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Résumé (français)

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Résumé (anglais)

Health Utilities Index Mark 3 (HUI3) is a multi-attribute and utility-based measure of health-related quality of life (HRQL). HUI3 is widely used in population health surveys and clinical studies in Canada and elsewhere. The general objective of this thesis was to assess the determinants of health of Canadians. The usefulness of HUI3 in population health research was assessed for this purpose. In particular, two specific objectives were to assess the validity of HUI3 and to investigate cross-sectional and longitudinal determinants of health using HUI3. Statistics Canada National Population Health Survey cross-sectional (community and institutional) as well as longitudinal (community) surveys were used as a data source throughout the thesis. The cross-sectional validity of HUI3 was assessed for three chronic conditions common to the middle-age and elderly population: Alzheimer Disease (AD), arthritis (AR), and cataracts (CA). HUI3 was able to describe overall burdens of AD, AR and CA. HUI3 was also able to identify speech and cognition burdens associated with AD, ambulation and pain burdens associated with AR and vision problems associated with CA; all were hypothesized to be important for the specified conditions. The assessment of cross-sectional determinants of health showed important heterogeneity in health determinants between community-dwelling and institutionalized populations. Usual determinants such as advanced age, low education, low financial status and not being married were unimportant for institutionalized residents, whereas they were important for residents in the community. Health trajectories were estimated using growth-curve models to assess longitudinal determinants of health. Important heterogeneities in life-course trajectories were found across three age groups (age 18-39, 40-64, and 65+). For young and middle-aged (18-64), variations in trajectories were mainly associated with socio-economic factors (i.e. financial status, education, marital status). For seniors (65+), however, unfavourable lifestyle, in particular, physical inactivity was important determinants. Moreover, having more chronic conditions lowered the mean trajectories by similar magnitudes regardless of age. Understanding differential impacts of the determinants of health factors is important in developing effective health policy across populations as well as for various life stages. The program of research showed that HUI3 is a useful tool as a measure of HRQL in population health research.