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中国老年多重慢性病患者健康相关生命质量及其影响因素研究

泰然健康网
2024-12-02 14:04

摘要： 背景随着人口老龄化，我国慢性病患病率逐年升高，多重慢性病的情况也越来越普遍。我国目前有关生命质量的研究多集中在特定疾病，如糖尿病、高血压、心血管疾病等，而有关多重慢性病的生命质量研究相对较少。目的了解我国老年多重慢性病患者的健康相关生命质量及其影响因素，为提高老年多重慢性病患者的健康水平提供依据。方法使用中国健康与养老追踪调查（CHARLS）2018年数据，选取年龄≥55周岁且关键变量值完整的3 361例多重慢性病患者作为研究对象。采用欧洲五维度三水平健康评定（EQ-5D-3L）量表评估健康相关生命质量；采用年龄调整合并症指数计算十年生存率；使用Mann-Whitney或Kruskal-Wallis检验、Tobit回归模型分析健康相关生命质量的影响因素。结果老年多重慢性病患者的健康效用值为0.888（0.709，0.964）分，"困难"比例最高的维度为疼痛/不适[2 430例（72.30%）]，"严重困难"比例最高的维度为行动能力[593例（17.64%）]。十年生存率测算结果显示，十年生存率最高为90.15%，仅有2.44%（82/3 361）的患者达到；大部分患者[848例（25.23%）]的十年生存率为21.36%，有43.59%（1 465/3 361）的患者十年生存率接近于0。Tobit回归模型分析结果显示，小学及以上学历、不吸烟是健康相关生命质量的保护因素；女性、>60岁、丧偶、自评健康状况为不好、不饮酒、夜间睡眠时长不足或过长、未进行中等强度活动、患病数量≥4种、门诊次数≥3次是健康相关生命质量的危险因素（P<0.05）。结论我国老年多重慢性病患者的健康相关生命质量较差，应重点关注婚姻状况、受教育程度、夜间睡眠时长、体力活动、患病数量等因素。应加强对老年多重慢性病患者的健康生活方式指导，进一步提高该人群的生命质量。

关键词: 多重慢性病, 慢性病共病, 健康相关生命质量, EQ-5D-3L, Tobit模型

Abstract:

Background

With the population aging, the prevalence of chronic diseases in China is increasing annually, contributing to a growing incidence of multimorbidity. Research on quality of life focuses mostly on specific diseases, such as diabetes, hypertension, and cardiovascular diseases. However, there are relatively few studies on the quality of life of multimorbidity.

Objective

To understand the status and influencing factors of the health-related quality of life (HRQoL) among elderly patients with multimorbidity, so as to provide a basis for improving their health level.

Methods

A total of 3 361 patients with multimorbidity aged ≥55 years and with complete values of key variables were selected as the study subjects by using the China Health and Retirement Longitudinal Study (CHARLS) 2018 data. The EQ-5D-3L was used to assess the HRQoL. The Age-adjusted Charlson Comorbidity Index (ACCI) was used to calculate the ten-year survival. Mann-Whitney or Kruskal-Wallis tests and the Tobit regression model were employed to explore factors influencing the HRQoL.

Results

The health utility value for elderly patients with multimorbidity was 0.888 (0.709, 0.964), the dimension with the highest proportion of "difficulty" was pain/discomfort [2 430 (72.30%) ], the dimension with the highest percentage of "severe difficulty" was mobility [593 (17.64%) ]. The highest ten-year survival rate was 90.15%, which was achieved by only 2.44% (82/3 361) of patients; the majority of patients [848 (25.23%) ] had a ten-year survival rate of 21.36%, and 43.59% (1 465/3 361) had a ten-year survival rate close to zero. The Tobit regression results showed that primary school degree or above and non-smoking behavior were protective factors for HRQoL; while female, aged over 60 years, widowhood, self-rated health status as poor, non-drinking behavior, insufficient or excessive sleep duration, no moderate-intensity activity, four or more chronic diseases, and more than three outpatient visits were risk factors for HRQoL (P<0.05) .

Conclusion

The HRQoL among Chinese elderly patients with multimorbidity was relatively poor, and factors such as marital status, educational level, sleep duration, physical activity, number of chronic diseases deserve to be focused on. Healthy lifestyle guidance for elderly patients with multimorbidity should be strengthened to further improve the quality of life of this population.

Key words: Multimorbidity, Multiple chronic conditions, Health-related quality of life, EQ-5D-3L, Tobit model