in recent years , cancer , stroke , and cardiovascular disease ( cvd ) are emerging as potent 
 threats to the world s health care systems . in 2014 ,
the top three causes of death in south 
 korea were cancer , stroke , and cvd , and they accounted for approximately 47% of all deaths 
 that year1 .
many people with these 
 diseases have physical and psychological problems , and these problems are placing a growing 
 economic burden on health care . in particular , cancer and cvd are frequently associated with 
 various complications including depression , hypertension , and diabetes2 , 3 .
stroke commonly 
 influences various aspects of attitudes , perceptions , and performance in the long - term4 , 5 . in 
 addition
, stroke patients report poorer health - related quality of life ( hrqol ) than the 
 general population6 .
individuals hrqol offers a multidimensional perspective of their physical , psychological , 
 and social function7 . for that reason , 

hrqol has gained ground as a primary measure of the impact of disease8 , 9 .
in addition , it 
 can often be used more easily than clinical parameters as a health - related index helping 
 healthcare workers to understand patients needs and provide them with quality health 
 services10 , 11 .
hrqol in populations with cancer , stroke , cvd , and other chronic 
 diseases has been studied extensively using different methods in recent years12,13,14,15 . 
 however , previous studies had limitations with respect to identifying features according to 
 disease and generalizing results , because the study subjects were typically compared with 
 healthy subject groups and the studies were not designed as randomized controlled 
 trials16,17,18 .
healthcare teams need to 
 provide intensive and focused programs for people with any of the above - mentioned diseases . 
 thus , the primary aim of this study was to investigate the health conditions of 
 community - dwelling populations with cancer , stroke , and cvd based on standardized data .
this study used data collected during health interviews carried out as part of the sixth 
 korean national health and nutrition examination survey ( knhanes vi 2013 ) .
knhanes vi was 
 conducted among the non - institutionalized korean population by the korea centers for disease 
 control and prevention ( kcdcp ) . in addition , knhanes vi implemented a complex , stratified , 
 probability - based study design using multi - stage and cluster sampling to select household 
 units based on region , gender , and age .
knhanes vi was approved by the institutional review 
 board of the kcdcp ( irb no .
the study subjects numbered 422 in total , all of whom had diseases diagnosed by a doctor . 
 among the subjects , 179 had cancer , 128 were stroke patients , and 115 had cvd according to 
 knhanes vi .
comorbidity of diseases was excluded because the aim of this study was to 
 identify the specific features of each disease .
the face - to - face health interviews were 
 conducted by trained surveyors who visited households during 2013 .
the contents of the 
 interviews included data on demographic factors , physical condition , psychological 
 condition , and hrqol .
the general characteristics of the subjects are presented in table 1table 1.characteristics of subjectsparameterscancerstrokecvdtotal subjects179 ( 100)128 ( 100)115 ( 100)gender male65 ( 39.1)74 ( 59.8)57 ( 57.1)female114 ( 60.9)54 ( 40.2)58 ( 42.9)age 3912 ( 7.6)4 ( 5.7)1 ( 3.2)404927 ( 18.9)6 ( 8.3)5 ( 9.1)505936 ( 23.5)23 ( 26.1)17 ( 18.2)606938 ( 17.0)40 ( 23.1)44 ( 33.2)7066 ( 33.1)55 ( 36.9)48 ( 36.3)*sample size ( estimated percent of the population ) .
their physical and psychological conditions were assessed based on the 
 following : a normal week s hard physical activities ( e.g. , participation in exercise such as 
 running , climbing , riding a bicycle quickly , fast swimming , and carrying heavy objects for 
 more than 10 minutes ) ; a normal week s moderate physical activities ( e.g. , participation in 
 exercise such as slow swimming , playing table tennis , tennis doubles , badminton , and 
 carrying light objects for more than 10 minutes ) ; a normal week s walking ( e.g. , 
 participation in walking for work or school , mobility , and exercise for more than 10 
 minutes ) ; sleep duration for a normal day ; and degree of stress ( 4-point likert scale : 1 
 indicates feeling very much , 2 indicates feeling much , 3 indicates feeling a little , and 4 
 indicates feeling rarely ) .
the hrqol scale used was the korean version euroqol , eq-5d-3l ( 3 
 level version of the euroqol 5 dimensional questionnaire)19 , 20 .
eq-5d-3l defines hrqol 
 in terms of five dimensions : mobility , self - care , usual activities , pain / discomfort , and 
 anxiety / depression .
each dimension is rated on a scale from 1 to 3 , where 1 indicates no 
 problems , 2 indicates some problems , and 3 indicates severe problems .
cvd : cardiovascular disease spss 21.0 ( ibm corporation , armonk , ny , usa ) was used for statistical analysis purposes . 

statistical analysis took into account the clustering and stratification of the sample 
 survey data as usually done in complex survey design .
linear regression analysis was also performed to 
 identify differences in health conditions and hrqol for each disease according to 
 population .
individuals physical conditions did not differ significantly across the populations of 
 cancer , stroke , and cvd patients .
stress perceptions relating to psychological condition 
 differed significantly across the populations of cancer , stroke , and cvd patients ( p = 
 0.022 ) .
the scores of the stroke population ( mean score = 3.18 ) were higher than those of 
 the other diseases ( mean score of cancer = 2.88 , mean score of cvd = 2.87 ) . however , no 
 significant difference was found between populations regarding the relationship between 
 sleeping and the three diseases ( table 
 2table 2.mean scores of health condition of the three diseasesparameterscancer ( ref.)strokecvdphysical conditionhard physical activities64.43 ( 13.46)62.38 ( 13.67)83.31 ( 27.58)moderated physical activities748.32 ( 8.58)51.23 ( 17.11)66.96 ( 16.66)walking347.33 ( 49.80)263.66 ( 33.47)269.13 ( 35.43)psychological conditionsleeping6.92 ( 0.193)8.13 ( 1.08)6.60 ( 0.21)stress*2.88 ( 0.73)3.18 ( 0.09)2.87 ( 0.09)values are mean ( standard error ) . *
significantly different among the disease groups hrqol items of mobility , self - care , usual activities , and anxiety / depression differed 
 significantly across the populations of cancer , stroke , and cvd patients .
the mean scores of 
 the stroke population were significantly higher than those of the other diseases in all 
 dimensions except for anxiety / depression ( table 
 3table 3.mean scores of hrqol of the three diseaseseq-5d-3lcancer ( ref.)strokecvdmobility*1.18 ( 0.03)1.56 ( 0.09)1.41 ( 0.06)self - care*1.07 ( 0.02)1.41 ( 0.09)1.17 ( 0.04)usual activities*1.17 ( 0.03)1.55 ( 0.09)1.33 ( 0.09)pain / discomfort*0.36 ( 0.05)1.77 ( 0.11)1.44 ( 0.06)anxiety / depression1.17 ( 0.03)1.39 ( 0.11)1.20 ( 0.04)values are mean ( standard error ) .
the results of this study show that health condition and hrqol were significantly different 
 across the populations with cancer , stroke , and cvd .
populations with cancer and cvd were 
 found to experience greater stress than the stroke population . in this study , as with 
 previous studies , cancer was found to have a relationship with stress21 .
the current study highlights a need for customized stress 
 management programs aimed at the cancer population . for cancer patients in south korea , 
 naturopathic treatments such as music , dance , laughter ,
yoga , aromatherapy , and enzyme 
 therapies have been introduced to decrease stress22 . the population with stroke showed lower ( table 
 2 ) scores than the other disease populations in dimensions of physical activity 
 related to hrqol .
one year after stroke 
 onset , physical functions are almost recovered , however quality of life is about 40% lower 
 than before stroke onset24 .
in addition , 
 hrqol scores were lower for stroke patients than for cancer patients25 .
the results of this study highlight the need for programs 
 to improve the physical activities of stroke patients . according to hansson et al .
, 
 functional independence is an important factor that influences hrqol of stroke patients26 . in the anxiety / depression dimension of 
 the results ,
the mean values for stroke were higher than those of the other diseases ; 
 however , the differences were not significant . in previous studies ,
depression prevalence 
 was found to be high in stroke patients and strongly linked with post - stroke disabilities in 
 areas such as social participation27 , 28 .
however , some studies have reported that 
 although chronic diseases usually exert a negative impact on physical health in terms of 
 hrqol , mental health may be relatively unaffected in terms of hrqol , as shown by the results 
 of the present study29,30,31 .
first , it was intended to compare the diseases that are 
 known to be the top three causes of death in south korea .
it is difficult to find features 
 of diseases other than those three that require the planning of customized health management 
 programs .
second , this study used secondary data from the knhanes vi , and all factors 
 related to the diseases could not be managed . however , because all data were collected from 
 a systematically randomized sample by trained surveyors and medical doctors , the potential 
 for generalization is strong . in conclusion ,
the cancer population had high perceptions of 
 stress , while the stroke population showed strong associations with the physical dimensions 
 of hrqol .
on the basis of these findings , healthcare teams will now be in a position to plan 
 programs for improvement in these areas according to the features of each disease .
 [ purpose ] the purpose of this study was to investigate health conditions and hrqol 
 ( health - related quality of life ) of community - dwelling populations with cancer , stroke , 
 and cvd ( cardiovascular disease ) based on standardized data . 
 [ subjects ] the study subjects 
 numbered 422 in total : 179 patients had cancer , 128 were stroke patients , and 115 were cvd 
 patients . 
 [ methods ] this study used data collected during health interviews carried out as 
 part of the sixth korean national health and nutrition examination survey . 
 face - to - face 
 health interviews were conducted by trained surveyors who visited households during 2013 . 
 
 the contents of the interviews included data on demographic factors , physical condition , 
 psychological condition , and hrqol . 
 [ results ] stress perceptions related to health 
 condition differed significantly across the populations of cancer , stroke , and cvd 
 patients . 
 the hrqol items of mobility , self - care , usual activities , and anxiety / depression 
 also differed significantly across these populations . 
 [ conclusion ] healthcare teams will 
 now be in a position to plan programs for improvement in these areas according to the 
 features of each disease . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION