not proposed by other tools [21].

There is an interest in finding a simple short, self-reporting measure of HRQoL in healthy adolescents that is in the French language. The DUKE score has been used primarily for research in the clinical setting, both as a predictor of health-related outcomes and as an outcome [2224]. The original DUKE was developed in English (United States) and was validated primarily in the United States. Subsequently, the DUKE has been translated into 17 other languages and language variations such as Afrikaans, Chinese, Dutch, Dutch (Belgium), English (UK), French, French (Canada), German, Italian, Korea, Norwegian, Polish, Portuguese, Spanish, Swedish, Thai and Vietnamese. It has been translated in French and used extensively by the Public Health School of Nancy (France) [12, 2529].

Medical and scientific committees need validated instruments to assess HRQoL, but general population norms are lacking, which limits their full use in research and clinical practice. Community norms of HRQoL are important because they provide a base level of HRQoL to compare illness groups or individuals' HRQoL to expected values. To our knowledge, norms for the DUKE for all countries are lacking.

We aimed to use the DUKE to determine HRQoL norms for French adolescents and adults and analyze these by gender, age and self-reported chronic disease.

Methods

Data source

Since 1992, the French National Health Barometer, a 5-year periodic study by the French National Institute for Prevention and Health Education (INPES), has surveyed behaviours, attitudes, opinions and knowledge about health (e.g., alcohol consumption, tobacco use, drug consumption, physical activity) and evolution of the health of adolescents and adults in France. The whole questionnaire includes more than 400 questions. Data for the 2005 National Health Barometer were collected between October 14, 2005 and February 12, 2005. This survey was carried out in France by use of a computer-assisted telephone interview (CATI) system with a sample of 30,514 people aged 12 to 75 years who spoke French. Households received a letter in advance to explain the purpose of the survey and to encourage people in the household to take part. The eligible subject within each household whose next birthday was nearest the interview day was selected to answer the questions [30]. All data collected were anonymous and self-reported. Subjects were asked to isolate themselves before the interview began. The mean duration of an interview was about 40 minutes for landline phones.

Young people (younger than 15 years) had to be accompanied by their mother or father to participate. Parents were asked to consent to their child's participation and that the child could be isolated to speak more freely.

The INPES commissioned the "EA4360 Apemac", a French research team specialised in HRQoL studies (School of Public Health, Nancy, France), to analyse the data and determine norms [15].

This population-based survey was approved by the French National Institutional Review Board (Commission Nationale Informatique et Liberté).

Sampling

Of 30,514 participants in the 2005 Health Barometer survey, 26,672 were contacted by landline phone to answer all questions of the Health Barometer, and 3,842 persons, without a landline phone, were contacted by their mobile phone to answer questions related only to tobacco, alcohol and illegal drug use because by the year 2000, more people had only a mobile phone. When the Barometer started, questioning all participants by mobile phone for more than 20 minutes was difficult (problems with the battery, attention, satellite range). So, the researchers decided to ask questions about sociodemographic characteristics and tobacco, alcohol, and illegal drug consumption only to limit the duration of the interview.

Among the 26,672 participants contacted by landline phone, 17,783 (two-thirds of the sample) were randomly selected to participate in the QoL survey by the DUKE. Among these, 17,733 responded to the DUKE. The 8,889 participants not randomized responded to another HRQoL questionnaire (WHOQOL-brief) (see figure 1).
https://static-content.springer.com/image/art%3A10.1186%2F1471-2458-11-401/MediaObjects/12889_2010_Article_3174_Fig1_HTML.jpg
Figure 1

Selection of the participants in the health-related quality-of-life survey.

Duke Health Profile questionnaire

HRQoL was assessed by use of a French validated version of the DUKE (Table 1), a 17-item generic self-reporting instrument, with question responses according to a 3-point Likert scale, which covers a 1-week time frame [12]. The DUKE includes 10 domains. Six domains are about health function: physical health (items 8-12), mental health (items 1, 4, 5, 13, 14), social health (items 2, 6, 7, 15, 16), general health (aggregation of physical, mental and social health measures to indicate overall well-being) (15 items), perceived health (item 3) and self-esteem (items 1, 2, 4, 6, 7), with high scores indicating better HRQoL; and 4 are about health dysfunction: anxiety (items 2, 5, 7, 10, 12, 14), depression (items 4, 5, 10, 12, 13), pain (item 11) and disability (item 17), with high scores indicating greater dysfunction. The DUKE is suitable for computerised telephone administration by a trained interviewer. It can be completed in a short time and has good acceptability [14, 31].
Table 1

Content of the Duke Health Profile questionnaire

Item (French version)

Dimension *

1. I like who I am

(Je me trouve bien comme je suis)

Mental health, self-esteem, anxiety

2. I am not an easy person to get along with

(Je ne suis pas quelqu'un de facile à vivre)

Social health

3. I am basically a healthy person

(Au fond, je suis bien portant)

Perceived health

4. I give up too easily

(Je me décourage trop facilement)

Mental health, self-esteem, depression

5. I have difficulty concentrating

(J'ai du mal à me concentrer)

Mental health, anxiety, depression

6. I am happy with my family relationships

(Je suis content de ma vie de famille)

Social health, self-esteem

7. I am comfortable being around people

(Je suis à l'aise avec les autres)

Social health, anxiety

8. Would you have any physical trouble or difficulty : Walking up a flight of stairs

(Vous auriez du mal à monter un étage)

Physical health

9. Would you have any physical trouble or difficulty : Running the length of a football field

(Vous auriez du mal à courir une centaine de mètres)

Physical health

10.How much trouble have you had with: sleeping.

(Vous avez eu des problèmes de sommeil)

Physical health, anxiety, depression

11. How much trouble have you had with: hurting or aching in any part of your body

(Vous avez eu des douleurs quelque part)

Physical health, pain

12. How much trouble have you had with: getting tired easily

(Vous avez eu l'impression d'être vite fatigué(e))

Physical health, anxiety, depression

13. How much trouble have you had with: feeling depressed or sad

(Vous avez été triste ou déprimé(e))

Mental health, depression

14. How much trouble have you had with: nervousness

(Vous avez été tendu(e) ou nerveux(se))

Mental health, anxiety

15. How often did you: socialize with other people (talk or visit with friends or relatives).

Vous vous êtes retrouvé(e) avec les gens de votre famille qui n'habitent pas chez vous, ou avec des copains en dehors de l'école (posée aux 12-17 ans) Vous avez rencontré des parents ou des amis au cours de conversations ou de visites (posée aux 18 ans et plus)

Social health

16. How often did you: take part in social, religious, or recreation activities (meetings, church, movies, sports, parties).

(Vous avez eu des activités de groupes ou de loisirs)

Social health

17. How often did you: stay in your home, a nursing home, or hospital because of sickness, injury, or other health problem

(Vous avez dû rester chez vous ou faire un séjour en clinique ou à l'hôpital pour raison santé)

Disability

* The general health dimension consists of all items, except items 3 and 17.

Other data collected

Like many other authors [7, 32], we considered age, gender and self-reported chronic disease to determine norms.

Statistical analysis

Questionnaires were coded and calculated according to instructions in the DUKE manual [14]. The score for each dimension is the sum of the scores for the items, standardized from 0 to 100. For the 6 health dimension scores, 100 indicates the best HRQoL, whereas for the 4 dysfunction dimension scores, 100 indicates the greatest dysfunction. Missing dimension scores were imputed if scores were missing for < 50% of items for a dimension, using the mean score of the items completed within that dimension. Scores were analysed for the whole sample and then after stratification by gender, age and self-reported chronic disease.

Norms for the DUKE for French adolescents and adults are presented as means, standard deviation (SD), standard error of the mean (SEM), median (interquartile range), minimum, maximum, and percentage of floor and ceiling effect. In this study, with lack of consensus, floor and ceiling effects were considered present if more than 10% of the respondents achieved the highest or lowest score, and strong effects if more than 30% of the respondents achieved the highest or lowest score.

Qualitative variables were compared by Student's t test, with Bonferroni correction. Interaction of gender, age groups and self-perceived chronic disease with HRQoL was analyzed by linear regression models. Only strong interactions are presented (p < 0.01).

Data and t test values were weighted by the number of eligible persons in the household and by the French population structure imputed from 1999 INSEE (National Institute for Statistic and Economic surveys) National Census data. In this way, the sample was representative of the French general population between 12 and 75 years old who speak French and have a landline phone.

Internal consistency was assessed by Cronbach's α, an inter-item correlation statistic ranging from 0-1, except for perceived health, pain and disability domains, which contain only one item. Higher values indicate that items on a domain are correlated and therefore the scale measures an underlying single dimension of the questionnaire. A Cronbach α of ≥ 0.5 is usually considered acceptable [33], but Nunnally recommends values of ≥ 0.7 [34].

Statistical analysis involved use of SAS v9.1 (SAS Inc., Cary, NC).

Results

Description of the sample

Table 2 shows the characteristics of the observed sample and after weighting by gender, age, geographic area and size of community. The response rate to the HRQoL survey was close to 100%. Among 17,783 randomly selected people, completed questionnaires were obtained from 17,733 subjects questioned by the CATI system. Participants of the HRQoL survey (n = 17,733) and people not randomly selected (n = 9,539) did not differ in age, gender or self-reported chronic disease. After weighting by the 1999 INSEE National Census data, 49.1% of the sample were males. Adolescents (12-17 years old) represented 10.5% of the sample, young adults (18-24 years old) 11.1% and elderly people (65-75 years old) 12%. Self-reported chronic disease prevalence was 21.7%.
Table 2

Characteristics of the sample

 

Men

Women

Total

 

n observed

% corrected*

n 1999 NCD

n observed

% corrected*

n 1999 NCD

n observed

% corrected*

n 1999 NCD

 

7425

49,1

22 828 184

10308

50,9

23501064

17733

-

46329248

Age, years

         

12-17

670

11,5

2,360,572

737

9,6

2256154

1407

10,5

4616726

18-24

638

11,9

2706126

810

10,4

2628525

1448

11,1

5334651

25-34

1400

17,8

4201394

1927

18,9

4215311

3327

18,4

8416705

35-44

1404

17,6

4246510

1919

19,6

4337674

3323

18,6

8584184

45-54

1320

18,1

4081008

1776

17,5

4110160

3096

17,8

8191168

55-64

1125

11,2

2684944

1730

12

2798797

2855

11,6

5483741

65-75

868

11,9

2284992

1409

12,2

2859393

2277

12,1

5144385

Chronic disease

         

Yes

1619

20,6

4702606

2534

22,8

5358243

4153

21,7

10053447

No

5798

79,4

18125578

7761

77,2

18142821

13559

78,3

36275801

*weighted by number of eligible persons in the household and imputed from 1999 INSEE National Census Data (1999 NCD)

Internal consistency

Internal consistency ranged from poor to good. The Cronbach α was 0.34 for social health, 0.46 for self-esteem, 0.57 for anxiety, 0.61 for depression, 0.62 for physical health, 0.63 for mental health, and 0.71 for general health. The Cronbach α for adolescents was lower than or equal to that for adults for dimensions.

Description of norms by gender, age and self-reported chronic disease

The HRQoL norms globally, by gender and by age are in Table 3. In summary, mean function scores for physical, mental, social, and general health, as well as perceived health and self-esteem, were 72.3 (SEM 0.2), 74.6 (0.2), 66.8 (0.1), 71.3 (0.1), 71.3 (0.3), 76.5 (0.1), respectively. Dysfunction scores for anxiety, depression, pain and disability were 30.9 (0.1), 27.6 (0.2), 34.3 (0.3), 3.1 (0.1), respectively. Scores for men were always higher than those for women, except for social health and disability dimensions.
Table 3

HRQoL norms* in French general population from 12 to 75 years old (n = 17,733)

 

Men

Women

Total

 

12-17

18-24

25-34

35-44

45-54

55-64

65-75

Total

12-17

18-24

25-34

35-44

45-54

55-64

65-75

Total

 

Physical health

                 

n=

670

637

1396

1403

1316

1121

863

7406

733

809

1927

1910

1770

1721

1381

10251

17657

Mean

80.7

79.3

79.0

77.6

74.0

75.9

71.1

76.8

72.9

71.3

70.1

69.2

66.1

64.8

61.3

67.9

72.3

Standard deviation

19.1

20.1

17.6

18.1

22.2

18.2

23.1

19.9

20.2

20.6

18.9

20.0

20.1

18.0

19.5

19.7

20.3

Error standard of the mean

0.6

0.6

0.4

0.5

0.6

0.6

0.7

0.2

0.7

0.7

0.5

0.5

0.5

0.5

0.6

0.2

0.2

Percentile 25 th

70.0

70.0

70.0

70.0

60.0

70.0

60.0

70.0

60.0

60.0

60.0

60.0

50.0

50.0

50.0

60.0

60.0

Median

80.0

80.0

80.0

80.0

80.0

80.0

70.0

80.0

70.0

70.0

70.0

70.0

70.0

70.0

60.0

70.0

80.0

Percentile 75th

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

80.0

80.0

80.0

80.0

80.0

80.0

90.0

Minimum

20.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.3

0.1

0.2

0.8

0.3

1.0

0.4

0.3

0.2

0.4

0.7

0.8

0.8

1.1

0.6

0.5

Ceiling effect (%)

18.0

15.6

17.1

14.4

12.8

17.0

10.1

14.9

11.2

8.4

8.7

7.7

7.0

8.1

3.9

7.8

11.3

Mental health

                 

n=

668

637

1398

1401

1311

1123

856

7394

734

809

1924

1909

1766

1718

1387

10247

17641

Mean

74.3

75.2

80.0

79.5

78.2

81.5

81.0

78.6

65.8

67.5

72.0

71.2

70.2

72.3

74.1

70.7

74.6

Standard deviation

22.7

24.6

18.4

18.3

19.6

16.6

18.6

19.6

23.5

22.1

19.3

20.4

20.1

17.1

18.8

19.9

20.2

Error standard of the mean

0.7

0.8

0.5

0.5

0.5

0.5

0.6

0.2

0.8

0.7

0.5

0.5

0.5

0.5

0.6

0.2

0.2

Percentile 25 th

60.0

60.0

70.0

70.0

70.0

70.0

70.0

70.0

50.0

50.0

60.0

60.0

60.0

60.0

60.0

60.0

60.0

Median

80.0

80.0

80.0

80.0

80.0

90.0

80.0

80.0

70.0

70.0

80.0

70.0

70.0

80.0

80.0

70.0

80.0

Percentile 75th

90.0

90.0

90.0

90.0

90.0

100.0

100.0

90.0

80.0

80.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

Minimum

0.0

0.0

0.0

0.0

10.0

0.0

10.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.1

0.1

0.2

0.0

-0.0

0.1

0.0

0.1

0.4

0.2

0.4

0.1

0.8

0.5

0.5

0.4

0.2

Ceiling effect (%)

12.2

15.4

21.6

20.5

19.7

27.4

25.2

20.3

8.6

7.6

11.0

12.4

13.0

15.3

15.8

12.1

16.2

Social health

                 

n=

669

634

1388

1387

1296

1118

841

7333

730

807

1923

1901

1756

1699

1378

10194

17527

Mean

70.3

68.1

68.7

66.4

65.7

64.9

64.4

66.9

65.7

66.7

68.6

67.0

65.5

66.7

65.7

66.7

66.8

Standard deviation

20.2

22.8

18.2

18.1

18.9

16.7

19.2

18.9

18.6

19.5

15.9

17.1

16.7

14.6

15.9

16.6

17.6

Error standard of the mean

0.6

0.7

0.5

0.5

0.5

0.5

0.6

0.2

0.6

0.6

0.4

0.4

0.4

0.4

0.5

0.2

0.1

Percentile 25 th

60.0

60.0

60.0

60.0

50.0

50.0

50.0

60.0

50.0

60.0

60.0

60.0

50.0

50.0

50.0

60.0

60.0

Median

70.0

70.0

70.0

70.0

70.0

70.0

60.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

Percentile 75th

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

Minimum

20.0

10.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

10.0

0.0

10.0

0.0

0.0

10.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

0.2

0.0

0.2

0.1

0.1

0.1

0.2

0.0

0.1

0.0

0.1

0.2

0.0

0.1

0.1

Ceiling effect (%)

6.0

5.1

4.7

3.5

3.8

3.5

4.0

4.3

2.8

4.7

4.7

5.4

4.6

6.1

5.2

4.9

4.6

General health

                 

n=

667

633

1384

1383

1285

1113

824

7289

725

805

1921

1883

1742

1682

1336

10094

17383

Mean

75.1

74.2

75.9

74.5

72.7

74.0

72.1

74.1

68.2

68.6

70.2

69.1

67.3

67.9

67.1

68.5

71.3

Standard deviation

14.4

16.4

13.3

13.7

14.7

12.5

14.8

14.1

15.2

15.3

13.3

14.7

14.4

12.4

13.6

14.0

14.3

Error standard of the mean

0.5

0.5

0.3

0.4

0.4

0.4

0.5

0.2

0.5

0.5

0.3

0.4

0.4

0.4

0.4

0.1

0.1

Percentile 25 th

70.0

66.7

70.0

66.7

63.3

66.7

63.3

66.7

60.0

60.0

60.0

60.0

56.7

56.7

56.7

60.0

63.3

Median

76.7

76.7

76.7

76.7

73.3

76.7

73.3

76.7

70.0

70.0

73.3

70.0

66.7

70.0

70.0

70.0

73.3

Percentile 75th

83.3

83.3

83.3

83.3

83.3

83.3

83.3

83.3

80.0

80.0

80.0

80.0

76.7

80.0

76.7

80.0

80.0

Minimum

26.7

23.3

20.0

16.7

13.3

16.7

26.7

13.3

20.0

20.0

16.7

10.0

6.7

0.0

10.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

96.7

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

-0.0

0.0

-0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.1

0.0

0.0

0.0

Ceiling effect (%)

0.7

0.5

0.7

0.6

0.4

0.8

0.5

0.6

0.0

0.4

0.5

0.2

0.4

0.5

0.3

0.4

0.5

Perceived health

                 

n=

669

638

1399

1403

1317

1121

864

7411

735

810

1925

1919

1770

1728

1403

10290

17701

Mean

71.4

75.4

78.6

76.0

69.9

67.1

64.5

72.4

69.4

72.1

74.8

73.2

69.6

67.0

61.5

70.2

71.3

Standard deviation

43.5

44.5

33.5

34.0

37.0

31.5

37.5

36.8

39.3

38.9

32.4

32.4

31.3

27.1

29.5

32.3

34.3

Error standard of the mean

1.4

1.4

0.9

0.9

0.9

1.0

1.2

0.4

1.3

1.3

0.8

0.8

0.8

0.8

0.9

0.3

0.3

Percentile 25 th

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

Median

100.0

100.0

100.0

100.0

100.0

50.0

50.0

100.0

100.0

100.0

100.0

100.0

50.0

50.0

50.0

100.0

100.0

Percentile 75th

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

13.1

11.9

8.0

8.7

11.1

11.7

13.2

10.8

14.5

13.8

11.3

10.4

10.2

12.3

13.5

11.9

11.3

Ceiling effect (%)

55.9

62.8

65.3

60.7

50.9

45.8

42.3

55.6

53.2

58.1

60.9

56.7

49.4

46.3

36.5

52.3

53.9

Self-esteem

                 

n=

669

635

1389

1387

1295

1120

838

7333

728

807

1924

1897

1754

1697

1372

10179

17512

Mean

77.1

76.2

80.2

79.4

79.3

78.7

79.3

78.8

68.2

70.6

75.7

75.2

74.8

75.6

77.2

74.4

76.5

Standard deviation

20.6

23.7

17.7

17.8

18.0

15.8

17.7

18.4

20.0

19.7

16.4

17.4

17.6

14.6

16.2

17.2

17.9

Error standard of the mean

0.7

0.7

0.5

0.5

0.5

0.5

0.6

0.2

0.7

0.6

0.4

0.4

0.4

0.5

0.5

0.2

0.1

Percentile 25 th

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

60.0

60.0

60.0

60.0

60.0

60.0

70.0

60.0

70.0

Median

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

70.0

70.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

Percentile 75th

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

80.0

80.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

Minimum

20.0

10.0

0.0

0.0

10.0

0.0

10.0

0.0

0.0

0.0

10.0

0.0

0.0

0.0

10.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

0.1

0.1

0.0

0.0

0.0

0.0

0.2

0.1

0.0

0.1

0.2

0.1

0.0

0.1

0.1

Ceiling effect (%)

15.2

16.0

20.6

20.0

19.4

19.2

20.5

18.9

5.6

7.0

13.6

14.3

14.2

15.7

18.2

13.2

16.0

Anxiety

                 

n=

669

636

1394

1395

1300

1116

845

7355

731

808

1924

1898

1756

1703

1381

10201

17556

Mean

29.2

32.1

28.3

28.3

28.5

24.4

24.5

28.0

35.9

37.4

34.1

33.5

34.1

31.6

30.0

33.7

30.9

Standard deviation

22.5

23.1

18.9

18.8

19.6

16.2

17.5

19.4

21.0

20.0

16.9

18.2

17.7

15.3

16.5

17.7

18.6

Error standard of the mean

0.7

0.7

0.5

0.5

0.5

0.5

0.6

0.2

0.7

0.7

0.4

0.4

0.4

0.5

0.5

0.2

0.1

Percentile 25 th

16.7

16.7

16.7

16.7

16.7

8.3

16.7

16.7

25.0

25.0

25.0

16.7

16.7

16.7

16.7

16.7

16.7

Median

25.0

33.3

25.0

25.0

25.0

25.0

25.0

25.0

33.3

33.3

33.3

33.3

33.3

33.3

25.0

33.3

33.3

Percentile 75th

41.7

41.7

41.7

41.7

41.7

33.3

33.3

41.7

50.0

50.0

50.0

41.7

50.0

41.7

41.7

50.0

41.7

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

83.3

91.7

100.0

91.7

91.7

91.7

83.3

100.0

91.7

91.7

91.7

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

5.6

4.3

8.0

8.0

7.5

12.7

10.5

8.0

4.4

1.5

4.0

4.1

5.2

7.8

7.4

4.9

6.4

Ceiling effect (%)

0.0

0.0

0.1

0.0

-0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.1

0.3

0.1

0.1

0.1

0.1

Depression

                 

n=

670

637

1398

1403

1313

1121

856

7398

736

810

1926

1915

1767

1721

1398

10273

17671

Mean

28.6

29.1

22.2

22.0

23.1

19.5

21.4

23.5

36.3

34.3

30.6

30.6

31.7

30.2

29.5

31.5

27.6

Standard deviation

24.2

24.6

19.1

18.3

20.3

16.8

19.5

20.2

23.6

22.3

19.4

20.2

20.0

17.1

18.9

19.9

20.4

Error standard of the mean

0.8

0.8

0.5

0.5

0.5

0.5

0.6

0.2

0.8

0.7

0.5

0.5

0.5

0.5

0.6

0.2

0.2

Percentile 25 th

10.0

10.0

10.0

10.0

10.0

10.0

10.0

10.0

20.0

20.0

20.0

20.0

20.0

10.0

10.0

20.0

10.0

Median

30.0

30.0

20.0

20.0

20.0

20.0

20.0

20.0

30.0

30.0

30.0

30.0

30.0

30.0

30.0

30.0

20.0

Percentile 75th

40.0

40.0

30.0

30.0

30.0

30.0

30.0

30.0

50.0

50.0

40.0

40.0

40.0

40.0

40.0

40.0

40.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

90.0

100.0

100.0

100.0

100.0

80.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

9.3

8.7

15.9

15.8

17.4

23.8

18.6

15.7

7.3

5.9

8.5

9.2

9.1

11.9

11.2

9.1

12.4

Ceiling effect (%)

0.3

0.0

0.1

0.1

0.0

0.1

0.0

0.1

0.6

0.3

0.5

0.1

0.7

0.3

0.7

0.4

0.3

Pain

                 

n=

670

638

1398

1404

1320

1124

867

7421

736

810

1927

1919

1775

1729

1406

10302

17723

Mean

22.6

25.7

26.3

29.3

35.3

33.2

39.0

30.2

29.4

32.4

33.8

36.2

41.8

45.3

47.9

38.2

34.3

Standard deviation

37.4

41.5

32.8

33.3

37.3

30.5

36.9

35.6

34.0

37.7

32.8

33.4

33.8

28.9

32.3

33.4

34.5

Error standard of the mean

1.2

1.3

0.8

0.9

0.9

1.0

1.1

0.4

1.2

1.2

0.8

0.8

0.9

0.9

1.0

0.4

0.3

Percentile 25 th

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Median

0.0

0.0

0.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

Percentile 75th

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

61.1

57.4

54.5

49.7

42.5

43.9

36.3

49.2

48.9

48.4

45.9

42.0

35.4

31.9

28.8

40.1

44.6

Ceiling effect (%)

6.4

8.7

7.0

8.2

13.0

10.3

14.3

9.7

7.6

13.2

13.5

14.3

18.9

22.5

24.6

16.4

13.1

Disability

                 

n=

670

638

1399

1403

1319

1125

867

7421

737

810

1926

1919

1775

1730

1407

10304

17725

Mean

2.7

2.3

2.4

3.3

2.7

2.2

3.9

2.8

2.7

3.2

4.6

3.6

3.5

3.1

2.7

3.5

3.1

Standard deviation

15.6

15.9

13.8

16.4

15.8

12.2

19.5

15.6

14.2

14.4

17.0

16.0

15.8

12.3

12.5

14.9

15.2

Error standard of the mean

0.5

0.5

0.4

0.4

0.4

0.4

0.6

0.2

0.5

0.5

0.4

0.4

0.4

0.4

0.4

0.2

0.1

Percentile 25 th

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Median

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Percentile 75th

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

95.4

96.3

96.5

95.1

96.3

96.9

95.1

96.0

95.5

94.2

93.3

94.9

95.3

95.7

96.2

94.9

95.4

Ceiling effect (%)

0.7

0.9

1.2

1.8

1.7

1.3

2.8

1.5

0.9

0.6

2.4

2.2

2.4

1.9

1.5

1.9

1.7

*Weighted by number of eligible persons in the household and imputed from 1999 INSEE National Census data.

Mean disability, depression, self-esteem and mental health scores were low for men (2.8 ± 15.6, 21.4 ± 19.5, 78.8 ± 18.4, 78.6 ± 19.6, respectively), and disability, mental health, self-esteem and physical health scores were low for women (3.5 ± 14.9, 74.6 ± 20.2, 74.4 ± 17.2, 72.3 ± 20.3, respectively). The most affected dimension was social health for men (64.4 ± 19.2) and pain for women (38.31 ± 33.4).

Tables 4 and 5 provide the HRQoL norms by gender, age and self-reported chronic disease. Self-reported chronic disease was associated with a mean decrease of 12.5 points in the score for physical health, 4.6 for mental health, 2.3 for social health, 6.5 for general health, 19.3 for perceived health, and 3.2 for self-esteem and a mean increase of 4.8 points in the score for anxiety, 5.1 for depression, 18.4 for pain and 2.5 for disability (for the last 4 dimensions, the interpretation of the score is inversed). All differences were statistically significant (p < 0.001), whatever the gender and age. After adjustment for gender and age, significant interactions were found between self-reported chronic disease and age for perceived health (p < 0.0001) and depression (p < 0.0001): increase in age had a lower effect on HRQoL score in the group with a self-reported chronic disease. We also observed a significant interaction between gender and self-reported chronic disease, with greater effects for women than men in score for physical health (-14 points and -11 points, respectively, p = 0.003), general health (-7 points and -5.7 points, respectively, p = 0.002), and pain (+23.6 points and 15.9 points, respectively, p = 0.001).
Table 4

HRQoL norms* in French general population from 12 to 75 years old with self-reported chronic disease (n = 4,153)

 

Men

Women

Total

 

12-17

18-24

25-34

35-44

45-54

55-64

65-75

Total

12-17

18-24

25-34

35-44

45-54

55-64

65-75

Total

 

Physical health

                 

n=

62

44

177

222

329

375

402

1611

55

105

276

338

489

631

625

2519

4130

Mean

74.2

72.1

69.2

70.1

66.5

68.3

65.7

68.0

60.0

61.9

63.4

57.2

55.9

57.3

55.4

57.6

62.5

Standard deviation

23.7

20.8

21.4

20.2

25.2

19.6

23.7

22.4

21.8

21.7

20.1

23.5

20.4

18.2

19.6

20.3

21.7

Error standard of the mean

2.5

2.4

1.6

1.3

1.3

1.1

1.1

0.5

2.7

2.0

1.3

1.3

1.0

0.9

0.9

0.4

0.4

Percentile 25 th

60.0

60.0

60.0

60.0

50.0

60.0

50.0

60.0

50.0

50.0

50.0

40.0

40.0

40.0

40.0

40.0

50.0

Median

80.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

60.0

60.0

70.0

60.0

60.0

60.0

60.0

60.0

70.0

Percentile 75th

90.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

70.0

80.0

80.0

80.0

70.0

70.0

70.0

70.0

80.0

Minimum

20.0

30.0

0.0

0.0

0.0

0.0

0.0

0.0

20.0

10.0

10.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

0.5

0.8

1.4

0.6

1.6

1.0

0.0

0.0

0.0

2.5

1.8

1.1

1.8

1.4

1.2

Ceiling effect (%)

16.2

7.7

9.1

3.3

6.7

9.2

4.5

6.9

4.2

3.7

4.4

2.4

2.5

3.4

1.2

2.7

4.6

Mental health

                 

n=

62

44

178

221

329

376

401

1611

55

105

276

338

486

628

620

2508

4119

Mean

67.9

73.8

74.4

73.4

74.6

78.2

79.1

75.9

61.8

65.7

67.4

65.0

63.2

68.3

70.4

66.8

71.0

Standard deviation

26.5

23.3

21.4

19.6

20.6

17.2

18.2

19.8

24.0

24.6

21.0

23.1

21.3

17.4

19.3

20.5

20.7

Error standard of the mean

2.8

2.7

1.6

1.3

1.1

0.9

0.8

0.5

3.0

2.2

1.4

1.3

1.0

0.9

0.9

0.5

0.3

Percentile 25 th

50.0

60.0

60.0

60.0

60.0

70.0

70.0

60.0

50.0

50.0

50.0

50.0

50.0

60.0

60.0

50.0

60.0

Median

70.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

60.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

Percentile 75th

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

80.0

80.0

80.0

80.0

80.0

90.0

90.0

80.0

90.0

Minimum

20.0

20.0

0.0

0.0

10.0

0.0

10.0

0.0

10.0

10.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

1.3

0.3

0.0

0.2

0.0

0.2

0.0

0.0

1.5

0.1

1.6

0.7

1.0

0.9

0.6

Ceiling effect (%)

9.1

8.7

13.1

12.3

14.9

21.2

17.7

15.7

6.0

7.4

7.0

8.2

7.8

8.4

10.9

8.5

11.9

Social health

                 

n=

62

45

176

217

327

374

392

1593

55

105

276

336

486

623

617

2498

4091

Mean

67.9

69.6

69.0

65.4

64.3

64.5

63.1

65.1

66.2

64.8

68.9

63.7

63.9

65.8

64.0

65.0

65.0

Standard deviation

22.0

23.8

19.4

19.7

19.4

17.1

19.9

19.4

19.6

22.6

15.9

18.8

17.4

15.2

16.6

17.1

18.0

Error standard of the mean

2.3

2.8

1.4

1.3

1.0

0.9

0.9

0.5

2.4

2.0

1.0

1.0

0.9

0.8

0.8

0.4

0.3

Percentile 25 th

60.0

60.0

60.0

50.0

50.0

50.0

50.0

50.0

60.0

50.0

60.0

50.0

50.0

50.0

50.0

50.0

50.0

Median

70.0

70.0

70.0

60.0

60.0

70.0

60.0

70.0

70.0

70.0

70.0

60.0

70.0

70.0

70.0

70.0

70.0

Percentile 75th

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

Minimum

20.0

10.0

0.0

10.0

0.0

0.0

10.0

0.0

0.0

10.0

20.0

10.0

0.0

0.0

10.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

90.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

0.4

0.0

0.5

0.4

0.0

0.2

2.5

0.0

0.0

0.0

0.5

0.1

0.0

0.2

0.2

Ceiling effect (%)

8.9

11.7

6.9

5.4

4.8

2.1

4.3

5.0

0.0

8.4

4.9

4.2

4.9

5.9

5.2

5.1

5.0

General health

                 

n=

62

44

175

216

324

374

385

1580

55

105

276

333

481

614

599

2463

4043

Mean

70.0

71.9

71.0

69.7

68.4

70.3

69.2

69.6

62.7

64.2

66.6

62.0

61.0

63.8

63.3

63.1

66.2

Standard deviation

17.7

14.5

15.3

15.0

16.0

13.0

14.5

14.8

15.7

16.5

14.0

17.3

15.1

12.6

13.6

14.5

14.9

Error standard of the mean

1.9

1.7

1.1

1.0

0.8

0.7

0.7

0.4

1.9

1.5

0.9

1.0

0.7

0.6

0.6

0.3

0.2

Percentile 25 th

60.0

66.7

63.3

60.0

56.7

63.3

60.0

60.0

53.3

53.3

56.7

50.0

50.0

53.3

53.3

53.3

56.7

Median

70.0

73.3

73.3

73.3

70.0

73.3

70.0

73.3

63.3

66.7

70.0

63.3

63.3

66.7

63.3

63.3

66.7

Percentile 75th

80.0

80.0

83.3

80.0

80.0

80.0

80.0

80.0

73.3

76.7

76.7

73.3

73.3

76.7

73.3

73.3

76.7

Minimum

36.7

26.7

20.0

30.0

13.3

16.7

26.7

13.3

26.7

23.3

16.7

10.0

6.7

16.7

10.0

6.7

6.7

Maximum

93.3

86.7

96.7

100.0

96.7

100.0

96.7

100.0

86.7

93.3

96.7

96.7

100.0

96.7

96.7

100.0

100.0

Floor effect (%)

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Ceiling effect (%)

0.0

0.0

0.0

0.8

0.0

0.3

0.0

0.2

0.0

0.0

0.0

0.0

0.2

0.0

0.0

0.0

0.1

Perceived health

                 

n=

62

45

178

222

330

374

403

1614

55

105

275

340

489

633

631

2528

4142

Mean

70.8

80.5

66.6

59.9

53.9

51.5

52.0

57.0

66.9

60.6

62.7

57.6

54.0

53.3

50.3

55.4

56.2

Standard deviation

40.1

34.4

34.0

39.9

38.7

32.7

36.5

37.2

39.2

43.2

34.3

35.8

33.0

27.4

28.3

32.0

34.1

Error standard of the mean

4.3

4.0

2.5

2.5

2.0

1.8

1.7

0.9

4.8

3.9

2.2

2.0

1.6

1.4

1.3

0.7

0.6

Percentile 25 th

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

Median

100.0

100.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

Percentile 75th

100.0

100.0

100.0

100.0

100.0

100.0

50.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

50.0

100.0

100.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

10.1

2.0

11.0

20.5

22.7

22.8

20.2

19.0

13.9

23.4

17.5

20.1

21.9

20.9

20.8

20.5

19.8

Ceiling effect (%)

51.6

63.0

44.2

40.4

30.4

25.8

24.3

33.1

47.6

44.5

42.8

35.4

30.0

27.6

21.4

31.3

32.2

Self-esteem

                 

n=

62

45

176

217

327

375

391

1593

55

105

276

335

483

619

612

2485

4078

Mean

71.7

77.5

77.8

74.5

77.4

76.2

77.5

76.6

66.8

68.6

73.1

70.5

70.3

72.7

73.8

71.7

74.0

Standard deviation

20.7

21.4

18.5

19.1

19.5

16.8

17.9

18.5

20.4

22.3

16.4

19.4

19.0

14.9

16.4

17.4

18.0

Error standard of the mean

2.2

2.5

1.4

1.2

1.0

0.9

0.8

0.4

2.5

2.0

1.1

1.1

0.9

0.8

0.8

0.4

0.3

Percentile 25 th

60.0

70.0

70.0

60.0

70.0

70.0

70.0

70.0

60.0

60.0

60.0

60.0

60.0

60.0

60.0

60.0

60.0

Median

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

70.0

70.0

80.0

70.0

70.0

80.0

80.0

70.0

80.0

Percentile 75th

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

80.0

90.0

90.0

80.0

90.0

90.0

90.0

90.0

90.0

Minimum

40.0

10.0

20.0

0.0

10.0

0.0

10.0

0.0

10.0

10.0

20.0

0.0

0.0

0.0

20.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

0.0

0.2

0.0

0.1

0.0

0.0

0.0

0.0

0.0

0.1

0.8

0.1

0.0

0.2

0.1

Ceiling effect (%)

6.4

12.4

17.2

14.2

17.8

14.7

15.0

15.1

2.9

10.5

10.6

7.1

10.4

11.2

13.0

10.4

12.6

Anxiety

                 

n=

62

44

177

220

328

375

395

1601

55

105

276

336

486

626

620

2504

4105

Mean

36.2

35.7

35.0

34.5

32.1

28.2

26.5

30.9

43.5

41.8

38.8

41.8

40.5

35.8

33.2

38.1

34.7

Standard deviation

25.3

22.7

19.9

20.5

20.2

17.3

17.1

19.4

21.5

20.7

17.4

19.8

17.4

15.5

16.9

17.7

18.7

Error standard of the mean

2.7

2.6

1.5

1.3

1.0

1.0

0.8

0.5

2.6

1.9

1.1

1.1

0.9

0.8

0.8

0.4

0.3

Percentile 25 th

25.0

25.0

25.0

16.7

16.7

16.7

16.7

16.7

33.3

25.0

25.0

25.0

25.0

25.0

16.7

25.0

16.7

Median

33.3

41.7

33.3

33.3

33.3

25.0

25.0

25.0

41.7

41.7

41.7

41.7

41.7

33.3

33.3

33.3

33.3

Percentile 75th

50.0

41.7

50.0

50.0

41.7

41.7

33.3

41.7

50.0

58.3

50.0

50.0

50.0

50.0

41.7

50.0

50.0

Minimum

0.0

8.3

0.0

0.0

0.0

0.0

0.0

0.0

0.0

8.3

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

83.3

75.0

100.0

91.7

91.7

91.7

83.3

100.0

91.7

91.7

91.7

100.0

100.0

91.7

91.7

100.0

100.0

Floor effect (%)

3.3

0.0

3.1

3.9

5.6

7.1

6.7

5.3

4.4

0.0

1.2

0.6

2.0

4.9

6.2

3.2

4.2

Ceiling effect (%)

0.0

0.0

0.8

0.0

0.0

0.0

0.0

0.1

0.0

0.0

0.0

0.6

0.7

0.0

0.0

0.2

0.2

Depression

                 

n=

62

44

178

222

330

376

400

1612

55

105

276

339

487

631

627

2520

4132

Mean

35.7

33.3

28.7

27.1

27.7

23.6

23.1

26.3

44.9

37.1

35.5

38.7

39.1

34.0

32.9

36.2

31.6

Standard deviation

30.5

26.5

21.3

19.4

22.0

17.9

19.4

20.9

26.2

24.2

21.0

22.2

20.2

17.2

19.4

20.2

21.0

Error standard of the mean

3.2

3.1

1.6

1.2

1.1

1.0

0.9

0.5

3.2

2.2

1.4

1.2

1.0

0.9

0.9

0.4

0.3

Percentile 25 th

20.0

20.0

10.0

10.0

10.0

10.0

10.0

10.0

30.0

20.0

20.0

20.0

20.0

20.0

20.0

20.0

20.0

Median

30.0

30.0

30.0

30.0

20.0

20.0

20.0

20.0

50.0

30.0

30.0

40.0

40.0

30.0

30.0

30.0

30.0

Percentile 75th

50.0

50.0

40.0

40.0

40.0

40.0

30.0

40.0

60.0

50.0

50.0

60.0

50.0

50.0

50.0

50.0

50.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

80.0

100.0

100.0

100.0

90.0

80.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

7.7

6.4

9.6

8.4

13.3

16.4

13.9

12.4

4.4

5.6

5.0

3.7

2.8

7.1

8.9

5.7

8.8

Ceiling effect (%)

3.4

0.0

0.4

0.5

0.2

0.0

0.0

0.3

1.5

1.7

2.1

0.3

1.6

0.3

1.4

1.2

0.8

Pain

                 

n=

62

45

177

222

331

375

404

1616

55

105

276

340

490

635

632

2533

4149

Mean

34.5

39.9

41.0

41.2

44.9

43.0

44.6

42.8

41.2

53.7

46.5

52.3

56.1

55.9

56.8

53.9

48.7

Standard deviation

39.2

46.8

37.7

34.2

39.5

32.4

38.1

36.9

36.5

39.6

34.8

36.9

34.8

29.2

32.3

33.6

35.3

Error standard of the mean

4.2

5.4

2.8

2.2

2.0

1.8

1.7

0.9

4.5

3.6

2.2

2.0

1.7

1.5

1.5

0.7

0.6

Percentile 25 th

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

50.0

0.0

0.0

50.0

50.0

50.0

50.0

0.0

Median

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

Percentile 75th

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

100.0

50.0

100.0

100.0

100.0

100.0

100.0

100.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

41.6

38.1

37.8

31.3

32.9

31.8

30.2

32.9

32.1

23.2

31.5

26.0

23.1

22.1

21.5

24.3

28.3

Ceiling effect (%)

10.6

17.8

19.8

13.7

22.7

17.8

19.5

18.6

14.5

30.6

24.4

30.6

35.4

34.0

35.1

32.0

25.8

Disability

                 

n=

62

45

178

222

331

376

404

1618

55

105

276

340

490

635

633

2534

4152

Mean

5.5

2.0

6.9

6.7

4.1

3.5

5.8

5.1

3.7

5.5

6.6

6.1

5.6

4.5

3.7

5.1

5.1

Standard deviation

20.5

12.8

22.6

23.4

19.2

15.1

24.2

20.7

14.5

19.1

21.0

20.2

19.1

14.8

14.7

17.4

18.7

Error standard of the mean

2.2

1.5

1.7

1.5

1.0

0.8

1.1

0.5

1.8

1.7

1.4

1.1

0.9

0.7

0.7

0.4

0.3

Percentile 25 th

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Median

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Percentile 75th

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

50.0

100.0

100.0

100.0

100.0

100.0

100.0

50.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

90.0

95.9

90.1

90.8

94.6

95.0

92.9

93.1

92.6

90.3

91.1

90.8

92.5

93.8

94.8

92.7

92.9

Ceiling effect (%)

1.0

0.0

3.9

4.1

2.7

1.9

4.6

3.2

0.0

1.3

4.3

3.1

3.6

2.8

2.2

2.9

3.0

* Weighted by number of eligible persons in the household and imputed from 1999 INSEE National Census data.

Table 5

HRQoL norms* in French general population from 12 to 75 years old with no self-reported chronic disease (n = 13559)

 

Men

Women

Total

 

12-17

18-24

25-34

35-44

45-54

55-64

65-75

Total

12-17

18-24

25-34

35-44

45-54

55-64

65-75

Total

 

Physical health

                 

n=

608

593

1217

1180

985

745

460

5788

676

703

1648

1571

1279

1089

753

7719

13507

Mean

81.3

79.8

80.4

79.1

76.3

79.7

75.8

79.1

73.9

72.7

71.2

72.0

69.8

69.1

66.0

71.0

75.0

Standard deviation

18.4

19.8

16.5

17.2

20.5

16.3

21.3

18.4

19.6

20.0

18.4

18.2

18.8

16.9

18.4

18.6

19.0

Error standard of the mean

0.6

0.6

0.4

0.5

0.6

0.6

0.9

0.2

0.7

0.7

0.5

0.5

0.6

0.6

0.8

0.2

0.2

Percentile 25 th

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

60.0

60.0

60.0

60.0

60.0

60.0

50.0

60.0

60.0

Median

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

70.0

70.0

80.0

70.0

70.0

70.0

70.0

80.0

Percentile 75th

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

80.0

80.0

80.0

80.0

90.0

90.0

Minimum

20.0

0.0

10.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.3

0.0

0.1

0.6

0.2

0.4

0.2

0.4

0.2

0.5

0.3

0.4

0.7

0.6

0.4

0.3

Ceiling effect (%)

18.1

16.2

18.2

16.5

14.7

21.0

15.1

17.0

11.7

9.1

9.4

8.9

8.6

10.9

6.0

9.2

13.1

Mental health

                 

n=

606

593

1218

1179

981

745

454

5776

677

703

1646

1570

1278

1089

764

7727

13503

Mean

74.9

75.3

80.8

80.6

79.3

83.1

82.6

79.3

66.0

67.7

72.8

72.6

72.8

74.6

77.0

71.9

75.6

Standard deviation

22.1

24.7

17.8

17.9

19.2

16.1

18.9

19.4

23.4

21.7

18.9

19.5

19.1

16.6

17.8

19.6

19.9

Error standard of the mean

0.7

0.8

0.5

0.5

0.6

0.6

0.8

0.2

0.8

0.8

0.5

0.5

0.6

0.6

0.7

0.2

0.2

Percentile 25 th

60.0

60.0

70.0

70.0

70.0

70.0

70.0

70.0

50.0

50.0

60.0

60.0

60.0

60.0

70.0

60.0

60.0

Median

80.0

80.0

80.0

80.0

80.0

90.0

90.0

80.0

70.0

70.0

80.0

80.0

70.0

80.0

80.0

70.0

80.0

Percentile 75th

90.0

90.0

90.0

90.0

90.0

100.0

100.0

90.0

80.0

80.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

Minimum

0.0

0.0

20.0

10.0

20.0

10.0

20.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.1

0.1

0.0

0.0

0.0

0.0

0.0

0.0

0.5

0.2

0.3

0.1

0.5

0.4

0.2

0.3

0.2

Ceiling effect (%)

12.5

15.9

22.8

22.1

21.2

30.6

31.9

21.5

8.7

7.6

11.7

13.3

14.9

19.4

19.6

13.2

17.3

Social health

                 

n=

607

589

1210

1169

967

742

448

5732

674

701

1644

1564

1268

1075

758

7684

13416

Mean

70.5

68.0

68.7

66.6

66.1

65.2

65.5

67.4

65.6

67.0

68.6

67.8

66.1

67.2

67.1

67.2

67.3

Standard deviation

20.0

22.7

18.1

17.8

18.7

16.6

18.5

18.8

18.5

19.0

15.9

16.6

16.4

14.2

15.3

16.4

17.5

Error standard of the mean

0.7

0.7

0.5

0.5

0.5

0.7

0.8

0.2

0.7

0.7

0.4

0.4

0.5

0.6

0.6

0.2

0.1

Percentile 25 th

60.0

60.0

60.0

60.0

60.0

50.0

50.0

60.0

50.0

60.0

60.0

60.0

50.0

60.0

60.0

60.0

60.0

Median

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

Percentile 75th

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

Minimum

20.0

10.0

0.0

0.0

0.0

10.0

0.0

0.0

10.0

10.0

0.0

10.0

10.0

0.0

20.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

0.1

0.0

0.0

0.0

0.1

0.0

-0.0

0.0

0.1

0.0

0.0

0.2

-0.0

0.0

0.0

Ceiling effect (%)

5.7

4.5

4.5

3.1

3.5

4.2

3.7

4.1

3.0

4.1

4.6

5.7

4.5

6.2

5.1

4.8

4.5

General health

                 

n=

605

589

1207

1166

960

738

438

5703

669

699

1643

1549

1259

1067

734

7620

13323

Mean

75.6

74.4

76.6

75.4

74.0

76.0

74.6

75.3

68.6

69.2

70.8

70.8

69.6

70.3

70.2

70.1

72.7

Standard deviation

13.8

16.6

12.9

13.2

13.9

11.8

14.5

13.7

15.1

15.0

13.1

13.6

13.5

11.9

12.9

13.5

13.8

Error standard of the mean

0.5

0.5

0.3

0.4

0.4

0.5

0.6

0.2

0.5

0.5

0.3

0.4

0.4

0.5

0.5

0.2

0.1

Percentile 25 th

70.0

66.7

70.0

66.7

66.7

66.7

66.7

66.7

60.0

60.0

63.3

63.3

60.0

60.0

63.3

60.0

63.3

Median

76.7

76.7

76.7

76.7

73.3

76.7

76.7

76.7

70.0

70.0

73.3

73.3

70.0

73.3

73.3

70.0

73.3

Percentile 75th

83.3

83.3

86.7

86.7

83.3

86.7

83.3

83.3

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

83.3

Minimum

26.7

23.3

26.7

16.7

13.3

23.3

30.0

13.3

20.0

20.0

23.3

20.0

16.7

0.0

10.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

96.7

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

0.0

0.0

0.0

-0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.1

0.0

0.0

0.0

Ceiling effect (%)

0.7

0.5

0.8

0.6

0.5

1.1

0.9

0.7

0.0

0.5

0.6

0.3

0.5

0.8

0.6

0.4

0.6

Perceived health

                 

n=

607

593

1219

1180

985

745

460

5789

678

704

1647

1578

1279

1094

769

7749

13538

Mean

71.4

75.0

80.3

79.1

75.1

75.2

75.6

76.4

69.5

73.9

76.8

76.7

75.3

75.0

70.4

74.6

75.5

Standard deviation

43.8

45.1

33.1

31.8

34.6

28.1

34.2

35.4

39.3

37.9

31.7

30.6

28.8

24.8

28.1

31.3

33.1

Error standard of the mean

1.5

1.5

0.9

0.9

1.0

1.1

1.5

0.4

1.4

1.3

0.8

0.8

0.8

0.9

1.1

0.4

0.3

Percentile 25 th

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

Median

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

50.0

100.0

100.0

Percentile 75th

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

13.4

12.7

7.7

6.5

7.3

5.8

7.1

8.6

14.6

12.4

10.3

8.2

6.0

7.2

7.6

9.3

9.0

Ceiling effect (%)

56.3

62.8

68.2

64.6

57.5

56.2

58.2

61.4

53.6

60.1

63.9

61.6

56.5

57.1

48.5

58.5

60.0

Self-esteem

                 

n=

607

590

1211

1169

966

743

446

5732

672

701

1646

1561

1269

1077

757

7683

13415

Mean

77.6

76.2

80.5

80.4

79.8

79.9

80.9

79.4

68.2

70.9

76.1

76.3

76.4

77.2

80.0

75.1

77.2

Standard deviation

20.5

23.9

17.5

17.4

17.4

15.2

17.5

18.4

20.0

19.3

16.3

16.8

16.8

14.4

15.5

17.1

17.8

Error standard of the mean

0.7

0.8

0.5

0.5

0.5

0.6

0.8

0.2

0.7

0.7

0.4

0.4

0.5

0.6

0.6

0.2

0.2

Percentile 25 th

70.0

70.0

70.0

70.0

70.0

70.0

70.0

70.0

60.0

60.0

70.0

70.0

70.0

70.0

70.0

60.0

70.0

Median

80.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

70.0

70.0

80.0

80.0

80.0

80.0

80.0

80.0

80.0

Percentile 75th

90.0

90.0

90.0

90.0

90.0

90.0

100.0

90.0

80.0

80.0

90.0

90.0

90.0

90.0

90.0

90.0

90.0

Minimum

20.0

10.0

0.0

0.0

10.0

30.0

10.0

0.0

0.0

0.0

10.0

0.0

10.0

0.0

10.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

0.0

0.0

0.1

0.1

0.0

-0.0

0.0

0.0

0.2

0.1

0.0

0.1

0.0

0.1

0.0

0.1

0.0

Ceiling effect (%)

16.1

16.3

21.1

21.1

19.8

21.6

25.4

19.9

5.8

6.5

14.1

15.9

15.6

18.4

22.3

14.0

17.0

Anxiety

                 

n=

607

592

1215

1174

971

740

449

5748

674

702

1645

1561

1268

1076

758

7684

13432

Mean

28.6

31.8

27.4

27.1

27.3

22.4

22.6

27.3

35.3

36.8

33.3

31.7

31.8

29.1

27.5

32.4

29.9

Standard deviation

22.1

23.1

18.6

18.3

19.2

15.3

17.7

19.3

20.9

19.8

16.7

17.4

17.3

14.8

15.8

17.5

18.5

Error standard of the mean

0.7

0.7

0.5

0.5

0.6

0.6

0.8

0.2

0.7

0.7

0.4

0.5

0.5

0.6

0.6

0.2

0.2

Percentile 25 th

16.7

16.7

16.7

16.7

16.7

8.3

8.3

16.7

25.0

25.0

25.0

16.7

16.7

16.7

16.7

16.7

16.7

Median

25.0

33.3

25.0

25.0

25.0

16.7

16.7

25.0

33.3

33.3

33.3

33.3

33.3

25.0

25.0

33.3

25.0

Percentile 75th

41.7

41.7

41.7

41.7

41.7

33.3

33.3

41.7

50.0

50.0

41.7

41.7

41.7

41.7

41.7

41.7

41.7

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

83.3

91.7

91.7

91.7

91.7

83.3

75.0

91.7

91.7

83.3

91.7

91.7

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

5.8

4.6

8.7

8.8

8.1

15.7

13.9

8.7

4.4

1.8

4.4

4.9

6.4

9.4

8.3

5.4

7.0

Ceiling effect (%)

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.1

0.1

0.1

0.0

0.0

Depression

                 

n=

608

593

1218

1180

982

744

455

5780

679

704

1647

1575

1278

1089

768

7740

13520

Mean

27.9

28.8

21.3

21.0

21.7

17.4

19.8

22.8

35.6

33.9

29.7

28.8

29.0

27.9

26.8

30.1

26.5

Standard deviation

23.3

24.5

18.6

18.0

19.4

15.9

19.6

20.0

23.2

22.0

19.0

19.3

19.3

16.8

18.1

19.6

20.1

Error standard of the mean

0.8

0.8

0.5

0.5

0.6

0.6

0.8

0.2

0.8

0.8

0.5

0.5

0.6

0.6

0.7

0.2

0.2

Percentile 25 th

10.0

10.0

10.0

10.0

10.0

0.0

10.0

10.0

20.0

20.0

20.0

10.0

10.0

10.0

10.0

10.0

10.0

Median

20.0

30.0

20.0

20.0

20.0

10.0

20.0

20.0

30.0

30.0

30.0

30.0

30.0

30.0

20.0

30.0

20.0

Percentile 75th

40.0

40.0

30.0

30.0

30.0

30.0

30.0

30.0

50.0

50.0

40.0

40.0

40.0

40.0

40.0

40.0

40.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

90.0

90.0

90.0

90.0

90.0

100.0

70.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

9.4

8.9

16.7

17.1

18.7

27.6

22.8

16.6

7.5

6.0

9.1

10.5

11.4

14.7

13.0

10.1

13.3

Ceiling effect (%)

0.0

0.0

0.0

0.0

0.0

0.1

0.0

0.0

0.5

0.1

0.2

0.1

0.4

0.4

0.1

0.2

0.1

Pain

                 

n=

608

593

1219

1181

987

747

462

5797

679

704

1648

1578

1283

1093

771

7756

13553

Mean

21.5

24.6

24.3

27.0

32.1

28.2

34.0

26.9

28.5

29.2

31.7

32.5

36.5

39.1

40.9

33.5

30.3

Standard deviation

36.9

40.8

31.5

32.6

36.0

28.4

35.0

34.3

33.6

36.2

32.1

31.6

32.1

27.5

30.8

32.0

33.2

Error standard of the mean

1.2

1.3

0.9

0.9

1.0

1.1

1.5

0.4

1.2

1.3

0.8

0.8

0.9

1.1

1.2

0.4

0.3

Percentile 25 th

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Median

0.0

0.0

0.0

0.0

50.0

0.0

50.0

0.0

0.0

0.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

Percentile 75th

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

50.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

63.0

58.9

56.7

53.2

45.6

50.1

41.7

53.5

50.2

52.2

48.3

45.7

39.9

37.6

34.6

44.8

49.1

Ceiling effect (%)

6.0

8.0

5.3

7.1

9.9

6.4

9.7

7.4

7.1

10.6

11.6

10.6

13.0

15.8

16.4

11.8

9.6

Disability

                 

n=

608

593

1219

1180

986

747

462

5795

680

704

1647

1578

1283

1094

771

7757

13552

Mean

2.4

2.3

1.8

2.7

2.3

1.6

2.1

2.2

2.6

2.8

4.2

3.1

2.8

2.3

1.9

3.0

2.6

Standard deviation

15.0

16.1

11.9

14.7

14.5

10.5

14.0

13.7

14.2

13.5

16.3

14.9

14.4

10.5

10.4

14.0

13.9

Error standard of the mean

0.5

0.5

0.3

0.4

0.4

0.4

0.6

0.2

0.5

0.5

0.4

0.4

0.4

0.4

0.4

0.2

0.1

Percentile 25 th

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Median

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Percentile 75th

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Minimum

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

Maximum

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Floor effect (%)

95.9

96.4

97.3

96.0

96.8

97.9

97.0

96.7

95.7

94.9

93.7

95.9

96.3

96.8

97.2

95.6

96.1

Ceiling effect (%)

0.7

1.0

0.8

1.4

1.3

1.0

1.2

1.1

0.9

0.5

2.1

2.0

1.9

1.4

0.9

1.6

1.3

* Weighted by number of eligible persons in the household and imputed from 1999 INSEE National Census data.

We found a floor effect for anxiety, perceived health and depression scores (6.4, 11.3 and 12.4%, respectively) and a strong floor effect for pain and disability scores (44.6 and 95.4%, respectively) (Table 3). Ceiling effects were moderate for physical health (11.3%), self-esteem (16%) and mental health (16.2%) and strong for perceived health (53.9%).

Discussion

The DUKE questionnaire has been used for many years to describe HRQoL in different patient populations but has not been used for a general population. This is the first study presenting norms for the DUKE for French adolescents and adults. These normative data will be useful to researchers who wish to use the DUKE for health assessment and to clinical practitioners in daily practice.

The production of HRQoL community norms is important because they provide expected reference values to evaluate groups or individuals' HRQoL. Norms allow for appreciating the impact of diseases on HRQoL by comparing patients' HRQoL with normative data. However, some authors have suggested that norm-based interpretation in this situation may be irrelevant [35, 36] because the impact of the disease could be underestimated. This situation would be the case mainly in longitudinal studies if patients changed their way of estimating HRQoL over time because of their experience with disease or treatment, the response-shift phenomenon. Humans actively construct meaning from their environment and display a range of cognitive mechanisms to continually adapt to changing circumstances. Response shift refers to a change in the meaning of one's evaluation of a construct as a result of a change in one's internal standards of measurement, values or construct definition. Therefore, people might give different answers on patient-reported outcome measures over time, because their HRQoL has changed and because they might have changed their perception on what health or HRQoL means to them [37, 38]. However, comparing values between patients and the general population can be problematic with scales that have been developed in a hospital setting, but is not the case for the DUKE.

In public health, the continual monitoring of population HRQoL with validated instruments gives public health agencies data on current health for assessing, protecting, and promoting population health. Tracking population HRQoL over time also helps identify health disparities, evaluate progress on achieving broad health goals, and inform healthy public policy makers. These applications complement those of clinical research and practice, where HRQOL assessment measures patient-reported outcomes from medical, surgical, and behavioural interventions. In epidemiological research, these measures are particularly relevant to the field of chronic disease epidemiology by providing direct evidence of the considerable population burden of long-term health conditions such as disability, arthritis, obesity, asthma or diabetes. As previously mentioned, clinicians and researchers should carefully define their research questions related to patient-reported outcomes before selecting the instrument to use, by structure and content criteria and perhaps according to the availability of normative data.

Methodological considerations

We found relatively low internal consistency and a strong floor effect with the DUKE. Similar limitations were reported in young people [39] and in dementia [16], and in the French validity study of a cohort of 963 people from the general population, in which the Cronbach α varied from 0.63 to 0.81 [12]. However, this limitation should be moderately weighed because the use of the Cronbach α to assess the psychometric qualities of a HRQoL questionnaire might be inappropriate when the construct validity generates dimensions with few items. The Cronbach α is sensitive to the number of items in the dimension; with increasing number of items, the Cronbach α is likely to increase. In addition, the lower the mean inter-item correlation, the lower the Cronbach α.

We also showed some moderate and high floor effects in dysfunction measures (anxiety, depression, pain and disability) of the DUKE, which indicates poor discrimination properties. This finding was not surprising in a sample from a general population, which is, on average, in good health. These dimension scores are probably sensitive to the impact of disease, as we observed in other studies in patient samples [21, 40].

The response rate of the 2005 Health Barometer telephone survey was about 64% (30,514 participants in the 2005 Health Barometer of almost 48,000 contacted), which is lower than the response rate of mail surveys. To be representative of French population, data collected from 2005 Health Barometer have been weighted by number of eligible persons in the household (and by the number of landline phones in the household) and imputed from 1999 INSEE National Census data on gender, age, geographic area and size of agglomeration. In this way, the sample used for this study was representative of these criteria of the French population aged 12 to 75 years old, who speak French and have a landline phone. Characteristics of subjects selected (n = 17,733) and not selected (n = 8,889) for the HRQoL survey group were similar, but despite these precautions and checks, we cannot totally exclude the existence of selection bias.

Finally, the "next-birthday" method used in this national survey [30] to select the person to answer the questions can generate a low "self-selection" phenomenon. However, the results of the selection obtained with this method were very close to those expected. We could have used the Kish method, but it requires, before the selection, describing exactly the whole family, more time and more risk of generating refusals than does the next-birthday method.

Conclusions

We present HRQoL norms for all dimensions of the DUKE for adolescents and adults in France. These norms could be used as a reference for other studies assessing HRQoL, for specific illnesses, and for international comparisons.

List of abbreviations

HRQoL: 

Health-related quality of life

DUKE: 

DUKE health profile questionnaire

INPES: 

Institut National de Prévention et d'Education pour la Santé (French National Institute for Prevention and Health Education).

Declarations

Acknowledgements

We thank Stéphanie Boini (CHU Nancy) for contributions to the conception of the study. This study was financially supported by the National Institute for Prevention and Health Education, Paris, France, for the collection and the analysis of data.

Authors’ Affiliations

(1)
Nancy-Université, Université Paul Verlaine Metz, Université Paris Descartes
(2)
CHU Nancy, Hôpitaux de Brabois, Epidémiologie et Evaluation Cliniques
(3)
CHU Nancy, Hôpitaux de Brabois, service de gériatrie
(4)
INPES, département Observation et Analyse des Comportements de Santé

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  41. Pre-publication history

    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/11/401/prepub

Copyright

© Baumann et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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