心血管病高危与非高危人群的生存质量比较:倾向评分匹配分析

Differences in quality of life between populations with and without high risk for cardiovascular diseases: a propensity score matching analysis

目的探究心血管病高危与非高危人群生存质量差异。方法采用2015-2017年国家心血管病高危人群早期筛查与综合干预项目江苏省项目点调查数据,对调查对象进行问卷调查和体格检查,运用倾向评分匹配分析(PSM)方法,按照1∶1匹配心血管病高危组与非高危组间性别和年龄,采用多重线性回归模型分析心血管病高危对生存质量[欧洲五维度健康量表(EQ-5D)]得分及其中的直观相似尺度(EQ-VAS)评分的影响。结果调查对象40 243(高危组20 839,非高危组19 404)人,倾向评分匹配后得到调查对象31 605(高危组15 948,非高危组15 657)人,EQ-5D指数得分0.97±0.07,EQ-VAS评分79.83±9.36,高危组行动能力、自理能力、日常生活能力和疼痛/不适报告有困难率高于非高危组(1.9%比1.0%、0.6%比0.3%、1.5%比0.8%、16.8%比15.7%,均P<0.05);高危组与非高危组焦虑/不适报告有困难率差异无统计学意义(4.5%比4.4%,P=0.785);女性、高龄、不在婚、初中及以下学历、不吸烟、不饮酒、肥胖、患有高血压、患有血脂异常的调查对象EQ-5D指数得分和EQ-VAS评分低于不在此状态或不患有此疾病人群(P<0.05),家庭年收入≤5万元、患有糖尿病的调查对象EQ-VAS评分低于不在此状态或不患有此疾病人群(P<0.001);多因素线性回归分析显示,调整基本情况和主要慢性病情况后,高危组EQ-VAS评分降低(β=-0.054, 95 CI-1.264^-0.766,P<0.001)。结论高危组人群的EQ-VAS评分低,应关注心血管病高危人群的生存质量。

Objective To explore the differences in quality of life between subjects with and without high-risk for cardiovascular diseases(CVD). Methods Using the survey data of China patient-centered evaluative assessment of cardiac events(PEACE) Million Persons Project in Jiangsu Province from 2015 to 2017, age and gender were matched by 1∶1 propensity score matching(PSM) between the two groups. The inpact of CVD high risk on the quality of life score [EuroQol five dimensions questionnaire(EQ-5 D) and EuroQol visual analogue scale(EQ-VAS)] was analyzed by multiple linear regression. Results A total of 35 104 subjects(15 948 in high-risk group, 15 657 in non-high-risk group) after PSM from original sample size of 40 243(20 839 in high-risk group, 19 404 in non-high-risk group) were included. Scores of mobility, self-care, routine activities, pain/discomfort, EQ-5 D index score and EQ-VAS score were lower in high-risk group than those in the non-high-risk group(1.9% vs 1.0%, 0.6% vs 0.3%, 1.5% vs 0.8%, 16.8% vs 15.7%, P<0.05). There was no statistical difference in anxiety/depression between the two groups(4.5% vs 4.4%, P=0.785). The EQ-5 D index score and EQ-VAS score of female, elderly, unmarried, junior high school or lower educated, non-smoking, non-drinking, obesity, high blood pressure and dyslipidemia were lower than those of who were not in this state or did not have these diseases(P<0.05). The EQ-VAS score of the respondents with annual family income ≤50 000 yuan and diabetes mellitus were lower than that of the population without such condition or this disease(P<0.001). After adjusting the basic situation and major chronic diseases, multivariate linear regression showed that EQ-VAS score were lower [standardized β values(95% CI):-0.054(-1.264 to-0.766)]. Conclusion High CVD risk population has lower EQ-VAS score. Attention should be paid to the quality of life in high risk population of CVD.