广东省慢性病患者生存质量及健康调整期望寿命分析

Health-related quality of life and health-adjusted life expectancy among patients with chronic non-communicable diseases, in Guangdong province

目的分析广东省慢性病患者生存质量及健康调整期望寿命。方法基于广东省第五次全国卫生服务调查数据,通过欧洲五维度三水平健康量表对人群生存质量进行评价。运用多重线性回归和等级logistic回归评价慢性病对人群生存质量的影响,并用期望寿命和健康调整期望寿命指标评价慢性病对人群健康的综合影响。结果共纳入68 550名居民数据进行分析,等级logistic回归显示在校正了社会人口学特征后,慢性病对生存质量各个维度的影响均有统计学意义,其中对疼痛/不舒服维度的影响最大[OR=4.48(95%CI:4.20~4.77)],其余依次为焦虑/抑郁[OR=3.95(95%CI:3.62~4.31)]、日常活动[OR=3.69(95%CI:3.37~4.04)]、行动[OR=3.63(95%CI:3.34~3.94)]和自我照顾[OR=3.30(95%CI:2.98~3.66)]。慢性病患者期望寿命比非慢性病人群平均少12.7年,健康调整寿命平均减少14.6年(男性减少17.8年,女性减少9.7年)。人群去慢性病健康调整期望寿命收益为3.8年(男性为5.1年,女性为2.0年)。结论慢性病会影响患者生存质量的各维度,从而减少患者的健康调整期望寿命,给人群和社会带来沉重的健康负担。从卫生政策和卫生资源优化配置的角度看,需为慢性病患者尤其是为老年患者提供更全面可及的医疗照护,照护需不仅关注生理健康也要注重心理健康。

Objective To estimate the health-related quality of life (HRQOL) and health-adjusted life expectancy (HALE) which were associated with chronic non-communicable diseases (NCDs) in people from Guangdong province of China. Methods Data on both NCDs prevalence and EuroQol-5 Dimensions-3 Levels measured HRQOL were gathered from the Fifth National Health Survey in Guangdong province, 2013. Logistic regression model and multiple linear regression model were employed to explore the impact of NCDs on HRQOL. Life expectancy (LE) and HALE were used to evaluate the comprehensive impact of chronic diseases on population health. Results A total of 68 550 inhabitants were included in the analysis. Graded logistic regression showed that the impact of chronic diseases on all dimensions of quality of life was statistically significant after adjusting for social demographic characteristics. The greatest health impact was on the pain/discomfort health dimension [OR=4.48 (95%CI:4.20-4.77)], followed by anxiety/depression[OR=3.95 (95%CI: 3.62- 4.31)], daily activities [OR=3.69 (95%CI: 3.37-4.04)], mobility [OR=3.63 (95%CI: 3.34-3.94)]and ability on self-care [OR=3.30 (95%CI: 2.98-3.66)]. Losses of LE and HALE caused by NCDs were 12.7 and 14.6 years respectively while the overall expected gain was 3.8 years in HALE, when NCDs were taken away. Conclusions Our data showed that NCDs had shortened the healthy life span of patients through reducing the HRQOL and also causing heavy disease burden on both patients with NCDs and the communities. Health-care related policies on NCDs need to be developed, for the elderly, in particular.