中国城乡慢性病患者健康相关生命质量及其影响因素分析

Health-related quality of life and its influencing factors among urban and rural chronic disease patients in China

目的了解中国城乡慢性非传染性疾病(慢性病)患者的健康相关生命质量及其影响因素,为改善慢性病患者健康状况以及促进慢性病患者的健康管理提出针对性建议。方法于2018年7—8月采用多阶段分层随机抽样方法在广东省深圳市福田区、湖北省宜昌市西陵区和当阳市、贵州省铜仁市思南县抽取13362名≥15岁居民进行问卷调查,分析其中4052例慢性病患者健康相关生命质量及其影响因素。结果中国4052例慢性病患者中,城市1474例(36.38%),农村2578例(63.62%)。城市和农村慢性病患者存在行动能力、自我照顾能力、日常活动能力、疼痛或不适、焦虑或抑郁问题比例分别为12.89%和27.85%、8.07%和19.16%、12.21%和29.09%、24.90%和55.97%、4.95%和28.67%;中国城乡慢性病患者总体健康效用值为(0.939±0.105),其中城市慢性病患者的健康效用值为(0.966±0.090),高于农村慢性病患者健康效用值的(0.924±0.110),差异有统计学意义(t=13.629,P<0.001)。多水平线性回归分析结果显示,吸烟和定期体检的中国城市慢性病患者健康相关生命质量较高,女性、患多重慢性病和困难户的中国城市慢性病患者健康相关生命质量较低;已婚、在业、家庭最高文化程度为高中/职高/中专/技校及以上和家庭人均年收入≥8000元的中国农村慢性病患者健康相关生命质量较高,年龄≥25岁、签约家庭医生、患多重慢性病和困难户的中国农村慢性病患者健康相关生命质量较低。结论中国城市慢性病患者健康相关生命质量高于农村慢性病患者,是否患多重慢性病和是否困难户是城乡慢性病患者健康相关生命质量的共同影响因素。

Objective To examine the status and influencing factors of health-related quality of life(HrQoL)among patients with noncommunicable chronic diseases(NCDs)in urban and rural China for improving the health status of the patients and developing targeted measures on the patients′health management.Methods With a general questionnaire and the Three-Level EuroQol Five Dimensional Questionnaire(EQ-5D-3L),face-to-face interviews were conducted among13362 residents aged 15 years and older selected using stratified multistage random sampling in a district/prefecture/county of one of 5 provinces in eastern,central and western China during July-August,2018.From the 12470 participants with valid information,4052 NCDs patients(1474[36.38%]and 2578[63.62%]from urban and rural regions)were included in the study to analyze HrQoL and its associates among the patients.Results Among the urban and rural patients,the proportions of reporting difficulties in mobility,self-care,and daily activities were 12.89%and 27.85%,8.07%and 19.16%,and 12.21%and 29.09%;while,the proportions of reporting symptoms of pain/discomfort,anxiety/depression were 24.90%and 55.97%,4.95%and 28.67%,respectively.The health utility value was 0.939±0.105 for all the patients and the health utility value of the urban patients was significantly higher than that of the rural patients(0.966±0.090 vs.0.924±0.110;t=13.629,P<0.001).The results of multivariate linear regression analysis showed that for urban patients,those being smokers and having regular physical examination are more likely to have a higher HrQoL,but those being fremale,suffering from multiple chronic diseases,and in families with poor economic condition are more likely to have a lower HrQoL;for rural patients,those being married,being employed,with education of high school/vocational high school/technical secondary school and above,and having an annual household income of 8000 yuan RMB per capita are more likely to have a higher HrQoL,whereas,those aged 25 years and older,with medical service provided by contracted family doctors,suffering from multiple chronic diseases,and in families with poor economic condition are more likely to have a lower HrQoL.Conclusion Among NCDs patients in China,the HrQoL of urban patients is higher than that of rural patients and suffering from multiple chronic diseases and with poor household economic condition are risk factors of lower HrQoL for both urban and rural patients.