基于Tobit模型的安徽省蒙城县农村老年高血压患者生命质量影响因素分析

Analysis on the life quality and influencing factors of rural elderly hypertensive patients in Mengcheng county of Anhui Province based on the Tobit model

目的了解农村地区老年高血压患者的生命质量及影响因素,为提高农村老年高血压患者生命质量提供干预思路。方法于2021年7—9月采用整群随机抽样方法,在安徽省蒙城县抽取60岁以上老年人1223人,将其中自报由相关医疗机构诊断为高血压的675例患者数据纳入分析。问卷调查一般情况、健康行为、患病情况、用药依从性、睡眠质量等,进行体格检查。并采用欧洲五维健康量表(EQ-5D-3L)评价健康相关生命质量,采用中国健康效用值积分体系计算健康效用值。用SPSS 26.0和Stata 17.0进行Wilcoxon秩和检验、Kruskal-Wallis H检验和Tobit回归分析。结果老年高血压患者健康效用值中位数为0.795(P25~P75:0.696~0.875)。62.5%的老年高血压患者存在疼痛或不舒服,44.0%存在焦虑或抑郁。Tobit回归分析结果显示,女性(β=-0.058),工作状态为半劳作(β=-0.067)、家务劳动(β=-0.072)、安居晚年(β=-0.135),患1种(β=-0.055)、2种及以上的其他慢性病(β=-0.091),有睡眠障碍(β=-0.099)的农村高血压患者健康效用值较低;教育程度为初中及以上(β=0.064),劳动强度为较轻(β=0.116)、一般(β=0.123)、较重(β=0.087),有饮茶习惯(β=0.055),服药依从性好(β=0.043)的农村高血压患者健康效用值更高,均有统计学意义(P<0.05,P<0.01)。结论农村老年高血压患者生命质量较差,应将女性,工作状态为半劳作、家务劳动、安居晚年,患有其他慢性病,有睡眠障碍,教育程度低,无饮茶习惯以及服药依从性差的农村老年高血压患者作为重点人群,重点关注并改善其生命质量。

Objective To understand the life quality and influencing factors of rural elderly hypertension patients,and provide the intervention ideas for improving the life quality of rural elderly hypertension patients.Methods Cluster random sampling was used to select 1223 elderly residents(≥60 years old)in Mengcheng county of Anhui Province from July to September 2021 as the subjects,and data of 675 hypertension patients self-reported and diagnosed by relevant medical institutions were included in the analysis.The investigation was performed with the questionnaires(including the general information,health behaviors,disease conditions,medication adherence,sleep quality)and physical examination.The European Quality of Life-5 Dimensions-3 Levels(EQ-5D-3L)was used to assess health-related life quality,and health utility values were calculated using the Chinese health utility value scoring system.Wilcoxon rank-sum test,Kruskal-Wallis H test,and Tobit regression analysis were used to analyze the data.The used software were SPSS 26.0 and Stata 17.0.Results The median of health utility values of elderly hypertension patients was 0.795(P25-P75:0.696-0.875);62.5%of elderly hypertension patients experienced pain or discomfort,and 44.0%of elderly hypertension patients experienced anxiety or depression.The results of the Tobit regression analysis showed that the rural hypertension patients with lower health utility values were females(β=-0.058),engaged in semi-manual labor(β=-0.067),engaged in housework(β=-0.072),living in the countryside in old age(β=-0.135),suffering from 1(β=-0.055)or 2 or more other chronic diseases(β=-0.091),and experiencing sleep disturbances(β=-0.099);the rural hypertension patients with higher health utility values were the education level of junior high school or above(β=0.064),engaged in light(β=0.116),moderate(β=0.123),or heavy(β=0.087)labor,habit of drinking tea(β=0.055),and better medication adherence(β=0.043),P<0.05 or P<0.01.Conclusion The life quality of rural elderly hypertension patients is relatively poor.It should pay attention to key groups:females,those engaged in semi-manual labor,housework,living in the countryside in old age,suffering from other chronic diseases,experiencing sleep disturbances,patients with low education level,without tea-drinking habit,and with poor medication adherence.The improving life quality is the important point.