Determinants of quality of life after stroke in China: the ChinaQUEST (QUality Evaluation of Stroke care and Treatment) study

Background and Purpose- Limited information exists on the long-term consequences of stroke in China. We aimed to describe the profile and determinants of health-related quality of life among 12-month survivors of stroke. Methods- The ChinaQUEST (QUality Evaluation of Stroke care and Treatment) study was a prospective 62-hospital registry study of patients with acute stroke (ischemic stroke and intracerebral hemorrhage). Health-related quality of life was determined in 12-month survivors using a 35-item quality-of-life questionnaire (QOL-35) designed specifically for use in Chinese people. Proxy responses were used in those who were unable to personally complete the QOL-35. Results- A total of 4283 12-month stroke survivors completed assessments directly (1730 [40.4%]) or by a proxy (2553 [59.6%]). Mean (SD) health-related quality of life scores were higher in self-responders (70 [0.3] out of a best possible 100 score) than in proxy responders (60 [0.3]; P<0.001). The strongest baseline variables that predicted "low" (below median) health-related quality of life scores in self-responders were having a lower income (income <10 000 Chinese Yuan Renminbi [CNY, approximately US $1428] versus >19 000 CNY [approximately US $2714]; OR, 2.06; 95% CI, 1.37 to 3.10) and being disabled at discharge (OR, 3.65; 95% CI, 2.72 to 4.91). Proxy responders had similar predictive factors, including being disabled at discharge (OR, 4.99; 95% CI, 4.00 to 6.21), but income was not significant. Conclusions- In China, the strongest predictor of 12-month health-related quality of life after stroke is level of disability at hospital discharge. Level of income was another important factor. Health insurance schemes that offset the economic impact of stroke could help improve the health and well-being of Chinese people affected by stroke.