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Article(id=1241025208379831151, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202410471, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1729699200000, receivedDateStr=2024-10-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773813066810, onlineDateStr=2026-03-18, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773813066810, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773813066810, creator=13701087609, updateTime=1773813066810, updator=13701087609, issue=Issue{id=1241025201983508979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='7', pageStart='1153', pageEnd='1344', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773813065285, creator=13701087609, updateTime=1773815493878, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035388320543403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035388320543404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1153, endPage=1157, ext={EN=ArticleExt(id=1241025211005465581, articleId=1241025208379831151, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the correlation between different combinations of chronic diseases and health-related quality of life among patients with chronic diseases, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the relationship between different combinations of chronic diseases and health-related quality of life (HRQoL) among rural patients with chronic diseases in Shandong Province, and to provide references for improving the HRQoL of patients with chronic diseases.

Methods

A multi-stage random sampling method was used to select 531 patients with chronic diseases in Shandong Province for face-to-face questionnaires. The EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) was used to evaluate the patients’ HRQoL. The Tobit regression model was used to analyze the influencing factors of patients’HRQoL.

Results

Among rural patients with chronic diseases, the combinations of chronic diseases with relatively high prevalence rates were arthritis + other diseases (excluding digestive system diseases), pure metabolic diseases, and stroke + metabolic diseases or stroke + metabolic diseases + heart disease, accounting for 27.68%, 19.59%, and 12.81% respectively. The results of the Tobit model showed that the influencing factors of the health utility value of rural patients with chronic diseases were age ≥ 75 years, the course of multiple chronic diseases exceeding 10 years, and disease combinations: patients with any one of digestive system diseases, arthritis, or stroke as part of multiple chronic diseases had significantly lower HRQoL than those with other combinations of chronic diseases.

Conclusion

There are significant differences in the HRQoL of rural patients with chronic diseases with different combinations of chronic diseases. Attention should be paid to health promotion among rural residents, and early screening and prevention should be carried out for high-risk patients with digestive system diseases, arthritis, and stroke to improve the HRQoL of rural residents.

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目的

分析山东省农村慢性病患者不同慢病组合与健康相关生命质量(health-related quality of life，HRQoL)的关系，为提高慢性病患者HRQoL提供参考。

方法

采用多阶段随机抽样方法在山东省抽取531名慢性病患者进行面对面问卷调查；采用欧洲五水平五维生命质量量表（EuroQol five-dimensional five-level questionnaire，EQ-5D-5L）对患者HRQoL进行评定；以Tobit回归模型分析患者HRQoL的影响因素。

结果

在农村慢性病患者中，患病率较高的慢性病组合分别为关节炎+其他病（不包括消化系统疾病）、纯代谢性疾病、卒中+代谢性疾病或卒中+代谢性疾病+心脏病，分别占27.68%、19.59%、12.81%。Tobit模型结果显示，农村慢性病患者健康效用值的影响因素为年龄≥75岁、多重慢性病病程超过10年以及疾病组合（患有消化系统疾病、关节炎或者卒中里的任何一种作为多重慢性病一部分的患者），其HRQoL显著低于其他慢性病组合。

结论

不同慢性病组合的农村慢性病患者HRQoL的差异较大，应重视对农村居民的健康宣传，对消化系统疾病、关节炎和卒中的高危患者做到早筛查早预防，提高农村居民HRQoL。

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李慧，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=qpiP2N5o84mvId5HLoiSPg==, magXml=7Pu4wVnBgUXD0j9vyXwNkQ==, pdfUrl=null, pdf=Ao1AmhwpCYuKA5dwTc8aDQ==, pdfFileSize=716945, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=aOp1cpiB7R2k7brJhrD/tg==, mapNumber=null, authorCompany=null, fund=null, authors=

高士娟（2000—），女，硕士在读，研究方向：慢性病相关研究

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高士娟（2000—），女，硕士在读，研究方向：慢性病相关研究

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Countryside Agriculture Farmers， 2023，(10):32-35.(In Chinese), articleTitle=The influence of children's emotional support on mental health of the elderly and its difference between urban and rural areas, refAbstract=null)], funds=[Fund(id=1241025219373101526, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, awardId=2020YFC2006500; 2020YFC2006505, language=CN, fundingSource=国家重点研发计划项目(2020YFC2006500; 2020YFC2006505), fundOrder=null, country=null), Fund(id=1241025219473764825, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, awardId=18-298, language=CN, fundingSource=美国中华医学会公开竞争项目“基于远程血压测量的社区高血压管理模式研究”(18-298), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241025212670603434, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, xref=1., ext=[AuthorCompanyExt(id=1241025212674797741, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, companyId=1241025212670603434, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University,Jinan, Shandong 250012,China), AuthorCompanyExt(id=1241025212683186348, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, companyId=1241025212670603434, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心，山东 济南 250012)]), AuthorCompany(id=1241025212792238266, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, xref=2., ext=[AuthorCompanyExt(id=1241025212800626876, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, companyId=1241025212792238266, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学) ，山东 济南 250012)])], figs=[ArticleFig(id=1241025216822964623, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=EN, label=Table 1, caption=

Combinations of chronic diseases

, figureFileSmall=null, figureFileBig=null, tableContent=
名称慢病组合备注
组合一a、b、c （任2项及以上）所患疾病为纯代谢性疾病
组合二g+（a、b、c任一项及以上）心脏病+代谢性疾病
组合三h+（ a、b、c任一项及以上）或h+（ a、b、c任一项及以上）+g包含卒中+代谢性疾病或卒中+代谢性疾病+心脏病
组合四m+（a、b、c、d、e、f、g、h、i、k、l、n任一项及以上）关节炎+其他病（不包括消化系统疾病）
组合五j+（a、b、c、d、e、f、g、h、i、k、l、n任一项及以上）消化系统疾病+其他病（不包括关节炎）
组合六j+m+（a、b、c、d、e、f、g、h、i、k、l、n）消化系统疾病+关节炎+其他病
组合七其他组合疾病
), ArticleFig(id=1241025216944599452, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=CN, label=表1, caption=

慢病组合

, figureFileSmall=null, figureFileBig=null, tableContent=
名称慢病组合备注
组合一a、b、c （任2项及以上）所患疾病为纯代谢性疾病
组合二g+（a、b、c任一项及以上）心脏病+代谢性疾病
组合三h+（ a、b、c任一项及以上）或h+（ a、b、c任一项及以上）+g包含卒中+代谢性疾病或卒中+代谢性疾病+心脏病
组合四m+（a、b、c、d、e、f、g、h、i、k、l、n任一项及以上）关节炎+其他病（不包括消化系统疾病）
组合五j+（a、b、c、d、e、f、g、h、i、k、l、n任一项及以上）消化系统疾病+其他病（不包括关节炎）
组合六j+m+（a、b、c、d、e、f、g、h、i、k、l、n）消化系统疾病+关节炎+其他病
组合七其他组合疾病
), ArticleFig(id=1241025217041068452, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=EN, label=Table 2, caption=

The EQ-5D-5L scale based on the utility value points system of Chinese residents

, figureFileSmall=null, figureFileBig=null, tableContent=
水平行动能力（MO）自我照顾能力（SC）日常活动能力（UA）疼痛/不适（PD）焦虑/抑郁（AD）
1.没有困难00000
2.有一点困难0.0660.0480.0450.0580.049
3.中度困难0.1580.1160.1070.1380.118
4.有严重困难0.2870.2100.1940.2520.215
5.极度困难0.3450.2530.2330.3020.258
), ArticleFig(id=1241025217158508969, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=CN, label=表2, caption=

EQ-5D-5L量表基于中国居民的效用值积分体系

, figureFileSmall=null, figureFileBig=null, tableContent=
水平行动能力（MO）自我照顾能力（SC）日常活动能力（UA）疼痛/不适（PD）焦虑/抑郁（AD）
1.没有困难00000
2.有一点困难0.0660.0480.0450.0580.049
3.中度困难0.1580.1160.1070.1380.118
4.有严重困难0.2870.2100.1940.2520.215
5.极度困难0.3450.2530.2330.3020.258
), ArticleFig(id=1241025217238200747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=EN, label=Table 3, caption=

Comparison of health utility values of patients with multiple chronic diseases with different characteristics (n=531)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量健康效用值（）t/F值P值
性别0.5130.608
男(n=217)0.817±0.232
女(n=314)0.807±0.229
年龄（岁）9.137<0.001
<60(n=77)0.901±0.162
60～74(n=308)0.810±0.232
>74(n=146)0.765±0.243
婚姻0.2750.760
未婚(n=5)0.887±0.218
已婚(n=422)0.811±0.240
丧偶及离异(n=104)0.809±0.185
职业/退休前职业1.7870.168
非农业劳动者(n=54)0.853±0.229
农业劳动者(n=450)0.803±0.234
无业(n=27)0.860±0.126
文化程度2.0710.127
未上过学(n=183)0.792±0.215
小学及以下(n=212)0.806±0.242
初中及以上(n=136)0.844±0.228
医疗费用主要支出形式2.9280.004
家庭收入或积蓄(n=327)0.834±0.218
儿女及其他形式(n=204)0.774±0.243
家庭年收入(万元)4.6470.010
<1(n=334)0.789±0.237
1～3 (n=130)0.840±0.218
>3(n=67)0.867±0.198
疾病数量（种）3.975<0.001
2～3(n=415)0.832±0.216
4～6(n=116)0.737±0.262
慢病组合11.360<0.001
组合一(n=104)0.914±0.149
组合二(n=85)0.896±0.147
组合三(n=68)0.725±0.325
组合四(n=147)0.753±0.218
组合五(n=52)0.800±0.249
组合六(n=28)0.680±0.244
组合七(n=47)0.826±0.205
多重慢病病程(年)9.337<0.001
<5(n=179)0.847±0.214
5～10(n=254)0.818±0.216
>10(n=98)0.726±0.270
), ArticleFig(id=1241025217364029877, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=CN, label=表3, caption=

不同特征多重慢病患者健康效用值比较（n=531）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量健康效用值（）t/F值P值
性别0.5130.608
男(n=217)0.817±0.232
女(n=314)0.807±0.229
年龄（岁）9.137<0.001
<60(n=77)0.901±0.162
60～74(n=308)0.810±0.232
>74(n=146)0.765±0.243
婚姻0.2750.760
未婚(n=5)0.887±0.218
已婚(n=422)0.811±0.240
丧偶及离异(n=104)0.809±0.185
职业/退休前职业1.7870.168
非农业劳动者(n=54)0.853±0.229
农业劳动者(n=450)0.803±0.234
无业(n=27)0.860±0.126
文化程度2.0710.127
未上过学(n=183)0.792±0.215
小学及以下(n=212)0.806±0.242
初中及以上(n=136)0.844±0.228
医疗费用主要支出形式2.9280.004
家庭收入或积蓄(n=327)0.834±0.218
儿女及其他形式(n=204)0.774±0.243
家庭年收入(万元)4.6470.010
<1(n=334)0.789±0.237
1～3 (n=130)0.840±0.218
>3(n=67)0.867±0.198
疾病数量（种）3.975<0.001
2～3(n=415)0.832±0.216
4～6(n=116)0.737±0.262
慢病组合11.360<0.001
组合一(n=104)0.914±0.149
组合二(n=85)0.896±0.147
组合三(n=68)0.725±0.325
组合四(n=147)0.753±0.218
组合五(n=52)0.800±0.249
组合六(n=28)0.680±0.244
组合七(n=47)0.826±0.205
多重慢病病程(年)9.337<0.001
<5(n=179)0.847±0.214
5～10(n=254)0.818±0.216
>10(n=98)0.726±0.270
), ArticleFig(id=1241025218857202109, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=EN, label=Table 4, caption=

Composition distribution of EQ-5D in 5 dimensions in patients with multiple chronic diseases (n=531)

, figureFileSmall=null, figureFileBig=null, tableContent=
维度没有困难有一点困难中度困难有严重困难极度困难
例数构成比（%）例数构成比（%）例数构成比（%）例数构成比（%）例数构成比（%）
行动能力27752.1613926.186812.81417.7261.13
自我照顾能力41377.787514.13285.27112.0740.75
日常生活能力34164.2211722.03478.85193.5871.32
疼痛/不舒服21841.0620137.858415.82285.2700
焦虑/抑郁39273.829718.27346.4081.5100
), ArticleFig(id=1241025218978836931, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=CN, label=表4, caption=

多重慢病患者EQ-5D-5L五个维度各水平的构成分布（n=531）

, figureFileSmall=null, figureFileBig=null, tableContent=
维度没有困难有一点困难中度困难有严重困难极度困难
例数构成比（%）例数构成比（%）例数构成比（%）例数构成比（%）例数构成比（%）
行动能力27752.1613926.186812.81417.7261.13
自我照顾能力41377.787514.13285.27112.0740.75
日常生活能力34164.2211722.03478.85193.5871.32
疼痛/不舒服21841.0620137.858415.82285.2700
焦虑/抑郁39273.829718.27346.4081.5100
), ArticleFig(id=1241025219108860358, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=EN, label=Table 5, caption=

Multifactor Tobit regression analysis of health utility values in patients with multiple chronic diseases (n=531)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量sxbart值P值β(95%CI)
年龄（岁，≤59为参照）
60～740.029-1.5100.131-0.043 (-0.100～0.013)
≥750.033-2.3700.018-0.078 (-0.143～-0.013)
慢病组合（组合一为参照）
组合二0.031-0.1500.877-0.005 (-0.066～0.056)
组合三0.033-5.370<0.001-0.177 (-0.242～-0.112)
组合四0.028-4.910<0.001-0.139 (-0.195～-0.083)
组合五0.037-2.5500.011-0.094 (-0.166～-0.022)
组合六0.048-3.550<0.001-0.172 (-0.267～-0.077)
组合七0.038-1.5600.118-0.060 (-0.135～0.015)
多重慢病病程（<5年为参照）
5～10年0.021-0.1300.895-0.003 (-0.044～0.039)
>10年0.028-2.4000.017-0.067 (-0.123～-0.012)
), ArticleFig(id=1241025219238883791, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025208379831151, language=CN, label=表5, caption=

多重慢病患者健康效用值的多因素Tobit回归分析（n=531）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量sxbart值P值β(95%CI)
年龄（岁，≤59为参照）
60～740.029-1.5100.131-0.043 (-0.100～0.013)
≥750.033-2.3700.018-0.078 (-0.143～-0.013)
慢病组合（组合一为参照）
组合二0.031-0.1500.877-0.005 (-0.066～0.056)
组合三0.033-5.370<0.001-0.177 (-0.242～-0.112)
组合四0.028-4.910<0.001-0.139 (-0.195～-0.083)
组合五0.037-2.5500.011-0.094 (-0.166～-0.022)
组合六0.048-3.550<0.001-0.172 (-0.267～-0.077)
组合七0.038-1.5600.118-0.060 (-0.135～0.015)
多重慢病病程（<5年为参照）
5～10年0.021-0.1300.895-0.003 (-0.044～0.039)
>10年0.028-2.4000.017-0.067 (-0.123～-0.012)
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慢性病患者不同慢病组合与健康相关生命质量的相关性研究
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高士娟 1, 2 , 张茗语 1, 2 , 潘东杰 1, 2 , 王海鹏 1, 2 , 李慧 1, 2
现代预防医学 | 流行病与统计方法 2025,52(7): 1153-1157
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现代预防医学 | 流行病与统计方法 2025, 52(7): 1153-1157
慢性病患者不同慢病组合与健康相关生命质量的相关性研究
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高士娟1, 2, 张茗语1, 2, 潘东杰1, 2, 王海鹏1, 2, 李慧1, 2
作者信息
  • 1.山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心，山东 济南 250012
  • 2.国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学) ，山东 济南 250012

    • 高士娟（2000—），女，硕士在读，研究方向：慢性病相关研究

通讯作者:

李慧，E-mail:
Research on the correlation between different combinations of chronic diseases and health-related quality of life among patients with chronic diseases
Shi-juan GAO1, 2, Ming-yu ZHANG1, 2, Dong-jie PAN1, 2, Hai-peng WANG1, 2, Hui LI1, 2
Affiliations
  • Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University,Jinan, Shandong 250012,China
出版时间: 2025-04-10 doi: 10.20043/j.cnki.MPM.202410471
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摘要
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目的

分析山东省农村慢性病患者不同慢病组合与健康相关生命质量(health-related quality of life，HRQoL)的关系，为提高慢性病患者HRQoL提供参考。

方法

采用多阶段随机抽样方法在山东省抽取531名慢性病患者进行面对面问卷调查；采用欧洲五水平五维生命质量量表（EuroQol five-dimensional five-level questionnaire，EQ-5D-5L）对患者HRQoL进行评定；以Tobit回归模型分析患者HRQoL的影响因素。

结果

在农村慢性病患者中，患病率较高的慢性病组合分别为关节炎+其他病（不包括消化系统疾病）、纯代谢性疾病、卒中+代谢性疾病或卒中+代谢性疾病+心脏病，分别占27.68%、19.59%、12.81%。Tobit模型结果显示，农村慢性病患者健康效用值的影响因素为年龄≥75岁、多重慢性病病程超过10年以及疾病组合（患有消化系统疾病、关节炎或者卒中里的任何一种作为多重慢性病一部分的患者），其HRQoL显著低于其他慢性病组合。

结论

不同慢性病组合的农村慢性病患者HRQoL的差异较大，应重视对农村居民的健康宣传，对消化系统疾病、关节炎和卒中的高危患者做到早筛查早预防，提高农村居民HRQoL。

多重慢病  /  慢病组合  /  健康相关生命质量  /  EQ-5D-5L量表
Objective

To analyze the relationship between different combinations of chronic diseases and health-related quality of life (HRQoL) among rural patients with chronic diseases in Shandong Province, and to provide references for improving the HRQoL of patients with chronic diseases.

Methods

A multi-stage random sampling method was used to select 531 patients with chronic diseases in Shandong Province for face-to-face questionnaires. The EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) was used to evaluate the patients’ HRQoL. The Tobit regression model was used to analyze the influencing factors of patients’HRQoL.

Results

Among rural patients with chronic diseases, the combinations of chronic diseases with relatively high prevalence rates were arthritis + other diseases (excluding digestive system diseases), pure metabolic diseases, and stroke + metabolic diseases or stroke + metabolic diseases + heart disease, accounting for 27.68%, 19.59%, and 12.81% respectively. The results of the Tobit model showed that the influencing factors of the health utility value of rural patients with chronic diseases were age ≥ 75 years, the course of multiple chronic diseases exceeding 10 years, and disease combinations: patients with any one of digestive system diseases, arthritis, or stroke as part of multiple chronic diseases had significantly lower HRQoL than those with other combinations of chronic diseases.

Conclusion

There are significant differences in the HRQoL of rural patients with chronic diseases with different combinations of chronic diseases. Attention should be paid to health promotion among rural residents, and early screening and prevention should be carried out for high-risk patients with digestive system diseases, arthritis, and stroke to improve the HRQoL of rural residents.

Multiple chronic diseases  /  Combinations of chronic diseases  /  Health-related quality of life  /  EQ-5D-5L scale
高士娟, 张茗语, 潘东杰, 王海鹏, 李慧. 慢性病患者不同慢病组合与健康相关生命质量的相关性研究. 现代预防医学, 2025 , 52 (7) : 1153 -1157 . DOI: 10.20043/j.cnki.MPM.202410471
Shi-juan GAO, Ming-yu ZHANG, Dong-jie PAN, Hai-peng WANG, Hui LI. Research on the correlation between different combinations of chronic diseases and health-related quality of life among patients with chronic diseases[J]. Modern Preventive Medicine, 2025 , 52 (7) : 1153 -1157 . DOI: 10.20043/j.cnki.MPM.202410471
正文
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随着人均期望寿命的增加以及生活方式的变化，我国慢性疾病（简称慢病）患病率逐年升高。在中国，目前有超过1.8亿的老年人患有慢病，且其中75%的人口同时患有多种慢病[1]。多重慢病即同一个体同时患有两种或两种以上的慢病[2]。健康中国2030指出：“共建共享、全民健康”。实现全民健康、提高全民健康素养，需要我们深入理解健康相关生命质量(health-related quality of life，HRQoL)的内涵。HRQoL是衡量人群健康水平的重要指标，指个体在生理、心理和社会功能等方面的健康状况对其生活质量的影响，涵盖了与经济、文化背景、价值观以及社会支持等因素相关的主观体验，反映了个体对健康的整体感知和生活满意度[3]。相比城市地区，农村居民由于生活习惯、饮食习惯等因素影响，其多重慢病患病率更高[4]。不同的多重慢病具有独特的临床表现，治疗方案也各不相同。虽然这些治疗方法在一定程度上能够缓解患者的病情，但由于需要长期护理，患者不仅面临增加的经济和心理负担，还可能因治疗过程中的药物副作用、身体适应等原因，对身体健康造成不同程度的损害，从而降低患者的HRQoL，增加其死亡风险[5-7]。目前，仅有少量研究涉及常见的多重慢病疾病组合[8-10]，缺乏不同慢病组合与HRQoL关系的研究，因此，本研究旨在对山东省农村慢病患者HRQoL进行调查，并分析不同慢病组合与HRQoL的关系，以期为提升和改善农村慢病患者HRQoL提供依据。
1　对象与方法
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1.1　研究对象
本研究采用多阶段分层随机抽样方法，于2019年11月在山东省选取济南市平阴县和潍坊市寿光市两地作为抽样单位，在每个选定的县（市），随机选取两个乡镇，并进一步在每个乡镇中随机挑选四个村庄进行样本抽取。样本村庄中的调查对象由当地医务工作者从农村电子健康档案系统中的多重慢病患者群体中随机抽取，每个村庄抽取35名符合研究标准的多重慢病患者。整个抽样过程共选取了16个村庄，最终得到560名符合条件的农村多重慢病患者作为调查样本。在这些被选中的参与者中，共有531名完成了问卷调查，问卷的有效回收率达到了94.82%，本研究伦理审查编号为ECSHCMSDU20170401。
纳入标准：（1）年龄>18岁；（2）户籍为山东省抽样农村地区的常住居民；（3）意识清晰，并能够完成现场问卷调查；（4）患有至少2种慢病，且病程超过1年；（5）所纳入疾病的种类是基于中国健康与养老追踪调查数据库（China Health and Retirement Longitudinal Study， CHARLS）包含的14种慢病；（6）获得被访者的知情同意。排除标准：（1）存在严重听力障碍或无法与他人进行正常交流沟通者；（2）在调查过程中拒绝或无法配合完成完整问卷的被访者。
1.2　研究方法与工具
采用纸质版问卷进行面对面问卷调查。调查内容：（1）一般情况：包括基本信息（如性别、年龄、婚姻状况、职业/退休前职业、文化程度、家庭年收入、医疗费用主要支出形式等）以及慢病患病情况（疾病类型、疾病数量、多重慢病病程等）。本研究慢病类型包括：a高血压、b血脂异常（高脂血症或低脂血症）、c糖尿病或血糖升高（包括糖耐量异常和空腹血糖升高）、d癌症等恶性肿瘤（不包括轻度皮肤癌）、e慢性肺部疾病（如慢性支气管炎或肺气肿、肺心病，不包括肿瘤或者癌）、f肝脏疾病（除脂肪肝、肿瘤或癌外）、g心脏病（如心肌梗死、冠心病、心绞痛、心力衰竭等）、h卒中、i肾脏疾病（不包括肿瘤或癌）、j胃或消化系统疾病（简称消化系统疾病）、k情感及精神方面问题、l与记忆相关疾病（如阿尔茨海默症、脑萎缩、帕金森等）、m关节炎或风湿病（简称关节炎）、n哮喘。根据研究目的以及互不重合的原则，本研究将多重慢病分为7组，疾病组合编码见表1。（2）HRQoL测量：采用欧洲五水平五维生命质量量表（EuroQol five-dimensional five-level questionnaire，EQ-5D-5L），该量表是一种广泛使用的HRQoL评估工具。EQ-5D-5L量表包含五个维度，每个维度包含五个水平。本研究EQ-5D-5L量表的Cronbach α系数为0.806，内部一致性信度良好。不同的健康状况通过效用值积分体系的转换[11]得出相应的健康效用值，健康效用值越高表示生命质量越好。见表2。计算公式为：健康效用值=1-（MOn+SCn+UAn+PDn+ADn）；其中n=1，2，3，4，5。计算所得EQ-5D-5L得分范围为[-0.391～1.000]。
1.3　统计方法
本研究使用SPSS 27.0和Stata17.0软件进行数据分析。对计量资料以（均数±标准差）表示，计数资料以例数和构成比表示。单因素分析采用t检验或方差分析，分析不同慢病组合对HRQoL的影响时使用Tobit回归模型。检验水准α=0.05。
2　结果
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2.1　研究对象社会经济学特征及多重慢病患病情况
531名多重慢病患者中，男性217例（40.87%）女性314例（59.13%）。年龄在41～89岁，平均年龄为69.51岁，其中以60～74岁为主，占58.00%，其次为75岁以上，占27.50%。患2～3种慢病的患者有415人（78.15%）、4～6种慢病的患者有116人（21.85%）。根据本研究分类的组合，以组合四为主，占27.68%，其次为组合一，占19.59%，组合三、组合五、组合六比例分别为12.81%、9.79%、5.27%。多重慢病病程以5～10年居多，占比高达47.83%。见表3。
2.2　EQ-5D量表各维度不同水平分布
531例多重慢病患者中有149例（28.06%）患者各维度评价结果均为没有困难，有382例（71.94%）患者各维度均有不同程度的困难。在行动能力、自我照顾能力、日常生活能力、疼痛/不舒服、焦虑/抑郁这五个维度中，存在中度及以上困难者分别为115 (21.66%)、43 (8.09%)、73 (13.75%)、112 (21.09%)和42例(7.91%)，可见在所调查的多重慢病患者中行动能力受限最严重，其次为疼痛/不适，而焦虑/抑郁维度占比相对较少。见表4。
2.3　多重慢病患者健康效用值单因素分析
本研究中，多重慢病患者健康效用值为（0.811±0.230），最小值为-0.298，最大值为1.000。分析结果显示，不同的年龄、医疗费用主要支出形式、家庭年收入、疾病数量、慢病组合、多重慢病病程的患者健康效用值差异具有统计学意义（P<0.05）。见表3。
2.4　多重慢病患者健康效用值影响因素分析
运用Tobit回归模型进行多因素分析。将慢病组合作为自变量，年龄、医疗费用主要支出形式、家庭年收入、疾病数量以及多重慢病病程作为协变量，健康效用值作为因变量，检验水准设定为α=0.05。经过共线性诊断，发现本研究所包含的自变量的方差膨胀因子介于1.09～2.62之间，表明自变量之间不存在共线性问题。Tobit回归结果显示，影响山东省农村多重慢病患者健康效用值的影响因素包括年龄、慢病组合以及多重慢病病程。见表5。
3　讨论
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3.1　多重慢病患者的HRQoL显著低于其他人群，且疾病组合分类不统一
根据已有的研究成果[12-13]，多重慢病患者的HRQoL明显低于仅患一种或无慢病的人群。并且患有多种慢病的居民在五维度上遇到健康问题的可能性明显高于只患有一种慢病或没有慢病的居民。多重慢病不仅增加了疾病负担和治疗的复杂性[14]，还降低了居民的HRQoL。本研究结果表明农村多重慢病患者健康效用值为（0.811±0.230），这一数值显著低于社区居民的健康效用值[12]。目前，有关具体的慢病组合与HRQoL关系的研究较少且不统一[9，15]，本研究尝试以人体系统疾病的角度将多重慢病患者进行分类，该分组方式更能体现多重慢病患者的主要患病特征。结果发现本研究的慢病组合能够将多重慢病人群的HRQoL进行合理有效的区分，为多重慢病的分类管理提供支撑。本研究对不同慢病组合与HRQoL之间的关系进行了初步探讨，未来针对多重慢病的分组及管理需进一步细化，应结合患者的疾病类型、病程以及并发症等因素，制定更加个性化的干预措施。
3.2　患有消化系统疾病、关节炎或者卒中里的任何一种作为多重慢病一部分的患者，其HRQoL显著低于其他慢病组合
山东省农村慢性病患者不同慢病组合的HRQoL具有明显的差异。纯代谢性疾病的患者HRQoL状况是最好的，一旦患有消化系统疾病、关节炎或卒中里的任意一种，其HRQoL状况将明显下降。消化系统疾病会引起躯体反应（疼痛、恶心或呕吐等），引发负性情绪[16]，严重影响日常生活及工作。患有关节炎的患者行动能力受限严重，且经常处于疼痛/不适状态。卒中疾病的治疗时间长、效果不佳[17]，其后遗症不仅影响患者的行动能力，还影响认知及心理健康。由于农村居民对慢病防治知识的认知不足，对必要检测的知晓率偏低，且许多人在生活方式上存在不良习惯，这些因素在很大程度上影响了其慢病的发病风险。此外，已患病的农村居民治疗过程多不规范[18]，加之经济条件相对落后，这些因素共同导致农村地区居民对消化系统疾病、关节炎或卒中等常见慢病的了解和认识明显不足。他们对这类疾病的容忍度相对较高，往往在症状轻微时选择忽视。这种对疾病的轻视态度，往往导致了一个恶性循环：初期不重视，使得病情逐渐恶化；当疾病发展到难以忍受的程度时，才被迫前往医院就诊，此时治疗难度大，效果不佳，严重影响了患者的HRQoL。因此，除了在对患者进行常规治疗以及康复锻炼外，也应加强对农村居民的健康宣传以及对消化系统疾病、关节炎以及卒中的高危人群做到早筛查早预防，与家庭医生签约服务相结合，为农村居民提供全方位全周期的整合型医疗服务管理，帮助这一群体树立正确的健康观念，做到“未病先防，既病防变”，降低其发病率，延缓疾病的进展，保障多重慢病患者的HRQoL。
3.3　年龄和多重慢病病程也会影响多重慢病患者
HRQoL本研究结果表明，年龄≥75岁以及多重慢病病程超过10年的患者，其健康效用值显著降低。随着年龄增长和病程延长，患者的免疫功能减弱[19]，长期暴露于各种危险因素下，疾病易进展至中后期并引发并发症，进一步影响健康状况。此外，随着年龄增长和病程延长，患者医疗开支增多，生活自理能力下降，且对子女依赖性增加，同时与子女见面次数减少，这一系列变化导致老年患者的心理健康状况较差，进而显著影响其HRQoL[20-21]。因此，我们应加强老年群体的健康管理和早期干预，优化疾病管理模式，加强居家护理服务，并且关注老年患者的心理健康和社会支持，加强对老年群体的心理关怀。
综上所述，不同慢病组合对慢病患者的HRQoL有着显著影响。患有消化系统疾病、关节炎或者卒中里的任何一种作为多重慢病一部分的患者，其HRQoL显著低于其他慢病组合。目前，关于常见多重慢病组合的研究仍较为有限，且缺乏深入探讨不同慢病组合与HRQoL之间关系的文献。本研究从不同慢病组合与HRQoL的关系出发，具有较高的创新性和研究价值。然而，本研究主要针对山东省农村居民群体，未来的研究将进一步扩大样本范围，以更广泛的人群为基础，深入探讨不同慢病组合对HRQoL的影响。
基金
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  • 国家重点研发计划项目(2020YFC2006500; 2020YFC2006505)
  • 美国中华医学会公开竞争项目“基于远程血压测量的社区高血压管理模式研究”(18-298)
文献
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2025年第52卷第7期
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doi: 10.20043/j.cnki.MPM.202410471
  • 接收时间：2024-10-24
  • 首发时间：2026-03-18
  • 出版时间：2025-04-10
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  • 收稿日期：2024-10-24
基金
国家重点研发计划项目(2020YFC2006500; 2020YFC2006505)
美国中华医学会公开竞争项目“基于远程血压测量的社区高血压管理模式研究”(18-298)
作者信息
    1.山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心，山东 济南 250012
    2.国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学) ，山东 济南 250012

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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