健康生态学视角下社区老年2型糖尿病患者生命质量分析

Analysis of quality of life of elderly patients with type 2 diabetes mellitus in community based on health ecology aspect

[目的]基于健康生态学视角,分析社区老年2型糖尿病患者生命质量现况及影响因素。[方法]采用多阶段抽样法,对潍坊市社区2782名60岁及以上老年2型糖尿病患者进行问卷调查,以SF-12量表中生理健康总评分(PCS)及心理健康总评分(MCS)测量值是否正常为因变量,以个人特质、个人行为特点、人际网络、工作和生活环境、政策环境5个层面的指标为自变量,行χ2检验和分层logistic回归分析。[结果]正常PCS者1218人(43.78%),正常MCS者1484人(53.34%)。多因素分析表明:≥70岁、戒烟、主观睡眠状况一般及差、独居、地区经济水平中等是PCS的危险因素(OR>1.280,P<0.05);中学及以上文化、单一口服用药、运动锻炼、与配偶和子女同住、与其他人员同住、有城镇职工基本医疗保险、有城乡居民基本医疗保险是PCS的保护因素(OR<0.800,P<0.05)。≥70岁、主观睡眠状况差、丧偶、户籍所在地为农村、地区经济水平低等是MCS的危险因素(OR>1.256,P<0.05);家庭年收入为20000~49999元、家庭年收入≥100000元、地区经济水平中等是MCS的保护因素(OR<0.811,P<0.05)。[结论]社区老年2型糖尿病患者生命质量较差,其影响因素是多层次的,应从个体到环境因素加强对患者的干预,提高患者生命质量。

Objective To analyze status and influencing factors of quality of life of elderly patients with type 2 diabetes mellitus in community based on health ecology aspect.Methods A questionnaire survey was conducted among 2,782 elderly patients with type 2 diabetes mellitus aged 60 by using the multistage sampling method in Weifang community.Whether the measured values of Physical Component Summary(PCS)and Mental Component Summary(MCS)in SF-12 scale were normal or not was the dependent variable.Five levels of indicators including personal traits,characteristics of personal behavior,interpersonal network,working and living environment and policy environment were used as independent variables.Chi-square test and hierarchical logistic regression analysis were performed.Results There were 1,218(43.78%)with normal PCS and 1,484(53.34%)with normal MCS.Multivariate analysis showed that more than 70 years old,quitting smoking,common or poor subjective sleep quality,living alone,and medium level of regional economy were risk factors for PCS(OR>1.280,P<0.05).The education of middle school and above,single oral medication,exercise,living with spouses and children,living with other people,basic medical insurance for urban employees and basic medical insurance for urban and rural residents were protective factors for PCS(OR<0.800,P<0.05).More than 70 years old,poor subjective sleep quality,widowhood,rural domicile,and low level of regional economy were risk factors for MCS(OR>1.256,P<0.05).Annual household income of 20,000-49,999 yuan,annual household income≥100,000 yuan and medium level of regional economy were protective factors for MCS(OR<0.811,P<0.05).Conclusions The quality of life of elderly patients with type 2 diabetes mellitus in community is poor,and its influencing factors are multi-layered.The intervention for elderly patients with type 2 diabetes mellitus should be strengthened from individual to environmental factors to improve their quality of life.