Association between chronic conditions and health-related quality of life: differences by level of urbanization in Peru

Published in Quality of Life Research, v. 26:3439–3447

Taype-Rondan, A., Abbs, E.S., Lazo-Porras, M., Checkley, W., Gilman, R.H., Smeeth, L., Miranda, J.J., Bernabe-Ortiz, A.

Publication year 2017

CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Armendáriz 497, Miraflores, 18, Lima, Peru.

IAI Program


IAI Project crn3036



To evaluate the role of urbanization as an effect modifier for the association between specific chronic conditions and number of conditions with health-related quality of life (QOL).


We analyzed cross-sectional data from the CRONICAS Cohort Study conducted in Lima (highly urbanized), Tumbes (semi-urban), as well as rural and urban sites in Puno. Exposures of interest were chronic bronchitis, depressive mood, hypertension, type 2 diabetes, and a composite variable aggregating the number of chronic conditions (the four exposures plus heart disease and stroke). QOL outcomes were assessed with EuroQol&rsquos EQ-5D visual analogue scale (EQ-VAS). We fitted linear regressions with robust variance to evaluate the associations of interest. Study site was assessed as a potential effect modifier using the likelihood-ratio (LR) test.


We evaluated data on 2433 subjects: 51.3% were female, mean age was 57.2 years. Study site was found to be an effect modifier only for the association between depressive mood and EQ-VAS score (LR test p < 0.001). Compared to those without depressive mood, participants with depressive mood scored &minus13.7 points on the EQ-VAS in Lima, &minus7.9 in urban Puno, &minus11.0 in semi-urban Tumbes, and &minus2.7 in rural Puno. Study site was not found to be an effect modifier for the association between the number of chronic conditions and EQ-VAS (LR test p = 0.64).


The impact of depressive mood on EQ-VAS was larger in urban than in rural sites, while site was not an effect modifier for the remaining associations.

Electronic supplementary material

The online version of this article (doi:10.1007/s11136-017-1649-7) contains supplementary material, which is available to authorized users.