老年多病共存患者健康相关生命质量及影响因素研究

周珊; 刘艳丽; 李娜; 马力

doi:10.16766/j.cnki.issn.1674-4152.003488

老年多病共存患者健康相关生命质量及影响因素研究

doi: 10.16766/j.cnki.issn.1674-4152.003488

周珊¹,
刘艳丽²,
李娜³,
马力^2, ,

1.
首都医科大学全科医学与继续教育学院，北京 100069
2.
首都医科大学附属北京天坛医院全科医疗科，北京 100070
3.
首都医科大学附属北京天坛医院督导办公室

基金项目:

2022年度首都全科医学研究专项 22QK13

高层次公共卫生技术人才建设项目学科带头人-02-09

中国社区卫生协会"社区卫生科研基金"项目 2021-1-05

详细信息

通讯作者:
马力，E-mail：mali_ttyy@126.com

中图分类号: R592
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出版历程
- 收稿日期: 2023-10-13
- 网络出版日期: 2024-07-20

Analyzing the health-related quality of life among the elderly with multiple chronic conditions

ZHOU Shan¹,
LIU Yanli²,
LI Na³,
MA Li^{2
, ,}

1.
School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China

摘要

摘要: 目的了解老年多病共存患者健康相关生命质量现状及其影响因素, 为指导老年多病共存患者健康管理提供依据。方法纳入2022年11月-2023年6月北京天坛医院内科病房住院患者214例, 采用问卷调查法收集基本信息及患病情况, 应用Apriori算法分析慢病共病模式, 欧洲五维健康量表(EQ-5D-5L)评价健康相关生命质量, Tobit回归模型分析健康相关生命质量的影响因素。结果共纳入老年多病共存患者214例, 最常见的二元、三元共病组合分别为高血压+糖尿病、高血压+糖尿病+慢性肾功能不全。健康效用值为0.89(0.67, 1.00), 69.16%的患者有不同程度的生活质量下降, 焦虑/沮丧出现问题最少, 日常活动受影响最显著。Tobit回归结果显示, 较好的健康相关生命质量与积极参与锻炼、城镇职工医保相关(P < 0.05), 年龄大、慢性病患病数目多是其危险因素(P < 0.05)。结论多病共存严重影响老年人健康相关生命质量, 需重点关注年龄、患病数量、体育锻炼、医疗保险等因素, 加强生活方式指导, 积极治疗基础疾病, 促进健康老龄化。
- 多病共存 /
- 健康相关生命质量 /
- 欧洲五维健康量表
Abstract: Objective To investigate the status and factors influencing health-related quality of life (HRQoL) in elderly patients with multiple chronic conditions (MCC), in order to provide a basis for further health management. Methods Patients hospitalized in the internal medicine ward of the Beijing Tiantan Hospital between November 2022 and June 2023 were included as the study population.A self-developed questionnaire was used to collect the basic information.The Apriori algorithm was used to analyze the chronic disease comorbidity.The EuroQol 5-dimension 5-level was used to assess HRQoL, and the Tobit regression model was employed to analyze the factors influencing HRQoL. Results Among the 214 elderly patients with MCC, the most common chronic comorbidity patterns were hypertension+diabetes and hypertension+diabetes+chronic renal insufficiency.The health utility value for these patients was 0.89(0.67, 1.00).The self-reported problem of anxiety/depression was the lowest, while the problem related to daily activities was the highest.The Tobit regression results showed that better HRQoL was associated with younger age, fewer chronic diseases, active participation in exercise, and urban employee medical insurance (P < 0.05). Conclusion The HRQoL of elderly patients with MCC was found to be poor.It is suggested to focus on factors such as age, the number of chronic diseases, exercise participation, and medical insurance.It is essential to strengthen scientific lifestyle guidance and enhance the ability for comprehensive management of MMC.
- Multiple chronic conditions /
- Health-related quality of life /
- EuroQoL 5-dimension questionnaire

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表 1 单病种检出排序

Table 1. Ranking of single disease detection

顺位	疾病名称	例(%)	顺位	疾病名称	例(%)
1	高血压	187(87.38)	11	恶性肿瘤	21(9.81)
2	糖尿病	112(52.34)	12	心律失常	21(9.81)
3	冠心病	88(41.12)	13	周围血管病	19(8.88)
4	高脂血症	84(39.25)	14	骨骼及结缔组织病(骨质疏松、关节炎)	19(8.88)
5	慢性肾功能不全	44(20.56)	15	甲状腺功能异常	18(8.41)
6	脑卒中	40(18.69)	16	眼部疾病(青光眼、白内障等)	17(7.94)
7	慢性疼痛(慢性腰背腿疼、头痛等)	33(15.42)	17	高尿酸血症	16(7.48)
8	睡眠障碍	32(14.95)	18	心功能不全	16(7.48)
9	慢性胃肠道疾病	31(14.49)	19	前列腺增生	14(6.54)
10	慢性呼吸道疾病	30(14.02)	20	焦虑、抑郁	8(3.74)

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表 2 老年多病共存患者共病组合模式的关联规则

Table 2. Association rules of comorbidity patterns in elderly patients with multiple chronic conditions

前项	后项	支持度 (%)	置信度 (%)	提升比	共病例数	前项	后项	支持度 (%)	置信度 (%)	提升比	共病例数
高血压	糖尿病	87.38	52.41	1.00	98	慢性胃肠道疾病	冠心病	14.49	54.84	1.33	17
冠心病	高血压	41.12	87.50	1.00	77	慢性肾功能不全，高血压	糖尿病	20.09	62.79	1.20	27
高脂血症	糖尿病	39.25	52.38	1.00	44	高脂血症，冠心病	糖尿病	16.82	55.56	1.06	20
慢性肾功能不全	糖尿病	20.56	61.36	1.17	27	脑卒中，高血压	糖尿病	16.36	68.57	1.31	24
慢性肾功能不全	高血压	20.56	97.73	1.12	43	慢性疼痛，高血压	糖尿病	13.08	60.71	1.16	17
脑卒中	糖尿病	18.69	67.50	1.29	27	慢性胃肠道疾病，高血压	冠心病	11.21	58.33	1.42	14
脑卒中	高血压	18.69	87.50	1.00	35	睡眠障碍，高血压	高脂血症	11.21	54.17	1.38	13
慢性疼痛	糖尿病	15.42	63.64	1.22	21	慢性胃肠道疾病，高血压	糖尿病	11.21	54.17	1.03	13
睡眠障碍	高脂血症	14.95	53.13	1.35	17

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表 3 基于EQ-5D-5L量表的健康相关生命质量

Table 3. Health-related quality of life based on the EQ-5D-5L scale

维度	没有问题 [例(%)]	轻度问题 [例(%)]	中度问题 [例(%)]	严重问题 [例(%)]	极其严重问题 [例(%)]	得分 [M(P₂₅, P₇₅)，分]
行动能力	92(42.99)	66(30.84)	47(21.96)	7(3.27)	2(0.93)	0.07(0.00, 0.16)
自我照顾	143(66.82)	39(18.22)	26(12.15)	4(1.87)	2(0.93)	0.00(0.00, 0.06)
日常活动	91(42.52)	58(27.10)	52(24.30)	11(5.14)	2(0.93)	0.05(0.00, 0.11)
疼痛/不适	130(60.75)	56(26.17)	25(11.68)	3(1.40)	0	0.00(0.00, 0.06)
焦虑/沮丧	172(80.37)	15(7.01)	27(12.62)	0	0	0.00(0.00, 0.00)

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表 4 不同特征的健康效用值及单因素分析

Table 4. Health utility values and univariate analysis of different traits

变量	例(%)	健康效用值 [M(P₂₅, P₇₅)]	统计量	P值
性别			-0.377^a	0.706
男性	110(51.40)	0.89(0.69, 1.00)
女性	104(48.60)	0.89(0.67, 1.00)
年龄(岁)			20.063^b	< 0.001
60~69	111(51.87)	0.94(0.77, 1.00)
70~79	74(34.58)	0.86(0.67, 0.95)
80及以上	29(13.55)	0.63(0.56, 0.84)
文化程度			6.998^b	0.030
小学及以下	25(11.68)	0.83(0.50, 0.92)
初中	95(44.39)	0.89(0.64, 1.00)
高中及以上	94(43.93)	0.92(0.71, 1.00)
经济收入			4.320^b	0.115
< 2 000元	34(15.89)	0.81(0.61, 0.89)
2 000~5 000元	108(50.47)	0.89(0.69, 1.00)
>5 000元	72(33.64)	0.89(0.67, 1.00)
医疗保障方式			7.218^b	0.027
城镇居民医疗保险	34(15.89)	0.84(0.43, 1.00)
城镇职工医疗保险	169(78.97)	0.89(0.72, 1.00)
其他	11(5.14)	0.62(0.56, 0.89)
慢病患病数量			14.845^b	0.001
2种	34(15.89)	1.00(0.77, 1.00)
3~4种	108(50.47)	0.89(0.70, 1.00)
5种及以上	72(33.64)	0.78(0.62, 0.89)
长期治疗数量			3.413^b	0.181
0种	9(4.21)	0.79(0.68, 0.95)
1~4种	108(50.47)	0.92(0.70, 1.00)
5种及以上	97(45.33)	0.84(0.64, 1.00)
体育锻炼频率			13.431^b	0.001
3次及以上/周	80(37.38)	0.94(0.77, 1.00)
1~2次/周	65(30.37)	0.89(0.69, 1.00)
0次/周	69(32.24)	0.78(0.56, 0.95)
糖尿病+慢性肾功能不全			13.503^b	0.001
2种	27(12.62)	0.72(0.57, 0.89)
1种	102(47.66)	0.94(0.69, 1.00)
0种	85(39.72)	0.89(0.70, 1.00)
高血压+慢性肾功能不全			7.680^b	0.021
2种	43(20.09)	0.76(0.58, 0.93)
1种	145(67.76)	0.89(0.72, 1.00)
0种	26(12.15)	0.87(0.69, 1.00)
高血压+糖尿病+慢性肾功能不全			11.556^b	0.003
3种	27(12.62)	0.72(0.57, 0.89)
1~2种	175(81.78)	0.89(0.69, 1.00)
0种	12(5.61)	0.92(0.73, 1.00)
注：^a为Z值, ^b为H值。

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表 5 健康效用值影响因素的Tobit分析

Table 5. Tobit analysis of factors influencing health utility values

变量	β	95% CI	SE	Z值	P值
年龄	-0.012	-0.018~-0.007	0.003	-4.770	< 0.001
患慢病数量	-0.029	-0.050~-0.008	0.011	-2.690	0.008
文化程度
初中	0.017	-0.110~0.143	0.064	0.260	0.797
高中及以上	0.032	-0.100~0.164	0.067	0.470	0.635
医疗保障方式
城镇职工医疗保险	0.120	0.011~0.230	0.055	2.170	0.031
其他	-0.088	-0.277~0.100	0.096	-0.920	0.358
体育锻炼频率
1~2次/周	0.095	-0.002~0.192	0.049	1.940	0.054
3次及以上/周	0.137	0.042~0.231	0.048	2.850	0.005
高血压+慢性肾功能不全共病组合	-0.020	-0.126~0.017	0.074	-0.270	0.784
糖尿病+慢性肾功能不全共病组合	-0.127	-0.300~0.046	0.088	-1.440	0.151
注：文化程度以小学及以下为参照组；医疗保障方式以城镇居民医疗保险为参照组；体育锻炼频率以0次/周为参照组；共病组合以未患该项共病组合为参照组。

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参考文献(21)

[1]	唐天娇, 曹立, 董碧蓉, 等. 老年人多病共存名词和定义专家共识(2022)[J]. 中华老年医学杂志, 2022, 41(9): 1028-1031. doi: 10.3760/cma.j.issn.0254-9026.2022.09.002 TANG T J, CAO L, DONG BR, et al. Chinese expert consensus on the term and definition of Multimorbidity in older adults(2022)[J]. Chin J Geriatr, 2022, 41(9): 1028-1031. doi: 10.3760/cma.j.issn.0254-9026.2022.09.002
[2]	KHUNTI K, CHUDASAMA Y V, GREGG E W, et al. Diabetes and multiple long-term conditions: a review of our current global health challenge[J]. Diabetes Care, 2023, 46(12): 2092-2101. doi: 10.2337/dci23-0035
[3]	刘晓君, 陈雅婷, 蒙玲玲, 等. 我国老年人慢性病患病数量与健康相关生命质量的关系[J]. 医学与社会, 2022, 35(8): 73-77, 83. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSH202208014.htm LIU X J, CHEN Y T, MENG L L, et al. The relationship between the number of chronic diseases and health-related quality of life in the older adults in China[J]. Medicine and Society, 2022, 35(8): 73-77, 83. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSH202208014.htm
[4]	SOLEY-BORI M, ASHWORTH M, BISQUERA A, et al. Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature[J]. Br J Gen Pract, 2020, 71(702): e39-e46.
[5]	王一, 陈秀芹, 黄丽妹, 等. 社区老年人多病共存与死亡关系的队列研究[J]. 中国慢性病预防与控制, 2020, 28(9): 649-652, 658. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202009004.htm WANG Y, CHEN X Q, HUANG L M, et al. The cohort study of relationship between multiple diseases coexistence and mortality in older residents of communities[J]. Chin J Prev Contr Chron Dis, 2020, 28(9): 649-652, 658. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202009004.htm
[6]	XIE S T, WU J, XIE F. Population norms for SF-6Dv2 and EQ-5D-5L in China[J]. Appl Health Econ Health Policy, 2022, 20(4): 573-585. doi: 10.1007/s40258-022-00715-2
[7]	KAPLAN R M, HAYS R D. Health-related quality of life measurement in public health[J]. Annu Rev Public Health, 2022, 43(1): 355-373. doi: 10.1146/annurev-publhealth-052120-012811
[8]	杨光媚, 万乐平, 梁笑笑, 等. 基于EQ-5D量表分析老年人高血压患者健康相关生命质量及其影响因素[J]. 中国健康教育, 2022, 38(9): 801-806. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJK202209007.htm YANG G M, WAN L P, LIANG X X, et al. Analysis on health-related quality of life and its influencing factors among elderly patients with hypertension by EQ-5D scale[J]. Chinese Journal of Health Education, 2022, 38(9): 801-806. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJK202209007.htm
[9]	柳言, 林玥彤, 齐元涛, 等. 基于欧洲五维健康量表的2型糖尿病患者健康相关生命质量研究[J]. 公共卫生与预防医学, 2023, 34(4): 11-15. doi: 10.3969/j.issn.1006-2483.2023.04.003 LIU Y, Lin Y T, QI Y T, et al. Health related quality of life in patients with type 2 diabetes based on the European 5-Dimensional Health Scale[J]. J Pub Health Prev Med, 2023, 34(4): 11-15. doi: 10.3969/j.issn.1006-2483.2023.04.003
[10]	KAUR M N, YAN J, KLASSEN A F, et al. A systematic literature review of health utility values in breast cancer[J]. Med Decis Making, 2022, 42(5): 704-719. doi: 10.1177/0272989X211065471
[11]	SCANGAS G A, RATHI V K, METSON R B, et al. Defining the health utility value of medical management of chronic rhinosinusitis: a prospective pilot study[J]. OTO Open, 2022, 6(2): 2473974X221092381. DOI: 10.1177/2473974X221092381.
[12]	彭德荣, 陈晨, 喻梦珠, 等. 基于数据挖掘的社区高血压患者共病现状及关联规则分析[J]. 中华全科医学, 2023, 21(6): 907-910. doi: 10.16766/j.cnki.issn.1674-4152.003012 PENG D R, CHEN C, YU M Z, et al. Data mining-based analysis of comorbidity status and association rules of hypertensive patients in the community[J]. Chinese Journal of General Practice, 2023, 21(6): 907-910. doi: 10.16766/j.cnki.issn.1674-4152.003012
[13]	徐小兵, 李迪, 孙扬, 等. 基于关联规则的中国老年人慢性病共病分析[J]. 中国慢性病预防与控制, 2021, 29(11): 808-812. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202111003.htm XU X B, LI D, SUN Y, et al. Analysis of chronic diseases comorbidity among the elderly in China based on association rules[J]. Chin J Prev Contr Chron Dis, 2021, 29(11): 808-812. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202111003.htm
[14]	ZHANG C C, XIAO S J, SHI L, et al. Urban-rural differences in patterns and associated factors of multimorbidity among older adults in China: a cross-sectional study based on apriori algorithm and multinomial logistic regression[J]. Front Public Health, 2021, 9: 707062. DOI: 10.3389/fpubh.2021.707062.
[15]	田纬, 陶梦梦, 李坤坤, 等. 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[J]. 中国全科医学, 2024, 27(11): 1303-1309. doi: 10.12114/j.issn.1007-9572.2023.0593 TIAN W, TAO M M, LI K K, et al. Health-related quality of life and its influencing factors among elderly patients with multimorbidity in China[J]. Chinese General Practice, 2024, 27(11): 1303-1309. doi: 10.12114/j.issn.1007-9572.2023.0593
[16]	李岩静, 郝晓宁. 个体与群体视角下的北京市随迁老人健康相关生命质量及其影响因素分析[J]. 中国卫生事业管理, 2023, 40(9): 715-720. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWSG202309016.htm LI Y J, HAO X N. Analysis of the health-related quality of life of the elderly migrants in Beijing and its influencing factors from the individual and group perspective[J]. Chinese Health Service Management, 2023, 40(9): 715-720. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWSG202309016.htm
[17]	BUCHHOLZ I, JANSSEN M F. EQ-5D-3L norms for the European older population: country-specific norms for 15 European countries based on the survey of health, ageing, and retirement in Europe[J]. Value Health, 2023, 26(5): 721-732. doi: 10.1016/j.jval.2022.09.2478
[18]	CHEN C, LIU G G, SHI Q L, et al. Health-related quality of life and associated factors among oldest-old in China[J]. J Nutr Health Aging, 2020, 24(3): 330-338. doi: 10.1007/s12603-020-1327-2
[19]	AUBERT C E, KABETO M, KUMAR N, et al. Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study[J]. BMC Geriatr, 2022, 22(1): 910. DOI: 10.1186/s12877-022-03548-9.
[20]	宋靓珺, 杨玲. 老年人口健康寿命的演变轨迹及其影响因素: 一项基于CLHLS的实证研究[J]. 人口与经济, 2020, 41(3): 57-74. https://www.cnki.com.cn/Article/CJFDTOTAL-RKJJ202003005.htm SONG L J, YANG L. The trajectory of health expectancy among elderly and its influencing factors: an empirical study based on CLHLS[J]. POPULATION & ECONOMICS, 2020, 41(3): 57-74. https://www.cnki.com.cn/Article/CJFDTOTAL-RKJJ202003005.htm
[21]	程诺, 李林, 李伊然, 等. 东北地区中老年居民的健康相关生命质量及其影响因素[J]. 中国卫生统计, 2023, 40(2): 239-241, 245. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT202302019.htm CHENG N, LI L, LI Y R. Health-related quality of life and its influencing factors among middle-aged and elderly residents in Northeast China[J]. Chinese Journal of Health Statistics, 2023, 40(2): 239-241, 245. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT202302019.htm