Health-related quality of life in children and adolescents with congenital adrenal hyperplasia: a systematic review and meta-analysis

Gunawardana, S., Jayarajah, U., Ahmed, S. F. and Seneviratne, S. N. (2024) Health-related quality of life in children and adolescents with congenital adrenal hyperplasia: a systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism, (doi: 10.1210/clinem/dgae068) (PMID:38332657) (Early Online Publication)

Abstract

Objective To conduct a systematic-review(SR) and meta-analysis(MA) on health-related quality-of-life (QoL) and associated factors among children/adolescents with congenital adrenal hyperplasia(CAH). Method Following registration in the PROSPERO International-prospective-register-of-systematic-reviews(reg no:CRD42022313389), Google-scholar, PubMed, LILACS, Cochrane and Scopus databases were searched up to 03/05/2022, using pre-defined search strategy/MESH terms, to identify original studies describing/assessing self-reported/parent-reported health-related QoL in patients with CAH ≤21 years. Methodological quality was assessed by Newcastle-Ottawa quality-assessment-scale (NOS), and heterogeneity by I2 statistics. MA assessed mean difference (MD) in QoL between children/adolescents with CAH and healthy children/adolescents. Results Among 1308 publications, the 12 studies eligible for the SR (CAH n=781), showed NOS scales of 3-7/9, and the six eligible for MA (CAH n=227) showed moderate-considerable heterogeneity. MA showed that parent-reported psychosocial QoL (MD-9.9[-12.6,7.3], P=<0.001)) {consisting of school ((MD-7.4[-12.2, -2.5], P=0.003), emotional (MD-5.6[-10.2, -0.9], P=0.02) and social domains (MD-4.3[-8.1, -0.5], P =0.03)}, and self-reported school domain QoL (MD-8.5[-15.9, -1.2], p=0.02) was lower in children/adolescents with CAH while parent-reported and self-reported physical QoL were similar to controls. Factors associated with lower QoL among children/adolescents with CAH included: poor disease control, poor medication compliance, and complications including hyper-pigmentation, virilization, hypertension, hospital admission and urinary incontinence. Conclusion Based on available data, children/adolescents with CAH had preserved physical QoL but impaired psychosocial QoL, especially in the school domain. Factors associated with lower QoL included poor disease-control, and disease/treatment-related complications. There is a need for further high-quality research that investigates the relationship between disease-control, provision of psychosocial support and improvement in QoL in children/adolescents with CAH.

• Item Type: Articles
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ahmed, Professor Syed Faisal
• Authors: Gunawardana, S., Jayarajah, U., Ahmed, S. F., and Seneviratne, S. N.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Clinical Endocrinology and Metabolism
• Publisher: Oxford University Press
• ISSN: 0021-972X
• ISSN (Online): 1945-7197
• Published Online: 09 February 2024