农村老年糖尿病前期患者生活质量调查及影响因素分析

Quality of Life and Its Influencing Factors Among Elderly People With Pre-diabetes in Rural Areas

背景老年人生活质量备受社会各界关注,而糖尿病会影响其生活质量。目的分析农村老年糖尿病前期患者的生活质量及其影响因素。方法 2015年4—7月采用多阶段整群随机抽样法抽取湖南省益阳市42个行政村,2144例≥60岁的老年人参与口服葡萄糖耐量试验,共筛查出461例糖尿病前期患者,444例自愿参加问卷调查,回收有效问卷434份,有效回收率为97.75%,采用自行设计的基本情况问卷收集一般资料,采用国际体力活动问卷调查农村老年糖尿病前期患者体力活动情况,采用中国人群食物频数问卷调查患者膳食情况,采用城乡居民糖尿病健康素养调查问卷（公众版）调查患者糖尿病知识知晓情况,采用健康调查简表（SF-36）调查患者生活质量。采用单因素方差分析、Kruskal-Wallis H秩和检验和Ordinal等级回归分析农村老年糖尿病前期患者生活质量的影响因素。结果农村老年糖尿病前期患者SF-36生理功能评分（70.6±30.2）分、生理职能评分（61.7±35.5）分、躯体疼痛评分（67.5±21.6）分、总体健康评分（54.0±24.6）分、活力评分（70.6±17.7）分、社会功能评分（76.8±18.6）分、情感职能评分（88.0±29.4）分、心理健康评分（73.8±17.2）分、生理健康（PCS）评分（263.8±70.9）分、心理健康（MCS）评分（309.3±62.4）分。71-80岁农村老年糖尿病前期患者生理职能、PCS评分较60-70岁降低（P〈0.05）;≥81岁农村老年糖尿病前期患者生理功能、生理职能、PCS评分较60-70岁降低（P〈0.05）。60-70岁农村老年糖尿病前期患者躯体疼痛、总体健康、活力、社会功能、心理健康评分较普通老年人群降低（P〈0.05）;71-80岁农村老年糖尿病前期患者生理功能评分较普通老年人群升高,生理职能、躯体疼痛、总体健康、活力、社会功能、心理健康评分较普通老年人群降低（P〈0.05）;≥81岁农村老年糖尿病前期患者生理职能、躯体疼痛、社会功能评分较普通老年人群降低（P〈0.05）。Ordinal等级回归分析结果显示,性别、年龄、体质指数（BMI）、糖尿病早期症状和老年常见慢性病病史与农村老年糖尿病前期患者PCS评分有回归关系（P〈0.05）;婚姻状况、家庭人均年收入、糖尿病家族史、糖尿病早期症状和糖尿病知识知晓情况与农村老年糖尿病前期患者MCS评分有回归关系（P〈0.05）。结论农村老年糖尿病前期患者生活质量中总体健康受损严重,与普通老年人群相比生活质量下降更明显,生活质量的影响因素为性别、年龄、BMI、婚姻状况、家庭人均年收入、糖尿病家族史、糖尿病早期症状、老年常见慢性病病史和糖尿病知识知晓情况,为提高农村老年糖尿病前期人群的生活质量,卫生工作者应加强其生活方式的干预。

Background Quality of life（QOL）of elderly has aroused strong concern from all social sectors,but QOL can be affected by diabetes mellitus. Objective To analyze QOL and its influencing factors among elderly people with pre -diabetes in rural areas. Methods By multi - stage cluster sampling method,42 villages in Yiyang in Hunan Province were selected in this study from April to July in 2015. A total of 2 144 people who aged 60 and above volunteered to participate an oral glucose tolerance test,and pre - diabetes was found in 461 patients people. There were 444 patients who volunteered to have questionnaire survey,and 434 effective questionnaires were returned with an effective rate of 97. 75% . The general data of the patients were collected using a self - designed questionnaire;the physical activity of these patients was investigated by international physical activity questionnaire;dietary condition was surveyed by Chinese food frequency questionnaire;awareness of knowledge of diabetes was investigated using health literacy questionnaire for urban and rural residents（ public version）;SF-36 health survey was conducted to know the QOL of these patients. The influencing factors for QOL of elderly people with pre -diabetes in rural areas were investigated using univariate analysis of variance,Kruskal - Wallis H rank sum test and Ordinal hierarchical regression analysis. Results In SF-36 survey,the physiological function score was（70. 6 ± 30. 2）;physiological role score was（61. 7 ± 35. 5）;body pain score was（67. 5 ± 21. 6）;the overall health score was（54. 0 ± 24. 6）;the vitality score was（70. 6 ± 17. 7）;the social function score was（76. 8 ± 18. 6）;the emotional role score was（88. 0 ± 29. 4）;the mental health score was（73. 8 ± 17. 2）;the physical - health component score（PCS）was（263. 8 ± 70. 9）and the mental -health component score（MCS）was（309. 3 ± 62. 4）. Patients aged 71 - 80 had lower physiological role score and PCS than patients aged 60 - 70（P 〈 0. 05）;patients aged 81 and above had lower scores of physiological function,physiological role and PCS than patients aged 60 - 70（P 〈 0. 05）. Compared with healthy elders in a rural area in China,pre - diabetes patients aged 60 - 70 had lower scores of body pain,general health,vitality,social function and mental health（P 〈 0. 05）;pre - diabetes patients aged 71 - 80 had higher physiological function score and lower scores of physiological role,body pain,general health, vitality,social function and mental health（P 〈 0. 05）;patients aged 81 and above were lower in the scores of physiological role,body pain and social function（ P 〈 0. 05）. Ordinal hierarchical multiple regression analysis showed that gender,age, BMI,early symptoms of diabetes and medical history of common chronic diseases in elderly patients had regression analysis with PCS（P 〈 0. 05）. Marital status,family annual per capital income,family history of diabetes,early symptom of diabetes and awareness of knowledge of diabetes had regression relation with MCS（P 〈 0. 05）. Conclusion The general health of elderly people with pre - diabetes in rural areas is seriously impaired,and their life quality is evidently lower than healthy elderly people. The influencing factors for their QOL include gender,age,BMI,marital status,family annual per capital income, family history of diabetes,early symptom of diabetes,medical history of common chronic diseases in elders and awareness of knowledge of diabetes. In order to improve the QOL of elderly people with pre - diabetes in rural areas,health workers should intensify the interventions on their life style.