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Sheri L. Maddigan, PhD, David H. Feeny, PhD, Sumit R. Majumdar, MD, MPH, FRCPC, Karen B. Farris, PhD and Jeffrey A. Johnson, PhD

Sheri L. Maddigan, David H. Feeny, Sumit R. Majumdar, and Jeffrey A. Johnson are with the Institute of Health Economics, Edmonton, Alberta. David H. Feeny and Jeffrey A. Johnson are also with the Department of Public Health Sciences, University of Alberta, Edmonton. David H. Feeny also is with the Department of Economics, University of Alberta, and Health Utilities Inc, Edmonton. Sumit R. Majumdar is with the Department of Medicine, University of Alberta. Karen B. Farris is with the College of Pharmacy, University of Iowa, Iowa City.

Correspondence: Requests for reprints should be sent Jeffrey A. Johnson, PhD, Institute of Health Economics, #1200 – 10 405 Jasper Ave, Edmonton, Alberta, Canada T5J 3N4 (e-mail: jeff.johnson{at}ualberta.ca).

Objective. We assessed which of a broad range of determinants of health are most strongly associated with health-related quality of life (HRQL) among people with type 2 diabetes.

Methods. Our analysis included respondents from the Canadian Community Health Survey Cycle 1.1 (2000–2001) who were aged 18 years and older and who were identified as having type 2 diabetes. We used regression analyses to assess the associations between the Health Utilities Index Mark 3 and determinants of health.

Results. Comorbidities had the largest impact on HRQL, with stroke (–0.11; 95% confidence interval [CI] = –0.17, –0.06) and depression (–0.11; 95% CI = –0.15, –0.06) being associated with the largest deficits. Large differences in HRQL were observed for 2 markers of socioeconomic status: social assistance (–0.07; 95% CI=–0.12, –0.03) and food insecurity (–0.07; 95% CI=–0.10, –0.04). Stress, physical activity, and sense of belonging also were important determinants. Overall, 36% of the variance in the Health Utilities Index Mark 3 was explained.

Conclusion. Social and environmental factors are important, but comorbidities have the largest impact on HRQL among people with type 2 diabetes.

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