Preferences for current health and their association with outcomes in patients with kidney disease.

BACKGROUND: Patients with chronic disease who express stronger preference for their current health might be expected to have better outcomes than patients who assign lower utility to their current health state. OBJECTIVE: We sought to examine associations between preferences for current health and outcomes in a national cohort of incident hemodialysis patients. METHODS: In 567 patients treated at 74 clinics, we measured patients' preferences by time trade-off on a 0-1 scale (1=willingness to sacrifice no life expectancy to achieve perfect health; 0=zero value of current health). Associations between these preferences and outcomes were examined with Poisson (hospitalization), logistic (progression of comorbidity and clinical performance), and Cox proportional hazards (mortality) models. RESULTS: The distribution of preference scores was skewed, with a mean of 0.69 and a median of 0.83. Highest (1.0) scores were associated with decreased incidence of hospitalization (incidence risk ratio=0.88, 95% confidence interval=0.80-0.97), relative to the lowest (<0.50) scores, a finding that was consistent across gender and race, with women and white subjects having greater decreases (Pinteraction<0.001). Higher preferences for current health also were associated with less worsening of comorbidity. Adjusted risks of death for patients with intermediate (>or=0.50-1.0) and the highest preference scores for current health were not different from those with lower scores. CONCLUSION: In patients with chronic kidney disease, a stronger preference for current health is associated with lower hospital admission rates and improved comorbidity but not better survival.

Duke Scholars

Author L. Ebony Boulware Medicine, General Internal Medicine