Treatment burden and health-related quality of life in adults with multiple conditions: a cross-sectional study of associated factors
5 affiliations
- 1School of Management, Shandong Second Medical University
- 2Health Management Research Center, Shandong Second Medical University
- 3Department of Finance, Weifang People's Hospital
- 4Weifang Eye Hospital
- 5Shandong Provincial Hospital Affiliated to Shandong First Medical University
Abstract
Background: Treatment 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.
Methods: This 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).
Results: Overall, 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.
Conclusion: In 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.
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BibTeX
@article{wang2026treatment,
title = {{Treatment burden and health-related quality of life in adults with multiple conditions: a cross-sectional study of associated factors}},
author = {Zhaoxuan Wang and Kang Wang and Xin Zhang and Yelin Feng and Yuting Yang and Nannan Cheng and Xuan Chang and Wenqiang Yin and Zhongming Chen and Dongping Ma},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1987212},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1987212/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Treatment burden and health-related quality of life in adults with multiple conditions: a cross-sectional study of associated factors
AU - Zhaoxuan Wang
AU - Kang Wang
AU - Xin Zhang
AU - Yelin Feng
AU - Yuting Yang
AU - Nannan Cheng
AU - Xuan Chang
AU - Wenqiang Yin
AU - Zhongming Chen
AU - Dongping Ma
PY - 2026
DA - 2026/10/14
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1987212
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1987212/full
AB - Background: Treatment 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. Methods: This 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). Results: Overall, 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. Conclusion: In 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.
SN - 2296-2565
ER -