| 车鑫垚,胡晓斌,路杰,李巧娥,王聪,权佩钦,亓磊.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[J].中华流行病学杂志,2021,42(9):1670-1676 |
| 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 |
| 收稿日期:2020-07-14 出版日期:2021-09-27 |
| DOI：10.3760/cma.j.cn112338-20200714-00942 |
| 中文关键词: 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 |
| 英文关键词: Healthcare reform Diabetes Health-related quality of life EuroQol Five-Dimensions Questionnaire Tobit regression |
| 基金项目: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］ |
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| 中文摘要: |
| 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（60.53 vs. 63.89），健康效用指数升高0.04（0.83 vs. 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。 |
| 英文摘要: |
| 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. |
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