应用伤残调整生命年测量癫痫患者疾病负担的研究

Use of Disability Adjusted Life Years in Evaluation of Disease Burden of Patients with Epilepsy

目的采用伤残调整生命年(DALY)对癫痫患者的疾病负担进行研究,为癫痫防治提供基础数据。方法采用多阶段分层随机抽样的方法,2005年1月—2011年7月在河南省焦作市的孟州市、修武县,漯河市的郾城区、源汇区、舞阳县、临颍县、召陵区,南阳市的新野县和方城县9个项目示范点,以农村癫痫防治管理项目为依托,对874例癫痫患者(分为干预组、对照组)采用两套标准(A、B方案)测算DALY以评价患者的疾病负担。结果 A方案874例癫痫患者的人均DALY损失值为4.69人年,每千人口DALY损失值为1.75人年;干预组的人均DALY损失值为4.67人年,低于对照组的人均DALY损失值4.71人年,两组DALY值比较差异无统计学意义(Z=1.067,P=0.2859),BOX图形亦显示两组DALY值变异程度较小。B方案874例癫痫患者的人均DALY损失值为16.64人年,每千人口DALY损失值为3.41人年;干预组的人均DALY损失为8.56人年,低于对照组的人均DALY损失24.19人年,两组DALY损失差异有统计学意义(Z=23.146,P<0.001),BOX图形亦显示两组DALY值变异程度较大。年龄、病程、发作频率、依从性和焦虑状况是疾病负担主要的影响因素。结论采用WHO"6级残疾权重"+河南省居民期望寿命的个体水平信息计算DALY能更好地反映实际值,综合干预可以更好地降低癫痫患者的疾病负担。

Objective To evaluate the disease burden of patients with epilepsy using disability adjusted life years （DALYs） . Methods We used a multi - stage random sampling method to select patients of epilepsy from nine counties/districts of Henan Province. The subjects were divided into a study group and a control group based on their inclusion into a government funded comprehensive management program which encompassed standardized treatment, follow - ups, health education, and psychological intervention. The DALY of the patients was evaluated using two schemes. Scheme A was based on Model Life - Ta- ble West Level 26 for standard life expectancy and Global Burden of Disease 2004 Update for disability weight. Scheme B was based on Chiang C. L. ＇ method and WHO six levels of disability weights. Results Results of Scheme A showed an average DALY of 4. 69 years per capita, and 1.75 years per thousand persons. The average DALY of the study group was 4. 67 years and that of the control group was 4. 71 years. No significant difference was observed in average DALY between the study and control groups （ Z = 1. 067, P = 0. 2859）. Box plot also showed little difference of DALY between the two groups. Results of Scheme B showed an average DALY of 16. 64 years per capita, and 3.41 years per thousand persons. The average DALY of the study group was 8.56 years, significantly lower than that of the control group＇ s 24. 19 years （ Z = 23. 146, P 〈 0. 001 ）. Box plot also showed big difference of DALY between the two groups. Age, disease duration, seizure frequency, compliance and anxiety sta- tus were the main influencing factors of disease burden. Conclusion Scheme B which is based on Chiang C. L. ＇s method for life expectancy and WHO six levels of disability weights can better reflect the real situation. Comprehensive interventions are effective in reducing the burden of disease in patients with epilepsy.