新医改十年甘肃省糖尿病患者健康相关生命质量及其影响因素研究  

Health-related quality of life of diabetes patients and related factors before and after healthcare reform in Gansu province

作　　者：车鑫垚 胡晓斌[1] 路杰 李巧娥 王聪 权佩钦 亓磊 Che Xinyao;Hu Xiaobin;Lu Jie;Li Qiaoe;Wang Cong;Quan Peiqin;Qi Lei(Department of Epidemiology and Health Statistics,School of Public Health,Lanzhou University,Lanzhou 730000,China;Health Statistics Information Center of Gansu Province,Lanzhou 730000,China)

机构地区：[1]兰州大学公共卫生学院流行病与卫生统计学研究所,730000 [2]甘肃省卫生健康统计信息中心,兰州730000

出　　处：《中华流行病学杂志》2021年第9期1670-1676,共7页Chinese Journal of Epidemiology

基　　金：兰州大学服务甘肃省经济社会发展专项研究(2019-FWZX-11);甘肃省卫生健康委员会项目(2019GS-WSZFY-001);甘肃省卫生健康委统计信息中心项目(GSWT-2018001);甘肃省糖尿病患者管理现状及医疗费用趋势研究[20191210-(19)0565]。

摘　　要：目的调查新医改前后甘肃省糖尿病患者健康相关生命质量(HRQoL)并分析其影响因素,为提高糖尿病患者HRQoL提供科学依据。方法利用新医改前(2008年)及医改后(2018年)在甘肃省开展的第四次、第六次国家卫生服务入户调查数据,采用基于我国的欧洲五维健康量表(EQ-5D)效应值积分体系计算EQ-5D健康效用指数。结果新医改前后甘肃省≥15岁居民EQ-5D均有明显变化:行动能力改善8.08%(27.43%vs.19.35%)、自我照顾改善16.16%(26.55%vs.10.39%)、日常活动改善8.97%(28.32%vs.19.35%)、疼痛/不适恶化1.38%(38.05%vs.39.43%)、焦虑/抑郁恶化1.83%(16.81%vs.18.64%),EQ-VAS评分提高3.36(60.53vs.63.89),健康效用指数升高0.04(0.83vs.0.87)。多因素回归分析结果显示,各维度影响因素不完全一致,总的来看,年龄越高、文化程度低、从不锻炼、多重慢病的糖尿病患者HRQoL较差(P<0.05),其中多重慢病对糖尿病患者的健康状况影响最大,城镇职工医保及新医改后的糖尿病患者HRQoL较好(P<0.05)。结论新医改对甘肃省糖尿病患者HRQoL有着积极的影响。医疗保健提供者和决策者应当重视多重慢病对HRQoL的影响以及糖尿病患者的心理健康。Objective The study investigated and analyzed the health-related quality of life of diabetes patients in Gansu province before and after the healthcare reform and its influencing factors,so as to provide scientific evidence to improve the health-related quality of life of diabetes patients.Methods The study used data of the fourth and sixth national health service household survey in Gansu province before(2008)and after(2018)medical reform separately,and EQ-5D health utility index was calculated on the basis of Chinese time frade-off values for EuroQol Five-Dimensions Questionnaire Utility Value scoring system.Results Compared with the period before the healthcare reform,the five dimensions of EQ-5D for residents,aged 15 and above in Gansu,changed significantly after the healthcare reform:action capability improved by 8.08%(27.43%vs.19.35%),self-care improved by 16.16%(26.55%vs.10.39%),normal activity improved by 8.97%(28.32%vs.19.35%),pain/discomfort worsened by 1.38%(38.05%vs.39.43%),anxiety/depression worsened by 1.83%(16.81%vs.18.64%),and the EQ-VAS score increased by 3.36(60.53 vs.63.89).The health utility index increased by 0.04(0.83 vs.0.87).Multivariate regression analysis results showed that the dimension influence factors were not completely consistent,on the whole,the health-related quality of life of diabetes patients with older age,lower education level,no physical exercise and multi chronic diseases was worse(P<0.05),and multiple chronic disease had the most serious effect on the health of patients with diabetes.The health-related quality of life of diabetes patients with the medical insurance in urban area and after the new medical reform was higher(P<0.05).Conclusion The new healthcare reform has active influence on the health-related quality of life of diabetes patients in Gansu province,health care providers and policy makers should pay attention to the impacts of multi prechronic diseases on the health-related quality of life of diabetes patients and the mental health of patients with diabetes.

关 键 词：新医改 糖尿病 健康相关生命质量 欧洲五维健康量表 TOBIT回归 

分 类 号：R587.1[医药卫生—内分泌] R193[医药卫生—内科学]