基于Tobit模型的宫颈上皮内瘤变患者健康效用值影响因素研究

Factors related to health utility value in patients with cervical intraepithelial neoplasia based on the Tobit model

目的使用五水平欧洲五维度健康量表(the five-level EuroQol five-dimensional questionnaire,EQ-5D-5L)测量宫颈上皮内瘤变(cervical intraepithelialneoplasia,CIN)患者健康效用值,并建立Tobit模型探讨其影响因素。方法2018年11月—2019年8月及2020年10—12月,采用EQ-5D-5L量表对在新疆石河子某三甲医院妇科门诊就诊的CIN患者进行生命质量评估。基于EQ-5D健康效用评价体系,采用Wilcoxon秩和检验、Tobit回归模型分析患者健康效用值的影响因素。结果共纳入样本262例,EQ-5D-5L健康效用值中位数(四分位间距)为0.95(0.93,1.00)。EQ-5D-5L量表的五个维度中“焦虑或沮丧”(46.18%,121/262)和“疼痛或不舒服”(27.48%,72/262)存在问题比例较高。Tobit回归分析结果显示,年龄、职业、家庭常住人口数、家庭年收入及病程是CIN患者健康效用值的影响因素;其中年龄45~<55岁是CIN患者健康效用值的危险因素(β=-0.045,P=0.027);职业为无业或自由职业者(β=0.048,P=0.040)、家庭常住人口数较多(2例:β=0.054,P=0.041;≥3例:β=0.061,P=0.025)、家庭年收入较高(≥10万元:β=0.067,P=0.018)、病程较长(≥1个月:β=0.046,P=0.014)是CIN患者健康效用值的保护因素。结论焦虑或沮丧是CIN患者生命质量最突出的问题。应重点关注处于更年期阶段、独居、家庭收入较低、病程较短的CIN人群的心理健康,缓解其焦虑或沮丧程度,提高其生命质量。

Objective To assess the health utility value of patients with cervical intraepithelial neoplasia using the five-level EuroQol five-dimensional questionnaire(EQ-5D-5L),and to establish the Tobit model to explore the influencing factors.Methods From November 2018to August 2019and from October to December2020,the EQ-5D-5Lscale was used to assess the quality of life of patients with cervical intraepithelial neoplasia treated in a gynecological outpatient department of a tertiary hospital in Shihezi,Xinjiang.Based on the EQ-5Dhealth utility evaluation system,Wilcoxon rank-sum test and Tobit regression were used to analyze the influencing factors of patients’health utility value.Results A total of 262subjects were included,and the median health utility value of EQ-5D-5Lwas 0.95(P_(25)~P_(75):0.93~1.00).Among the five dimensions of EQ-5D-5Lscale,"anxiety or depression"accounted the highest of 46.18%(121/262),followed by"pain or discomfort"(27.48%,72/262).Tobit regression results showed that age,occupation,number of household,annual household income and disease course were major influencing factors of health utility value in patients with cervical intraepithelial neoplasia.Age of 45-<55was a risk factor for health utility value(β=-0.045,P=0.027),while occupation of unemployed or freelancer(β=0.048,P=0.040),number of household of 2(β=0.054,P=0.041)or 3and more(β=0.061,P=0.025),high annual household income(≥100000yuan:β=0.067,P=0.018),longer disease course(≥1 month:β=0.046,P=0.014)were protective factors for health utility value in patients with cervical intraepithelial neoplasia.Conclusions Anxiety or depression is the most prominent problem in the quality of life of patients with cervical intraepithelial neoplasia.More attention should be paid on the mental health of patients in menopausal stage,living alone,with low annual household income,and short disease course to relieve their anxiety or depression and improve their quality of life.