慢性病对老年人质量调整生命年与经济损失的影响研究

Effects of Chronic Diseases on Quality Adjusted Life Year and Economic Losses of the Elderly

背景慢性病已经成为影响国家经济社会发展和居民身体健康状况的重大公共卫生问题,量化老年人的疾病与经济负担,能够更好地了解慢性病对个人及社会所造成的影响。目的了解山西省老年人常见慢性病患病状况及其造成的质量调整生命年(QALY)损失与经济损失。方法2019年6—8月,采用多阶段随机抽样方法选取山西省11个城市3250例≥60岁老年人作为研究对象。对纳入老年人进行问卷调查,问卷内容包括一般人口学特征、疾病状况及健康相关生命质量状况。采用欧洲五维健康量表(EQ-5D-5L)评估老年人健康相关生命质量。基于中国EQ-5D-5L效用值积分体系来计算慢性病所造成的QALY损失,利用统计公报中人口与人均地区生产总值数据估算山西省2019年因常见慢性病造成的QALY损失与经济损失。结果单因素分析结果显示,不同年龄、生活区域、文化程度、婚姻状况、家庭人均月收入老年人EQ-5D-5L效用值比较,差异有统计学意义(P<0.05)。多元线性回归分析结果显示,年龄、婚姻状况、家庭人均月收入是EQ-5D-5L健康效用值的影响因素(P<0.05)。3250例老年人中,1901例(58.49%)患慢性病。患病率排名前5的慢性病依次为:高血压〔29.45%(957/3250)〕、糖尿病〔10.83%(352/3250)〕、风湿或类风湿关节炎〔10.28%(334/3250)〕、听力障碍〔8.09%(263/3250)〕、胃炎或消化性溃疡〔6.49%(211/3250)〕。以山西省总人口估算,2019年山西省5种常见慢性病造成的QALY损失为2078685年,经济损失为95045792940元。造成山西省QALY损失与经济损失最多的慢性病在大同、太原、吕梁市为风湿或类风湿关节炎;在晋城、阳泉市为听力障碍;在晋中、临汾、运城、朔州、忻州、长治市为高血压。结论山西省老年人慢性病患病率较高,慢性病不仅会造成老年人QALY损失,也会产生巨大的经济负担。不同地区存在的常见慢性病有所差异,各地要根据实际情况确定疾病防治的优先次序,明确健康管理的重点目标与人群,从而取得事半功倍的效果。

Background Chronic diseases have become an important public health problem that affects the economic and social development of country and population health.Quantifying the disease and economic burden of the elderly can provide a better understanding of the impact of chronic diseases on individuals and society.Objective To understand the prevalence of common chronic diseases among the elderly in Shanxi Province and explore the quality-adjusted life year(QALY)loss and economic loss which caused by chronic diseases.Methods From June to August in 2019,a multi-stage random sampling method was used to select 3250 elderly people aged≥60 years from 11 cities in Shanxi Province as the research subjects for a questionnaire survey.The questionnaire included general demographic information,disease status survey,and health-related quality of life status.The European Five-Dimensional Health Scale(EQ-5D-5L)was used to assess the health-related life quality of the elderly.The QALY loss caused by chronic diseases was calculated based on the Chinese EQ-5D-5L utility value score system,and the QALY loss and economic loss caused by common chronic diseases in Shanxi Province in 2019 were estimated by using population and GDP per capita from statistical bulletin.Results The results of univariate analysis showed that there were significant differences in the utility value of EQ-5D-5L among the elderly with different ages,living regions,educational levels,marital status,and family per capita monthly income(P<0.05).The results of multiple linear regression analysis showed that higher per capita monthly income of families,being married and younger age were the protective factors for the health utility value of EQ-5D-5L(P<0.05).The prevalence of chronic diseases among the elderly in Shanxi Province was 58.49%(1901/3250).The top 5 chronic diseases by prevalence were:hypertension 29.45%(957/3250),diabetes 10.83%(352/3250),rheumatism or rheumatoid arthritis 10.28%(334/3250),hearing impairment 8.09%(263/3250),gastritis or peptic ulcer 6.49%(211/3250).Based on the estimation of the total population of Shanxi Province,the loss of QALY caused by five common chronic diseases in Shanxi Province in 2019 was 2078685 years,and the economic loss was 95045792940 yuan.The chronic disease causing the most QALY loss and economic loss in Shanxi Province was rheumatism or rheumatoid arthritis in Datong,Taiyuan and Luliang;in Jincheng,Yangquan city was hearing impairment;In Jinzhong,Linfen,Yuncheng,Shuozhou,Xinzhou,Changzhi City was hypertension.Conclusion The prevalence of chronic diseases among the elderly in Shanxi Province was relatively high,and chronic diseases will not only cause the loss of QALY of the elderly,but also cause a huge economic burden.Common chronic diseases vary by region in Shanxi Province,each region should determine the priority of disease prevention and treatment according to the actual situation,identify the key objectives and population of health management,so as to achieve a multiplier effect.