Treatment burden and health-related quality of life in adults with multiple conditions: a cross-sectional study of associated factors

BackgroundTreatment burden and health-related quality of life (HRQoL) are closely interrelated patient-centered outcomes among people with multimorbidity, and several socioeconomic, clinical, and behavioral correlates of treatment burden have already been identified. However, the distribution and relative prominence of these characteristics may vary across regional socioeconomic and healthcare contexts. This study examined factors associated with moderate/high treatment burden among adults with multimorbidity in Shandong Province, China, and explored the relative importance of the analyzed factors using complementary random forest analysis.MethodsThis secondary analysis used cross-sectional data from 765 adults with multimorbidity who participated in the Survey of Residents’ Health and Contracted Family Doctor Services in Shandong Province, China, in 2023. Treatment burden was assessed using the Chinese version of the Multimorbidity Treatment Burden Questionnaire (C-MTBQ), and HRQoL was assessed using the EuroQol Five-Dimension Five-Level Questionnaire (EQ-5D-5L). Participants were classified into no/low and moderate/high treatment burden groups. Univariable analyses and multivariable logistic regression were performed to identify factors independently associated with moderate/high treatment burden. A supplementary random forest analysis was conducted using the variables retained in the regression model to describe their relative importance within the selected predictor set. Model discrimination was summarized using the area under the receiver operating characteristic curve (AUC).ResultsOverall, 65.8% of participants experienced moderate/high treatment burden. Lower health utility index, lower household income, higher annual household healthcare expenditure, having three chronic conditions, lower educational attainment, and lower frequency of physical activity were independently associated with moderate/high treatment burden (all p < 0.05). The random forest analysis yielded an AUC of 0.890. Among the included variables, health utility index showed the highest relative importance, followed by annual household income, annual household healthcare expenditure, physical activity, and number of chronic conditions.ConclusionIn this sample of adults with multimorbidity from Shandong Province, treatment burden was associated with HRQoL and several socioeconomic, clinical, and behavioral characteristics. These findings should be interpreted within the regional context of the study and should not be assumed to represent adults with multimorbidity across China.