您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2020, Vol. 1 ›› Issue (7): 115-121.doi: 10.6040/j.issn.1671-7554.0.2020.0080

• • 上一篇    下一篇

心血管疾病患者健康相关生命质量及其影响因素的多水平模型分析

邓清文,刘文彬   

  1. 福建医科大学公共卫生学院卫生管理学系, 福建 福州 350122
  • 出版日期:2020-07-20 发布日期:2020-07-10
  • 通讯作者: 刘文彬. E-mail:wenbinliu126@126.com
  • 基金资助:
    福建省高校杰出青年科研人才培育计划(2018B030)

Multilevel analysis of health related quality of life of patients with cardiovascular disease and its determinants

DENG Qingwen, LIU Wenbin   

  1. Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou 350122, Fujian, China
  • Online:2020-07-20 Published:2020-07-10

PDF (PC)

408

摘要： 目的 探讨心血管疾病患者的健康相关生命质量及其影响因素,为改善患者生命质量提供参考。 方法 选取2015年中国健康与养老追踪调查(CHARLS)中符合要求的心血管疾病患者1 201例,收集患者及地区信息,基于欧洲五维健康量表(EQ-5D-3L)测量健康效用值反映其健康相关生命质量。采用K-W检验对患者和地区因素进行单因素分析。以患者水平为水平1,地区水平为水平2,建立两水平回归模型,分析患者和地区因素对心血管疾病患者健康相关生命质量的影响。 结果 健康效用值平均值为0.749±0.166。单因素分析结果显示,心血管疾病患者健康相关生命质量的影响因素包括性别、受教育水平、婚姻状况、是否患有高血压、是否患有心脏病、是否患有中风、睡眠时长、吸烟状况、饮酒状况、每周中等强度体力活动时间、社交活动频率、体质量指数(BMI)、所在地区(P<0.05)。多水平模型结果显示,对心血管疾病患者健康相关生命质量有显著影响的因素有性别、受教育水平、婚姻状况、是否患有高血压病、是否患有血脂异常、是否患有心脏病、是否患有中风、吸烟状况、每周中等强度体力活动时间、社交活动频率、BMI以及地区水平的地区因素(P<0.05)。 结论 提高心血管疾病患者的健康相关生命质量既要考虑受教育水平、吸烟状况、BMI等个体因素,还应考虑不同地区患者的异质性,从而制定不同地区的针对性策略。

关键词: 心血管疾病, 健康相关生命质量, 健康效用值, 多水平回归模型, 欧洲五维健康量表

Abstract: Objective To explore health related quality of life(HRQoL)of patients with cardiovascular disease(CVD)and identify the influencing factors. Methods A total of 1 201 CVD patients eligible for the research requirements were selected from CHARLS investigation. Patients information and regions were collected. HRQoL was measured using EQ-5D-3L scale. Patients information and regions were analyzed with K-W test. With patient as level 1 and region as level 2, a two-level regression model was set up to identify the influencing factors. Results The mean health utility value was 0.749±0.166. Univariate analysis showed that determinants of HRQoL of CVD patients included gender, educational level, marital status, hypertension, heart disease, stroke, sleep duration, smoking status, drinking status, minutes of moderate-intensity physical activity per week, frequency of social activity, body mass index(BMI)and region(P<0.05). Multilevel model results indicated that determinants of HRQoL of CVD patients were gender, education level, marital status, hypertension, dyslipidemia, heart disease, stroke, smoking status, minutes of moderate-intensity physical activity per week, frequency of social activity, BMI and region(P<0.05). Conclusion To improve quality of life of CVD patients, education level, smoking status, BMI and heterogeneity of different regions should be considered so as to develop targeted strategies.

Key words: Cardiovascular disease, Health related quality of life, Health utility value, Multilevel model, EQ-5D-3L scale

中图分类号: 

  • R181.3
[1] 马丽媛, 吴亚哲, 陈伟伟. 《中国心血管病报告2018》要点介绍[J]. 中华高血压杂志, 2019, 27(8): 712-716.
[2] 徐琼琼, 郭晓雷, 楚洁, 等. 山东省2型糖尿病患者健康相关生命质量及其影响因素[J]. 山东大学学报(医学版), 2019, 57(3): 96-103. XU Qiongqiong, GUO Xiaolei, CHU Jie, et al. Health-related quality of life and its influencing factors in type 2 diabetes patients in Shandong Province[J] Journal of Shandong University(Health Sciences), 2019, 57(3): 96-103.
[3] 黄海涌, 汤少梁, 刘军军. 基于欧洲五维健康量表的浙川冀甘4省慢性病患者的健康相关生命质量现状及影响因素研究[J]. 中国慢性病预防与控制, 2019, 27(8): 575-579. HUANG Haiyong, TANG Shaoliang, LIU Junjun. The life quality related to health and influencing factors of chronic disease patients in Zhejiang,Sichuan,Hebei and Gansu Provinces based on EQ-5D-5L scale[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2019, 27(8): 575-579.
[4] Mok A, Khaw KT, Luben R, et al. Physical activity trajectories and mortality: population based cohort study[J]. BMJ, 2019, 365: l2323. doi:10.1136/bmj.l2323.
[5] Lear SA, Hu W, Rangarajan S, et al. The effect of physical activity on mortality and cardiovascular disease in 130000 people from 17 high-income, middle-income, and low-income countries: the PURE study[J]. Lancet, 2017, 390(10113): 2643-2654.
[6] Mora S, Cook N, Buring JE, et al. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms[J]. Circulation, 2007, 116(19): 2110-2118.
[7] Domínguez F, Fuster V, Fernández-Alvira JM, et al. Association of sleep duration and quality with subclinical atherosclerosis[J]. J Am Coll Cardiol, 2019, 73(2): 134-144.
[8] 国际生命科学学会中国办事处中国肥胖问题工作组联合数据汇总分析协作组. 中国成人体质指数分类的推荐意见简介[J]. 中华预防医学杂志, 2001, 35(5): 349-350.
[9] Zhou BF, Cooperative Meta-analysis Group of the Working Group on Obesity in China. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults[J]. Biomed Environ Sci, 2002, 15(1): 83-96.
[10] EuroQol Research Foundation. EQ-5D-3L/About[EB/OL].[2020-01-11]. https://euroqol.org/eq-5d-instruments/eq-5d-3l-about/, 2018.
[11] 刘文燕. 老年人生命质量评价及影响因素研究——基于CHARLS2012浙江和甘肃两省调查数据[D]. 南昌: 华东交通大学, 2015.
[12] Zhuo L, Xu L, Ye J, et al. Time trade-off value set for EQ-5D-3L based on a nationally representative Chinese population survey[J]. Value Health, 2018, 21(11): 1330-1337.
[13] 杨珉, 李晓松. 医学和公共卫生研究常用多水平统计模型[M]. 北京: 北京大学医学出版社, 2007.
[14] 石磊. 多水平模型及其在经济领域中的应用[M]. 北京: 科学出版社, 2013.
[15] Kularatna S, Byrnes J, Chan YK, et al. Comparison of the EQ-5D-3L and the SF-6D(SF-12)contemporaneous utility scores in patients with cardiovascular disease[J]. Qual Life Res, 2017, 26(2): 1-10.
[16] Heiskanen J, Tolppanen AM, Roine RP, et al. Comparison of EQ-5D and 15D instruments for assessing the health-related quality of life in cardiac surgery patients[J]. Eur Heart J Qual Care Clin Outcomes, 2016: 193-200. doi: 10.1093/ehjqcco/qcw002.
[17] Van Hout B, Janssen MF, Feng YS, et al. Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets[J]. Value Health, 2012, 15(5): 708-715.
[18] Batóg P, Rencz F, Péntek M, et al. EQ-5D studies in cardiovascular diseases in eight Central and Eastern European countries: a systematic review of the literature[J]. Kardiol Pol, 2018, 76(5): 860-870.
[19] Dyer MTD, Goldsmith KA, Sharples LS, et al. A review of health utilities using the EQ-5D in studies of cardiovascular disease[J]. Health Qual Life Outcomes, 2010, 8(1): 13.
[20] 吴兆苏, 姚崇华, 赵冬. 我国人群脑卒中发病率、死亡率的流行病学研究[J]. 中华流行病学杂志, 2003, 24(3): 236-239.
[21] Pan A, Wang Y, Talaei M, et al. Relation of smoking with total mortality and cardiovascular events among patients with diabetes mellitus: a meta-analysis and systematic review[J]. Circulation, 2015, 132(19): 1795-1804.
[22] Mons U, Müezzinler A, Gellert C, et al. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium[J]. BMJ, 2015, 350: 1551. doi: 1136/bmj.h1551.
[23] WHO. Global Strategy on Diet, Physical Activity and Health[EB/OL].[2020-01-11]. https://www.who.int/dietphysicalactivity/factsheet_adults/en/.
[24] John-Henderson NA, Counts CJ, Sanders CS, et al. Diminished cardiovascular stress reactivity is associated with lower levels of social participation[J]. J Psychosom Res, 2019, 118: 12-16. doi: 10.1016/j.jpsychores.2019.01.005.
[25] Lu J, Lu Y, Yang H, et al. Characteristics of High Cardiovascular Risk in 1.7 Million Chinese Adults[J]. Ann Intern Med, 2019, 170(5): 298-308.
[1] 李谧,苏丽娜,徐凌忠. 基于EQ-5D效用值积分体系的山东省贫困人群健康相关生命质量研究[J]. 山东大学学报 (医学版), 2017, 55(12): 71-76.
[2] 唐海荣,袁斌斌,胡大一,布艾加尔·哈斯木. 踝臂指数对心血管高危患者全因及心血管死亡率的预测作用[J]. 山东大学学报(医学版), 2013, 51(1): 53-.
[3] 刘继东，侯新国，宋君，李文娟，校娟，肖芳，王美建，邓楠，周晓莹，陈丽. 正常高值血压合并糖调节受损患者的心血管危险因素[J]. 山东大学学报(医学版), 2012, 50(7): 1-.
[4] 刘智1，刘同涛1，贾崇奇2. 心血管疾病患者心理特征研究[J]. 山东大学学报(医学版), 2011, 49(3): 120-123.
[5] 心血管疾病患者心理特征研究. 心血管疾病患者心理特征研究[J]. 山东大学学报(医学版), 2011, 49(3): 120-123.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 肖伟玲,林亚杰,牟东珍,孙萍,梁淑娟 . 分泌型人IL-1β表达载体的构建及在H7402细胞中的表达[J]. 山东大学学报(医学版), 2008, 46(2): 119 -122 .
[2] 王海峰,史本康,张克勤,李永智,朱耀丰,王海新. B超检测的精索静脉直径及返流与术后精液质量的关系[J]. 山东大学学报(医学版), 2007, 45(7): 751 -752 .
[3] 张元凯，刘培来，李德强，李明. 枢椎椎板螺钉联合寰椎侧块螺钉固定技术在复杂寰枢椎脱位中的应用[J]. 山东大学学报(医学版), 2010, 48(11): 98 .
[4] 刘益民，杜鲁涛，王丽丽，蒋秀梅，李娟，曲爱林，王海燕，郑桂喜，张欣，杨咏梅，王传新. 膀胱癌患者血清microRNA检测中内参基因的筛选及验证[J]. 山东大学学报（医学版）, 2014, 52(5): 86 -91 .
[5] 韩露1，王彬2，牟晓梅2，巩会平3，闫会敏1，王志浩1，张运1，张薇1，钟明1. 代谢综合征患者心脏损害与脂肪因子变化的临床研究[J]. 山东大学学报(医学版), 2011, 49(9): 63 .
[6] 蒋慧慧1，胡志敏2，李先哲1，席广民1，蒋汉明1，苑辉卿1. 人PDLIM4基因启动子报告基因载体的构建及其在人类肿瘤细胞中的表达[J]. 山东大学学报(医学版), 2011, 49(5): 19 .
[7] 李波1，刘艳丽1,2，魏璐婉1，王静3，刘执玉1，丁兆习1. 血管内皮生长因子C诱导骨髓间充质干细胞分化为淋巴管内皮细胞的研究[J]. 山东大学学报(医学版), 2011, 49(11): 8 .
[8] 张秀珍,刘莉,刘倩. 慢性乙型肝炎患者血清瘦素水平与抗病毒治疗应答的相关性[J]. 山东大学学报(医学版), 2012, 50(9): 96 -99 .
[9] 孙维彤,邹伟伟,李爱国,席延伟,张娜. 脂质体粒径对促进托氟啶口服吸收的影响[J]. 山东大学学报(医学版), 2007, 45(6): 639 -642 .
[10] 于清梅,武玉玲,宋海岩,尹华伟,庄园 . p38丝裂原活化蛋白激酶在小鼠早期胚胎及围植入期子宫内膜的表达[J]. 山东大学学报(医学版), 2008, 46(2): 123 -127 .
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发