摘要： 背景 隨著人口老齡化，我國(guó)慢性病患病率逐年升高，多重慢性病的情況也越來(lái)越普遍。我國(guó)目前有關(guān)生命質(zhì)量的研究多集中在特定疾病，如糖尿病、高血壓、心血管疾病等，而有關(guān)多重慢性病的生命質(zhì)量研究相對(duì)較少。目的 了解我國(guó)老年多重慢性病患者的健康相關(guān)生命質(zhì)量及其影響因素，為提高老年多重慢性病患者的健康水平提供依據(jù)。方法 使用中國(guó)健康與養(yǎng)老追蹤調(diào)查（CHARLS）2018年數(shù)據(jù)，選取年齡≥55周歲且關(guān)鍵變量值完整的3 361例多重慢性病患者作為研究對(duì)象。采用歐洲五維度三水平健康評(píng)定（EQ-5D-3L）量表評(píng)估健康相關(guān)生命質(zhì)量；采用年齡調(diào)整合并癥指數(shù)計(jì)算十年生存率；使用Mann-Whitney或Kruskal-Wallis檢驗(yàn)、Tobit回歸模型分析健康相關(guān)生命質(zhì)量的影響因素。結(jié)果 老年多重慢性病患者的健康效用值為0.888（0.709，0.964）分，"困難"比例最高的維度為疼痛/不適[2 430例（72.30%）]，"嚴(yán)重困難"比例最高的維度為行動(dòng)能力[593例（17.64%）]。十年生存率測(cè)算結(jié)果顯示，十年生存率最高為90.15%，僅有2.44%（82/3 361）的患者達(dá)到；大部分患者[848例（25.23%）]的十年生存率為21.36%，有43.59%（1 465/3 361）的患者十年生存率接近于0。Tobit回歸模型分析結(jié)果顯示，小學(xué)及以上學(xué)歷、不吸煙是健康相關(guān)生命質(zhì)量的保護(hù)因素；女性、>60歲、喪偶、自評(píng)健康狀況為不好、不飲酒、夜間睡眠時(shí)長(zhǎng)不足或過(guò)長(zhǎng)、未進(jìn)行中等強(qiáng)度活動(dòng)、患病數(shù)量≥4種、門(mén)診次數(shù)≥3次是健康相關(guān)生命質(zhì)量的危險(xiǎn)因素（P<0.05）。結(jié)論 我國(guó)老年多重慢性病患者的健康相關(guān)生命質(zhì)量較差，應(yīng)重點(diǎn)關(guān)注婚姻狀況、受教育程度、夜間睡眠時(shí)長(zhǎng)、體力活動(dòng)、患病數(shù)量等因素。應(yīng)加強(qiáng)對(duì)老年多重慢性病患者的健康生活方式指導(dǎo)，進(jìn)一步提高該人群的生命質(zhì)量。

關(guān)鍵詞: 多重慢性病, 慢性病共病, 健康相關(guān)生命質(zhì)量, EQ-5D-3L, Tobit模型

Abstract:

Background

With the population aging, the prevalence of chronic diseases in China is increasing annually, contributing to a growing incidence of multimorbidity. Research on quality of life focuses mostly on specific diseases, such as diabetes, hypertension, and cardiovascular diseases. However, there are relatively few studies on the quality of life of multimorbidity.

Objective

To understand the status and influencing factors of the health-related quality of life (HRQoL) among elderly patients with multimorbidity, so as to provide a basis for improving their health level.

Methods

A total of 3 361 patients with multimorbidity aged ≥55 years and with complete values of key variables were selected as the study subjects by using the China Health and Retirement Longitudinal Study (CHARLS) 2018 data. The EQ-5D-3L was used to assess the HRQoL. The Age-adjusted Charlson Comorbidity Index (ACCI) was used to calculate the ten-year survival. Mann-Whitney or Kruskal-Wallis tests and the Tobit regression model were employed to explore factors influencing the HRQoL.

Results

The health utility value for elderly patients with multimorbidity was 0.888 (0.709, 0.964), the dimension with the highest proportion of "difficulty" was pain/discomfort [2 430 (72.30%) ], the dimension with the highest percentage of "severe difficulty" was mobility [593 (17.64%) ]. The highest ten-year survival rate was 90.15%, which was achieved by only 2.44% (82/3 361) of patients; the majority of patients [848 (25.23%) ] had a ten-year survival rate of 21.36%, and 43.59% (1 465/3 361) had a ten-year survival rate close to zero. The Tobit regression results showed that primary school degree or above and non-smoking behavior were protective factors for HRQoL; while female, aged over 60 years, widowhood, self-rated health status as poor, non-drinking behavior, insufficient or excessive sleep duration, no moderate-intensity activity, four or more chronic diseases, and more than three outpatient visits were risk factors for HRQoL (P<0.05) .

Conclusion

The HRQoL among Chinese elderly patients with multimorbidity was relatively poor, and factors such as marital status, educational level, sleep duration, physical activity, number of chronic diseases deserve to be focused on. Healthy lifestyle guidance for elderly patients with multimorbidity should be strengthened to further improve the quality of life of this population.

Key words: Multimorbidity, Multiple chronic conditions, Health-related quality of life, EQ-5D-3L, Tobit model

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