基于EQ-5D-3L尘肺合并肺结核患者自报健康相关生命质量及影响因素分析  

EQ-5D-3L based quality of life for patients of pneumoconiosis combined with tuberculosis and its influencing factors

作　　者：罗凤萍 王焕强[1] 李涛[1] Luo Fengping;Wang Huanqiang;Li Tao(National Institute of Occupational Health and Poison Control,Chinese Center for Disease Control and Prevention,Beijing 100050,China)

机构地区：[1]中国疾病预防控制中心职业卫生与中毒控制所,北京100050

出　　处：《中华劳动卫生职业病杂志》2024年第6期432-441,共10页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：国家重点研发计划(2021YFC2500700)

摘　　要：目的:了解尘肺合并肺结核患者健康相关生命质量及其主要影响因素。方法:2023年11月,采用横断面研究选取2017年12月至2021年12月中国27个省市自治区尘肺调查中951例尘肺合并肺结核患者为研究对象,利用非参数Mann-Whitney检验和Kruskal-Wallis H检验比较反映其健康相关生命质量的健康效用值;运用多重线性回归进行多因素分析,并采用AMOS 24.0构建结构方程模型。结果:尘肺合并肺结核患者平均年龄(59.3±12.4)岁;以矽肺合并肺结核(62.2%,591/951)和煤工尘肺合并肺结核(34.9%,332/951)为主,其他类型尘肺合并肺结核占2.9%(28/951),其中临床诊断壹期、贰期、叁期和未分期尘肺患者分别占27.4%(261/951)、26.6%(253/951)、32.5%(309/951)和13.5%(128/951);63.3%(602/951)的研究对象共患其他慢性病,其中共患1种、2种、3种及以上慢性疾病者分别占24.1%(229/951)、16.3%(155/951)和22.9%(218/951)。尘肺合并肺结核患者健康效用值的中位数和四分位数以及自评分的±s分别为0.562(0.482,0.766)和(53.7±18.4)分,均低于未合并肺结核的尘肺患者(Z=-11.29,P<0.01;t=8.97,P<0.01),且城乡之间差异有统计学意义(Z=-2.22,P=0.027;t=4.85,P<0.01);在健康自评五维问题分布中疼痛/不适问题报告最多,其次是日常活动与焦虑/抑郁,且焦虑/抑郁报告比例在城乡间差异有统计学意义(χ^(2)=30.28,P<0.01)。多重线性回归结果显示,调查地区、身体质量指数、文化水平、年龄、就业状态、个人年收入、尘肺期别、共病数量、咯血、两周内症状急性加重、社会资助以及低保是尘肺合并肺结核患者健康效用值的主要影响因素(P<0.05)。结构方程模型结果显示经济保障和健康状况直接影响尘肺合并肺结核患者的健康相关生命质量,且在人口特征影响尘肺合并肺结核患者健康相关生命质量中发挥链式中介作用。结论:尘肺合并肺结核患者健康相关生命质量较差,疼痛/不适�Objective To understand the health-related quality of life for patients of pneumoconiosis combined with tuberculosis and its main influencing factors.Methods This was a cross-sectional study,and 951 patients of pneumoconiosis combined with tuberculosis from the pneumoconiosis survey in 27 provinces and autonomous regions in China from December 2017 to December 2021 were selected for the study.The nonparametric Mann-Whitney test and the Kruskal-Wallis H test were used to compare the health utility values,and multiple linear regression was used for multifactor analysis.AMOS 24.0 was used to establish a structural equation modeling.Results The mean age of 951 patients of pneumoconiosis combined with tuberculosis was(59.3±12.4)years.The main types were silicosis combined with tuberculosis(62.2%,591/951)and coal-worker's pneumoconiosis combined with tuberculosis(34.9%,332/951),and other type pneumoconiosis-combined tuberculosis was 2.9%(28/951).The proportion of patients with stageⅠ,Ⅱ,Ⅲ,and unstaged clinical diagnosis was 27.4%(261/951),26.6%(253/951),32.5%(309/951)and 13.5%(128/951),respectively.63.3%(602/951)of study participants suffered from other chronic diseases,and the percentage of patients combined the number of chronic diseases with 1,2,and more than 3 respectively were 24.1%(229/951),16.3%(155/951)and 22.9%(218/951).The median and quartiles of health utility values and the mean±standard deviation of self-rating scores of patients of pneumoconiosis combined with tuberculosis were 0.562(0.482,0.766)and(53.7±18.4),respectively,which were lower than patients of pneumoconiosis without tuberculosis(Z=-11.29,P<0.001;t=8.97,P<0.01).The health utility values and self-rating scores for patients of pneumoconiosis combined with tuberculosis were significantly different between urban and rural areas(Z=-2.22,P=0.027;t=4.85,P<0.01).Pain/discomfort was the most frequently reported problem in the five-dimensional distribution of problems,followed by daily activities and anxiety/depression,and the difference in the

关 键 词：尘肺病 肺结核 健康相关生命质量 结构方程模型 

分 类 号：R135.2[医药卫生—劳动卫生] R521[医药卫生—公共卫生与预防医学]