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Article(id=1241322671548461248, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241322661654098823, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308275, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1692115200000, receivedDateStr=2023-08-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773883987557, onlineDateStr=2026-03-19, pubDate=1706112000000, pubDateStr=2024-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773883987557, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773883987557, creator=13701087609, updateTime=1773883987557, updator=13701087609, issue=Issue{id=1241322661654098823, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='2', pageStart='193', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773883985198, creator=13701087609, updateTime=1773890256678, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241348966214849502, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241322661654098823, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241348966214849503, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241322661654098823, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=314, endPage=321, ext={EN=ArticleExt(id=1241322673146491097, articleId=1241322671548461248, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Impacts of Financial Burden on Health-Related Quality of Life in elderly patients with Chronic Comorbiditiesbased on the mediated effect of regulation, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigating the impact of Financial Burden on Health-Related Quality of Life in elderly patients with Chronic Comorbid Conditions and its mechanisms.

Methods

A convenience sample of 493 chronic comorbid patients was extracted from two community health service centers in Yanji City. General information was collected using a questionnaire, and the Patient Experiences with Primary Care (ASPC) scale, Comprehensive Score of Financial Burden (COST), Herth Hope Scale, and SF-36 Health Survey were utilized for the investigation.Univariate analysis, partial correlation analysis, and testing a moderated mediation model was conducted.

Results

(1) Financial Burden significantly predicted HRQoL(β=0.32, 95% CI:0.24-0.40, P<0.001);(2) Hope level partially mediated the relationship between Financial Burden and HRQoL (β=0.12, 95% CI:0.08-0.16, P<0.001), accounting for 37% of the total effect; (3) The direct predictive effect of Financial Burden on health-related quality of life (β=0.07, 95% CI:0.01-0.14，P<0.05) and the mediating role of hope in their relationship(β=0.13，95% CI：0.05-0.21，P<0.01) were both moderated by the core features of comprehensive primary care.

Conclusion

This study reveals the mechanism by which Financial Burden impacts HRQoL in elderly patients with chronic comorbidities. The findings emphasize the importance of enhancing economic support and hope levels for this patient group and highlight the role of comprehensive primary care function in mitigating the adverse effects of Financial Burden on HRQoL. These insights contribute to providing more comprehensive and effective medical services to patients with chronic comorbidities, alleviating the impact of Financial Burden, and enhancing their overall quality of life.

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目的

探究老年慢性病共病患者经济负担对健康相关生活质量的影响及其作用机制。

方法

便利抽取延吉市两所社区卫生服务中心门诊493名老年慢性病共病患者，采用一般资料调查表、全科医疗核心特征功能患者服务体验量表（ASPC）、慢性病治疗经济毒性功能评估综合评分量表(COST)和Herth希望量表、SF-36健康调查量表进行调查。对数据进行单因素分析、偏相关分析及有调节的中介模型检验。

结果

（1）经济负担对健康相关生活质量具有显著预测作用(β=0.32，95% CI：0.24～0.40，P<0.001);(2)希望水平在经济负担与健康相关生活质量的关系中起部分中介作用，效应值为0.12，（95% CI：0.08～0.16，P<0.001），占总效应的37%;(3) 经济负担对健康相关生活质量的直接预测作用（β=0.07，95% CI：0.01～0.14，P<0.05）及希望水平在二者关系中的中介作用（β=0.13，95% CI：0.05～0.21，P<0.01）均受全科医疗核心特征功能的调节。

结论

本研究展示了经济负担对老年慢性病患者健康相关生活质量可能的影响机制，强调了提高老年慢性病共病患者的经济保障和希望水平的重要性，并凸显了全科医疗核心特征功能在缓解经济负担对生活质量的不利影响中的作用。这些发现有助于为老年慢性病共病患者提供更全面和有效的医疗服务，从而缓解经济负担的影响，提高其生活质量。

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吴善玉，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=FqAxP838vPHkjhx+EH1UUA==, magXml=loNsLuRJrEntikaoeC4Iyw==, pdfUrl=null, pdf=33HOTs1UvmP2WkCDkEqPzQ==, pdfFileSize=866082, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=ETolApMYIP0oBGDT1KQyhg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=NdcTyydvUoN+aTi2q2lBDg==, mapNumber=null, authorCompany=null, fund=null, authors=

王哲（1999—），女，硕士在读，研究方向：社区护理

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王哲（1999—），女，硕士在读，研究方向：社区护理

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Health Education & Behavior: the Official Publication of the Society for Public Health Education, 2021, 48(6): 885-891., articleTitle=Debt-Related financial hardship and health, refAbstract=null), Reference(id=1241322688812217250, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, doi=null, pmid=null, pmcid=null, year=2017, volume=44, issue=24, pageStart=4454, pageEnd=4457, url=null, language=null, rfNumber=[20], rfOrder=27, authorNames=杨丽宏, 刘丽娟, journalName=现代预防医学, refType=null, unstructuredReference=杨丽宏，刘丽娟．希望水平在空巢老人家庭功能与生活质量间的中介作用研究[J]．现代预防医学，2017，44（24）：4454-4457., articleTitle=希望水平在空巢老人家庭功能与生活质量间的中介作用研究, refAbstract=null), Reference(id=1241322688879326116, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, doi=null, pmid=null, pmcid=null, year=2017, volume=44, issue=24, pageStart=4454, pageEnd=4457, url=null, language=null, rfNumber=[20], rfOrder=28, authorNames=Yang LH, Liu LJ, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Yang LH, Liu LJ. Mediating effect of aspiration level on the relationship between family function and quality of life among empty nesters[J]. Modern Preventive Medicine, 2017, 44(24): 4454-4457., articleTitle=Mediating effect of aspiration level on the relationship between family function and quality of life among empty nesters, refAbstract=null), Reference(id=1241322688946434982, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, doi=null, pmid=null, pmcid=null, year=2022, volume=25, issue=1, pageStart=62, pageEnd=69, url=null, language=null, rfNumber=[21], rfOrder=29, authorNames=杨斯曼, 张曦, 周梦萍, journalName=中国全科医学, refType=null, unstructuredReference=杨斯曼，张曦，周梦萍，等．全科医疗核心特征功能对糖尿病患者治疗依从性的影响研究[J]．中国全科医学，2022，25（1）：62-69., articleTitle=全科医疗核心特征功能对糖尿病患者治疗依从性的影响研究, refAbstract=null), Reference(id=1241322689042903978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, doi=null, pmid=null, pmcid=null, year=2022, volume=25, issue=1, pageStart=62, pageEnd=69, url=null, language=null, rfNumber=[21], rfOrder=30, authorNames=Yang SM, Zhang X, Zhou MP, journalName=Chinese General Practice, refType=null, unstructuredReference=Yang SM, Zhang X, Zhou MP, et al. 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Chinese General Practice, 2022, 25(1): 62-69., articleTitle=Effect of core values of general practice on adherence of patients with diabetes, refAbstract=null), Reference(id=1241322689122595754, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, doi=null, pmid=null, pmcid=null, year=2020, volume=47, issue=21, pageStart=3859, pageEnd=3862, url=null, language=null, rfNumber=[22], rfOrder=31, authorNames=夏昉, 刘金萍, 于露, journalName=现代预防医学, refType=null, unstructuredReference=夏昉，刘金萍，于露，等．脑卒中患者希望水平影响因素的结构方程模型分析[J]．现代预防医学，2020，47（21）：3859-3862., articleTitle=脑卒中患者希望水平影响因素的结构方程模型分析, refAbstract=null), Reference(id=1241322690590602155, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, doi=null, pmid=null, pmcid=null, year=2020, volume=47, issue=21, pageStart=3859, pageEnd=3862, url=null, language=null, rfNumber=[22], rfOrder=32, authorNames=Xia F, Liu JP, Yu L, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Xia F, Liu JP, Yu L, et al. Structural equation model analysis of the influence factors of the desired level in stroke patients[J]. Modern Preventive Medicine, 2020, 47(21): 3859-3862., articleTitle=Structural equation model analysis of the influence factors of the desired level in stroke patients, refAbstract=null)], funds=[Fund(id=1241322684399809306, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, awardId=JJKH20200530KJ, language=CN, fundingSource=吉林省教育厅“十三五”科学技术项目(JJKH20200530KJ), fundOrder=null, country=null), Fund(id=1241322684546609956, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, awardId=延大科合字（2019）26号, language=CN, fundingSource=延边大学校企合作项目(延大科合字（2019）26号), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241322675591770474, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, xref=null, ext=[AuthorCompanyExt(id=1241322675612741998, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, companyId=1241322675591770474, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Yanbian University, Yanbian Korean Autonomous Prefecture, Yanbian, Jilin 133000, China), AuthorCompanyExt(id=1241322675625324912, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, companyId=1241322675591770474, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=延边大学护理学院，吉林 延边朝鲜族自治州 133002)])], figs=[ArticleFig(id=1241322682604647106, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=EN, label=Fig.1, caption=Moderating Effects of Core Features of Primary Care on the Relationship between Financial Burden and Level of Hope, figureFileSmall=X+2wGtFBOjCUQFALNHEi6Q==, figureFileBig=ETolApMYIP0oBGDT1KQyhg==, tableContent=null), ArticleFig(id=1241322682692727494, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=CN, label=图1, caption=全科医疗核心特征功能在经济负担与希望水平之间关系中的调节作用, figureFileSmall=X+2wGtFBOjCUQFALNHEi6Q==, figureFileBig=ETolApMYIP0oBGDT1KQyhg==, tableContent=null), ArticleFig(id=1241322682898248404, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=EN, label=Fig.2, caption=Moderating Effects of Core Features of Primary Care on the Relationship between Financial Burden and Health-Related Quality of Life, figureFileSmall=qGa+RyfM1oPYR3gT/AJidA==, figureFileBig=sH/6ALcRoBpQYbD6ELdY4w==, tableContent=null), ArticleFig(id=1241322683024077527, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=CN, label=图2, caption=全科医疗核心特征功能在经济负担与健康相关生活质量之间关系中的调节作用, figureFileSmall=qGa+RyfM1oPYR3gT/AJidA==, figureFileBig=sH/6ALcRoBpQYbD6ELdY4w==, tableContent=null), ArticleFig(id=1241322683128935132, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=EN, label=Table 1, caption=

Differences in Various Variables on Sociodemographic Data between Elderly Patients with Chronic Comorbidities and the General Population（N=493）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目频数
（构成比%）		变量得分（分，）
健康相关生活质量得分经济负担得分希望水平得分全科医疗核心特征功能得分
性别
男230（46.7）52.91±12.6323.18±6.2834.80±4.4357.77±11.12
女263（53.3）51.62±13.3922.33±6.3134.45±4.0757.99±9.90
t/F值1.0901.4980.905-0.235
P值0.2750.1350.3660.841
年龄（岁）
60～70204（41.4）54.87±11.8723.07±6.2634.87±3.9657.99±10.35
>70岁～80255（51.7）51.40±12.9622.62±6.0734.69±4.4157.92±10.54
>8034（6.9）42.41±15.1121.50±8.1032.50±4.1357.09±10.96
t/F值15.1011.1764.6830.110
P值<0.0010.2470.0100.896
民族
汉族314（63.7）51.77±13.2121.84±6.5034.43±4.2558.19±10.66
朝鲜族及其他179（36.3）51.84±11.2123.95±5.7434.75±3.8456.21±9.14
t/F值-0.052-3.147-0.7301.842
P值0.9590.0010.4660.066
受教育水平
小学及以下154（31.2）51.12±12.9322.75±5.9834.57±3.8156.77±10.02
初中148（30.0）50.27±13.5121.11±6.9934.32±4.8755.80±10.66
高中及中专100（20.3）52.77±12.7023.05±6.0734.19±4.3058.27±11.44
大专及以上91（18.5）56.63±11.9124.96±5.1535.62±3.6559.38±9.42
t/F值5.1017.3742.2823.011
P值0.002<0.0010.0780.030
婚姻状况
已婚342（69.4）52.57±13.5122.41±6.4134.74±4.2057.72±10.89
未婚/离异/丧偶151（30.6）51.42±11.9123.46±6.0133.32±4.3458.28±9.50
t/F值0.902-1.7080.994-0.554
P值0.3660.0880.3210.580
退休前职业
工人/其他184（37.3）52.12±12.8422.95±6.0534.51±4.0157.46±10.86
公务员/事业单位70（14.2）56.61±12.0524.40±6.1835.33±4.4959.62±10.56
农民239（48.5）51.01±13.2521.80±6.5434.47±4.3457.72±10.14
t/F值5.0814.6771.1731.147
P值0.0070.0100.3100.319
居住情况
独居125（25.4）49.64±13.0022.53±6.3334.31±4.1358.10±9.38
非独居368（74.6）52.09±12.9623.30±6.2034.71±4.2857.82±10.83
t/F值-2.5711.182-0.9100.262
P值0.0100.2380.3630.793
家庭人均月收入（元）
<3 000200（40.6）50.76±12.7321.45±6.2934.03±4.1857.16±9.94
3 000～5 000145（29.4）51.90±12.2222.73±6.5434.57±3.7757.48±10.39
>5 000148（30.0）54.50±13.9924.45±5.6935.45±4.6359.28±11.18
t/F值3.5859.9884.8491.894
P值0.028<0.0010.0080.152
医疗付费方式
城镇职工医保238（48.3）53.87±13.8223.90±5.9534.91±4.3959.09±10.13
城乡居民医保128（26.0）51.22±12.5920.99±6.4334.06±3.7857.65±11.53
自费127（25.8）50.13±11.5922.28±6.4132.61±4.3755.88±9.72
t/F值3.9449.6311.6533.974
P值0.020<0.0010.1930.019
每月药费支出（元）
<200163（33.1）54.22±13.0023.71±5.6635.26±4.5858.82±10.60
200～500101（20.5）51.95±13.0022.75±7.1334.79±4.2056.46±10.27
<500～1 000134（27.2）53.16±13.0822.37±6.1234.73±4.0258.50±10.79
>1 00095（19.3）47.75±12.3820.31±6.1233.13±3.6556.96±9.92
t/F值5.3807.4945.3931.462
P值0.001<0.0010.0010.224
确诊疾病年限（年）
1～10268（54.4）53.02±13.0322.88±6.5135.96±4.3658.66±11.03
>10～20188（38.1）51.93±12.7622.63±6.0134.22±4.2457.15±9.65
>20～3032（6.5）48.00±14.5421.78±6.5134.56±2.8055.50±10.21
>305（1.0）47.16±10.7424.00±5.3831.00±3.5359.87±9.86
t/F值1.7420.3762.3631.416
P值0.1570.7710.0710.237
患病数量（种）
2～4333（67.5）53.13±13.1622.70±6.3634.60±4.3258.06±11.01
>4～6127（25.8）51.92±11.4422.61±5.8034.91±3.6558.14±8.87
>633（ 6.7）44.15±15.0823.48±7.6233.55±5.4055.19±10.52
t/F值7.3410.2641.3641.177
P值<0.0010.7680.2570.309
), ArticleFig(id=1241322683246375651, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=CN, label=表1, caption=

老年慢性病共病患者各变量得分在一般调查资料上的差异（N=493）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目频数
（构成比%）		变量得分（分，）
健康相关生活质量得分经济负担得分希望水平得分全科医疗核心特征功能得分
性别
男230（46.7）52.91±12.6323.18±6.2834.80±4.4357.77±11.12
女263（53.3）51.62±13.3922.33±6.3134.45±4.0757.99±9.90
t/F值1.0901.4980.905-0.235
P值0.2750.1350.3660.841
年龄（岁）
60～70204（41.4）54.87±11.8723.07±6.2634.87±3.9657.99±10.35
>70岁～80255（51.7）51.40±12.9622.62±6.0734.69±4.4157.92±10.54
>8034（6.9）42.41±15.1121.50±8.1032.50±4.1357.09±10.96
t/F值15.1011.1764.6830.110
P值<0.0010.2470.0100.896
民族
汉族314（63.7）51.77±13.2121.84±6.5034.43±4.2558.19±10.66
朝鲜族及其他179（36.3）51.84±11.2123.95±5.7434.75±3.8456.21±9.14
t/F值-0.052-3.147-0.7301.842
P值0.9590.0010.4660.066
受教育水平
小学及以下154（31.2）51.12±12.9322.75±5.9834.57±3.8156.77±10.02
初中148（30.0）50.27±13.5121.11±6.9934.32±4.8755.80±10.66
高中及中专100（20.3）52.77±12.7023.05±6.0734.19±4.3058.27±11.44
大专及以上91（18.5）56.63±11.9124.96±5.1535.62±3.6559.38±9.42
t/F值5.1017.3742.2823.011
P值0.002<0.0010.0780.030
婚姻状况
已婚342（69.4）52.57±13.5122.41±6.4134.74±4.2057.72±10.89
未婚/离异/丧偶151（30.6）51.42±11.9123.46±6.0133.32±4.3458.28±9.50
t/F值0.902-1.7080.994-0.554
P值0.3660.0880.3210.580
退休前职业
工人/其他184（37.3）52.12±12.8422.95±6.0534.51±4.0157.46±10.86
公务员/事业单位70（14.2）56.61±12.0524.40±6.1835.33±4.4959.62±10.56
农民239（48.5）51.01±13.2521.80±6.5434.47±4.3457.72±10.14
t/F值5.0814.6771.1731.147
P值0.0070.0100.3100.319
居住情况
独居125（25.4）49.64±13.0022.53±6.3334.31±4.1358.10±9.38
非独居368（74.6）52.09±12.9623.30±6.2034.71±4.2857.82±10.83
t/F值-2.5711.182-0.9100.262
P值0.0100.2380.3630.793
家庭人均月收入（元）
<3 000200（40.6）50.76±12.7321.45±6.2934.03±4.1857.16±9.94
3 000～5 000145（29.4）51.90±12.2222.73±6.5434.57±3.7757.48±10.39
>5 000148（30.0）54.50±13.9924.45±5.6935.45±4.6359.28±11.18
t/F值3.5859.9884.8491.894
P值0.028<0.0010.0080.152
医疗付费方式
城镇职工医保238（48.3）53.87±13.8223.90±5.9534.91±4.3959.09±10.13
城乡居民医保128（26.0）51.22±12.5920.99±6.4334.06±3.7857.65±11.53
自费127（25.8）50.13±11.5922.28±6.4132.61±4.3755.88±9.72
t/F值3.9449.6311.6533.974
P值0.020<0.0010.1930.019
每月药费支出（元）
<200163（33.1）54.22±13.0023.71±5.6635.26±4.5858.82±10.60
200～500101（20.5）51.95±13.0022.75±7.1334.79±4.2056.46±10.27
<500～1 000134（27.2）53.16±13.0822.37±6.1234.73±4.0258.50±10.79
>1 00095（19.3）47.75±12.3820.31±6.1233.13±3.6556.96±9.92
t/F值5.3807.4945.3931.462
P值0.001<0.0010.0010.224
确诊疾病年限（年）
1～10268（54.4）53.02±13.0322.88±6.5135.96±4.3658.66±11.03
>10～20188（38.1）51.93±12.7622.63±6.0134.22±4.2457.15±9.65
>20～3032（6.5）48.00±14.5421.78±6.5134.56±2.8055.50±10.21
>305（1.0）47.16±10.7424.00±5.3831.00±3.5359.87±9.86
t/F值1.7420.3762.3631.416
P值0.1570.7710.0710.237
患病数量（种）
2～4333（67.5）53.13±13.1622.70±6.3634.60±4.3258.06±11.01
>4～6127（25.8）51.92±11.4422.61±5.8034.91±3.6558.14±8.87
>633（ 6.7）44.15±15.0823.48±7.6233.55±5.4055.19±10.52
t/F值7.3410.2641.3641.177
P值<0.0010.7680.2570.309
), ArticleFig(id=1241322683359621864, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=EN, label=Table 2, caption=

Correlation Analysis of Financial Burden, Hope Level, Primary Care Core Feature Function, and Health-Related Quality of Life in Patients with Chronic Comorbidities(N=493, r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量希望水平全科医疗核心特征功能健康相关生活质量经济负担
希望水平1.000---
全科医疗核心特征功能0.241a1.000--
健康相关生活质量0.456a0.350a1.000-
经济负担0.316a0.233a0.325a1.000
), ArticleFig(id=1241322683481256688, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=CN, label=表2, caption=

老年慢性病共病患者经济负担、希望水平、全科医疗核心特征功能、健康相关生活质量的偏相关性分析（N=493，r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量希望水平全科医疗核心特征功能健康相关生活质量经济负担
希望水平1.000---
全科医疗核心特征功能0.241a1.000--
健康相关生活质量0.456a0.350a1.000-
经济负担0.316a0.233a0.325a1.000
), ArticleFig(id=1241322683607085811, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=EN, label=Table 3, caption=

Mediation model test of hope level

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程(n=275)拟合指标系数显著性
因变量自变量RR2FPβ（95% CI）P
健康相关生活质量经济负担0.420.1712.827<0.0010.32（0.24～0.40）<0.001
希望水平经济负担0.350.128.418<0.0010.32（0.23～0.41）<0.001
健康相关生活质量经济负担0.550.3023.352<0.0010.20（0.12～0.28）<0.001
希望水平0.38（0.30～0.46）<0.001
), ArticleFig(id=1241322683703554810, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=CN, label=表3, caption=

希望水平的中介模型检验

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程(n=275)拟合指标系数显著性
因变量自变量RR2FPβ（95% CI）P
健康相关生活质量经济负担0.420.1712.827<0.0010.32（0.24～0.40）<0.001
希望水平经济负担0.350.128.418<0.0010.32（0.23～0.41）<0.001
健康相关生活质量经济负担0.550.3023.352<0.0010.20（0.12～0.28）<0.001
希望水平0.38（0.30～0.46）<0.001
), ArticleFig(id=1241322683820995329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=EN, label=Table 4, caption=

Bootstrapped mediation effect test results

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项目效应值（95% CI）P效应占比
总效应0.32（0.24～0.40）<0.001
直接效应0.20（0.12～0.28）<0.0010.62
间接效应0.12（0.08～0.16）<0.0010.37
), ArticleFig(id=1241322683896492805, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=CN, label=表4, caption=

Bootstarp中介效应检验结果

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项目效应值（95% CI）P效应占比
总效应0.32（0.24～0.40）<0.001
直接效应0.20（0.12～0.28）<0.0010.62
间接效应0.12（0.08～0.16）<0.0010.37
), ArticleFig(id=1241322683967795977, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=EN, label=Table 5, caption=

Test of moderated mediation model

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程(n=493)拟合指标系数显著性
因变量自变量RR2FPβ（95% CI）P
希望水平0.410.179.783<0.001
经济负担0.30（0.21～0.39）<0.001
全科医疗核心特征功能0.16（0.08～0.25）<0.001
经济负担×全科医疗核心特征功能0.13（0.05～0.21）　0.002
健康相关生活质量0.590.3523.848<0.001
经济负担0.18（0.09～0.26）<0.001
希望水平0.33（0.25～0.40）<0.001
全科医疗核心特征功能0.22（0.14～0.29）<0.001
经济负担×全科医疗核心特征功能0.07（0.01～0.14）　0.040
), ArticleFig(id=1241322684060070668, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=CN, label=表5, caption=

有调节的中介模型检验

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程(n=493)拟合指标系数显著性
因变量自变量RR2FPβ（95% CI）P
希望水平0.410.179.783<0.001
经济负担0.30（0.21～0.39）<0.001
全科医疗核心特征功能0.16（0.08～0.25）<0.001
经济负担×全科医疗核心特征功能0.13（0.05～0.21）　0.002
健康相关生活质量0.590.3523.848<0.001
经济负担0.18（0.09～0.26）<0.001
希望水平0.33（0.25～0.40）<0.001
全科医疗核心特征功能0.22（0.14～0.29）<0.001
经济负担×全科医疗核心特征功能0.07（0.01～0.14）　0.040
), ArticleFig(id=1241322684198482704, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=EN, label=Table 6, caption=

Direct and Mediating Effects on Different Levels of Primary Care Core Feature Function in Moderation

, figureFileSmall=null, figureFileBig=null, tableContent=
项目高低组效应值（95% CI）BootSEP
直接作用低分组0.10（0.10～0.20）0.050.030
中分组0.18（0.10～0.26）0.04<0.001
高分组0.25（0.13～0.37）0.06<0.001
希望水平的中介作用低分组0.17（0.07～0.28）0.050.001
中分组0.30（0.21～0.39）0.04<0.001
高分组0.43（0.30～0.56）0.06<0.001
), ArticleFig(id=1241322684282368786, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322671548461248, language=CN, label=表6, caption=

不同全科医疗核心特征功能水平调节作用上的直接与中介效应

, figureFileSmall=null, figureFileBig=null, tableContent=
项目高低组效应值（95% CI）BootSEP
直接作用低分组0.10（0.10～0.20）0.050.030
中分组0.18（0.10～0.26）0.04<0.001
高分组0.25（0.13～0.37）0.06<0.001
希望水平的中介作用低分组0.17（0.07～0.28）0.050.001
中分组0.30（0.21～0.39）0.04<0.001
高分组0.43（0.30～0.56）0.06<0.001
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基于有调节的中介效应探讨老年慢性病共病患者经济负担对健康相关生活质量的影响
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王哲 , 许惠靖 , 王雪婷 , 王宇宇 , 高歌 , 赵展莹 , 吴善玉
现代预防医学 | 健康与社会行为 2024,51(2): 314-321
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现代预防医学 | 健康与社会行为 2024, 51(2): 314-321
基于有调节的中介效应探讨老年慢性病共病患者经济负担对健康相关生活质量的影响
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王哲, 许惠靖, 王雪婷, 王宇宇, 高歌, 赵展莹, 吴善玉
作者信息
  • 延边大学护理学院，吉林 延边朝鲜族自治州 133002

    • 王哲（1999—），女，硕士在读，研究方向：社区护理

通讯作者:

吴善玉，E-mail：
Impacts of Financial Burden on Health-Related Quality of Life in elderly patients with Chronic Comorbiditiesbased on the mediated effect of regulation
Zhe WANG, Hui-jing XU, Xue-ting WANG, Yu-yu WANG, Ge GAO, Zhan-ying ZHAO, Shan-yu WU
Affiliations
  • School of Nursing, Yanbian University, Yanbian Korean Autonomous Prefecture, Yanbian, Jilin 133000, China
出版时间: 2024-01-25 doi: 10.20043/j.cnki.MPM.202308275
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摘要
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目的

探究老年慢性病共病患者经济负担对健康相关生活质量的影响及其作用机制。

方法

便利抽取延吉市两所社区卫生服务中心门诊493名老年慢性病共病患者，采用一般资料调查表、全科医疗核心特征功能患者服务体验量表（ASPC）、慢性病治疗经济毒性功能评估综合评分量表(COST)和Herth希望量表、SF-36健康调查量表进行调查。对数据进行单因素分析、偏相关分析及有调节的中介模型检验。

结果

（1）经济负担对健康相关生活质量具有显著预测作用(β=0.32，95% CI：0.24～0.40，P<0.001);(2)希望水平在经济负担与健康相关生活质量的关系中起部分中介作用，效应值为0.12，（95% CI：0.08～0.16，P<0.001），占总效应的37%;(3) 经济负担对健康相关生活质量的直接预测作用（β=0.07，95% CI：0.01～0.14，P<0.05）及希望水平在二者关系中的中介作用（β=0.13，95% CI：0.05～0.21，P<0.01）均受全科医疗核心特征功能的调节。

结论

本研究展示了经济负担对老年慢性病患者健康相关生活质量可能的影响机制，强调了提高老年慢性病共病患者的经济保障和希望水平的重要性，并凸显了全科医疗核心特征功能在缓解经济负担对生活质量的不利影响中的作用。这些发现有助于为老年慢性病共病患者提供更全面和有效的医疗服务，从而缓解经济负担的影响，提高其生活质量。

慢性病共病  /  经济负担  /  全科医疗核心特征功能  /  希望水平  /  健康相关生活质量  /  有调节的中介
Objective

To investigating the impact of Financial Burden on Health-Related Quality of Life in elderly patients with Chronic Comorbid Conditions and its mechanisms.

Methods

A convenience sample of 493 chronic comorbid patients was extracted from two community health service centers in Yanji City. General information was collected using a questionnaire, and the Patient Experiences with Primary Care (ASPC) scale, Comprehensive Score of Financial Burden (COST), Herth Hope Scale, and SF-36 Health Survey were utilized for the investigation.Univariate analysis, partial correlation analysis, and testing a moderated mediation model was conducted.

Results

(1) Financial Burden significantly predicted HRQoL(β=0.32, 95% CI:0.24-0.40, P<0.001);(2) Hope level partially mediated the relationship between Financial Burden and HRQoL (β=0.12, 95% CI:0.08-0.16, P<0.001), accounting for 37% of the total effect; (3) The direct predictive effect of Financial Burden on health-related quality of life (β=0.07, 95% CI:0.01-0.14，P<0.05) and the mediating role of hope in their relationship(β=0.13，95% CI：0.05-0.21，P<0.01) were both moderated by the core features of comprehensive primary care.

Conclusion

This study reveals the mechanism by which Financial Burden impacts HRQoL in elderly patients with chronic comorbidities. The findings emphasize the importance of enhancing economic support and hope levels for this patient group and highlight the role of comprehensive primary care function in mitigating the adverse effects of Financial Burden on HRQoL. These insights contribute to providing more comprehensive and effective medical services to patients with chronic comorbidities, alleviating the impact of Financial Burden, and enhancing their overall quality of life.

Chronic comorbidities  /  Financial burden  /  Comprehensive primary care function  /  Hope level  /  Health-related quality of life  /  Moderated mediation
王哲, 许惠靖, 王雪婷, 王宇宇, 高歌, 赵展莹, 吴善玉. 基于有调节的中介效应探讨老年慢性病共病患者经济负担对健康相关生活质量的影响. 现代预防医学, 2024 , 51 (2) : 314 -321 . DOI: 10.20043/j.cnki.MPM.202308275
Zhe WANG, Hui-jing XU, Xue-ting WANG, Yu-yu WANG, Ge GAO, Zhan-ying ZHAO, Shan-yu WU. Impacts of Financial Burden on Health-Related Quality of Life in elderly patients with Chronic Comorbiditiesbased on the mediated effect of regulation[J]. Modern Preventive Medicine, 2024 , 51 (2) : 314 -321 . DOI: 10.20043/j.cnki.MPM.202308275
正文
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随着全球慢性病的不断增加，慢性病共病患者也显著增多。这类患者同时患有两种或更多慢性疾病，需要长期医疗护理，面临高昂的医疗费用，导致了客观和主观经济负担。老年慢性病患者尤其容易承受高经济负担[1-2]，这与患者心理不适、治疗依从性下降及死亡风险增加密切相关，是影响其健康相关生活质量的重要因素[3]。然而，目前对经济负担与健康相关生活质量的关系及具体影响机制的研究尚不深入。为阐明经济负担如何影响健康相关生活质量，压力系统理论提供了一个有力的理论框架，可解释患者在应对经济负担时的内在压力和应激反应，有必要综合考虑多因素对个体压力反应（健康相关生活质量）的影响机制。经济负担作为一种持续的压力源可能对患者的认知评价产生负面影响，使其感到担忧、恐惧，对其患病状态产生负面认知，甚至感到绝望和失去信心。同时，积极的心理状态，如高希望水平，为患者提供心理支持和动力，有助于应对各种困难和挑战[4]。研究表明，希望水平高的患者更可能采取积极的健康行为和应对策略，从而提高其健康相关生活质量。然而，希望水平在经济负担与健康相关生活质量关系中作用机制仍待研究。全科医疗核心特征功能作为一种综合性的医疗模式，为患者提供全面、协调、连续、全程的医疗服务[5]，积极调节患者希望水平和健康相关生活质量。但在老年慢性病共病患者中，全科医疗核心特征功能的具体作用机制还需要进一步探讨。因此，本研究基于压力系统理论，并构建有调节的中介模型，旨在更深入地探讨患者面对经济负担时的内在机制以及希望水平和全科医疗核心特征功能在其中的作用。研究结果将为医疗服务提供者和政策制定者提供重要参考，帮助满足老年慢性病共病患者的需求，推动全民健康水平的提高。
1　对象与方法
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1.1　研究对象
采用便利抽样法，于2023年1月至2023年6月，选取延吉市两所社区卫生服务中心门诊493名老年慢性病共病患者为研究对象。纳入标准：（1）年龄≥60岁；（2）经二级或二级以上医院诊断患有慢性病，慢性病种数≥2种；过去1年内在社区卫生服务中心看病3次以上；（3）与家庭医生签约（4）能够进行有效沟通，并独立或在他人协助下按照本人意愿完成问卷者；（5）知情同意，自愿参加。排除标准：（1）伴有精神病障碍及病史者；（2）合并严重并发症和器质性障碍者（如严重肾功能不全、心肌梗死等）；（3）近期3个月正在参加其他类似课题研究者。本研究获得延边大学医学院医学伦理委员会的审批（批号：20231048），并获得参与者的知情同意。
1.2　研究工具
1.2.1　一般资料调查表
本部分内容结合相关文献由研究者自行设计，包括一般人口学资料（性别、年龄、民族、受教育程度、婚姻状况、职业、居住情况、家庭经济状况）和疾病相关资料（医疗付费方式、患慢性病的种类、患病时间、每月疾病治疗支出情况）。
1.2.2　中文版全科医疗核心特征功能量表（Assessment Survey of Primary Care, ASPC）
此量表由李丽娜等[6]于2021年编制，由首诊/第一 线照护、服务可及性、医患关系连续性、综合性服务、协调性服务和以患者为中心的照护6个维度构成，共41个条目。每个条目采用Likert 4级评分法,“从来不是”～“总是”分别计1～4分。总分越高，表示患者对全科医疗核心特征功能的体验越好，该量表总体Cronbach α系数为0.915。本研究中该量表的Cronbach α系数为0.872。
1.2.3　慢性病治疗经济毒性功能评估综合评分量表（Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy, COST）
此量表是 Souza 等[7]于2014年开发编制，包含积极财富状况（4个条目）、负面心理反应（7个条目）2个维度。采用 Likert 5 级评分法，总分为 0～44 分，得分越高表示患者的经济负担越低。国内学者于慧会等[8]于 2017 年翻译汉化，中文版COST的Cronbach α 系数为 0.889，目前也已被用于多种慢性疾病群体经济负担的测量[9-11]。本研究中该量表的Cronbach α系数为0.784。
1.2.4　Herth希望量表(Herth Hope Index, HHI)
采用1991年Herth编制[12],赵海平教授[13]翻译并汉化的Herth希望量表。包含3个维度:对现实和未来的积极态度、采取积极的行动、与他人保持亲密的关系，共计12个条目，总分为12～48分。该量表的Cronbach α系数为0.85，具体评价标准:12～23分表示希望水平较低，24～35分表示处于中等希望水平，36～48分表示希望水平较高。本次测量的Herth希望量表的Cronbach α系数为0.759。
1.2.5　36 条目简明健康测量量表（SF-36）
该量表的标准版由美国波士顿新英格兰医学中心健康研究所研制[14]，李鲁等人[15]汉化。该量表Cronbach α系数在0.75～0.88之间，包括8个维度（生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康）11大项共36个条目。得分越高，生活质量越好。本研究中该量表的Cronbach α系数为0.809。
1.3　调查方法
根据样本量计算公式n=[Max(条目数)×(5～10)]×[1+(10%～30%)][16]，取量表最大条目数41，样本量应为226～533名。调查员统一培训，统一指导用语。所有问卷由研究者本人及调查员当场发放、收回，采用统一的指导语解释问卷的条目和问卷填写方法，做答时间控制在15～30分钟。问卷完成后，由研究者本人当场检查确认填写情况，如有遗漏项目及时补全，重新核实有疑问的项目，若研究对象因各种原因未能及时补全遗漏的项目，则视为无效问卷。共发放问卷533份，回收有效问卷493份，问卷有效率为92.5%。
1.4　统计学处理
采用SPSS 26.0软件及PROCESS程序进行数据分析和处理。符合正态分布计量资料采用（）描述，计数资料采用频数、构成比描述。并采用t检验、方差分析比其在一般人口学资料上的差异，不满足正态分布和方差齐性则采用非参数检验。采用偏相关分析探讨各变量间的相关性。采用SPSS PROCESS插件构建有调节的中介模型。检验水准α=0.05。
2　结果
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2.1　共同方法偏差检验
采用Harman单因子检验法进行共同方法偏差检验。纳入经济负担、希望水平、全科医疗核心特征功能、健康相关生活质量的全部条目。结果显示，有37个主成分的特征根大于1。第一个主成分的解释率为9.128%，未超过40%，说明无严重共同方法偏差。
2.2　老年慢性病共病患者各变量得分在一般调查资料上的差异
本研究共纳入老年慢性病共病患者493例，其健康相关生活质量得分（52.22±13.04）分，经济负担得分（19.80±7.17）分，希望水平得分（34.61±4.24）分，体验到的全科医疗核心特征功能平均得分（57.89±10.47）分。一般调查资料与健康相关生活质量得分相比，年龄、受教育水平、退休前职业、家庭人均月收入、医疗付费方式、每月药费支出、患病数量均存在差异；与经济负担得分相比，民族、受教育水平、退休前职业、家庭人均月收入、医疗付费方式、每月药费支出存在差异；与希望水平相比，年龄、家庭人均月收入、每月药费支出存在差异；与体验到的全科医疗核心特征功能得分相比，受教育水平、医疗付费方式存在差异。（P<0.05）。一般人口学特征及各变量在一般调查资料上的差异分析详见表1。
2.3　老年慢性病共病患者经济负担、希望水平、全科医疗核心特征功能、健康相关生活质量的偏相关性分析
在控制了年龄、受教育水平、退休前职业、家庭人均月收入、医疗付费方式、每月药费支出后、患病数量后，对本研究主要变量进行偏相关性分析。其中COST量表为反向计分，得分越高表示患者经济负担越低。相关性结果显示，各变量得分之间均呈显著正相关(P均<0.001)。见表2。
2.4　老年慢性病共病患者经济负担对健康相关生活质量的影响作用机制
有调节的中介模型检验在对所有核心变量标准化处理并控制对结果有影响的一般资料后，采用Hayes于2012年编制的SPSS宏中的Model4对希望水平的中介效应进行检验。结果表明(见表3)，经济负担对健康相关生活质量预测作用显著，(β=0.32，95% CI：0.24～0.40，P<0.001)，加入中介变量后，经济负担对健康相关生活质量的直接预测作用依然显著(β=0.20，95% CI：0.12～0.28，P<0.001)。经济负担对希望水平的预测作用显著(β=0.32，95% CI：0.23～0.41，P<0.001)。希望水平显著正向预测健康相关生活质量（β=0.38，95% CI：0.30～0.46，P<0.001）。Bootstarp中介效应检验结果显示，希望水平在经济负担与健康相关生活质量之间起部分中介作用，表明经济负担不仅可以直接预测健康相关生活质量，还可以通过希望水平的中介作用预测健康相关生活质量。经济负担通过希望水平对健康相关生活质量的间接效应β=0.12(95% CI：0.08～0.16，P<0.001)，经济负担对健康相关生活质量的直接效应β=0.20(95% CI：0.12～0.28，P<0.001)，直接效应和间接效应分别占总效应的62%和37%。详见表4。
采用PROCESS宏中的Model 8对有调节的中介模型进行检验。结果(见表5、表6)表明，将全科医疗核心特征功能放入模型后，经济负担与全科医疗核心特征功能的乘积项对健康相关生活质量及希望水平均有显著的预测作用(健康相关生活质量:β=0.07，95% CI：0.01～0.14，P<0.05; 希望水平:β=0.13，95% CI：0.05～0.21，P<0.01)，表明全科医疗核心特征功能不仅能够在经济负担对健康相关生活质量的直接预测中起调节作用，并且在希望水平的中介过程前半段起调节作用。简单斜率分析表明 (见图1、2)，经济负担对希望水平和健康相关生活质量的预测作用在全科医疗核心特征功能较高时更显著（希望水平：β=0.43，95% CI：0.30～0.56，P<0.001，健康相关生活质量：β=0.25，95% CI：0.13～0.37，P<0.001）。此外，在全科医疗核心特征功能的三个水平上，随着患者全科医疗核心特征功能体验感的增加，希望水平在经济负担与健康相关生活质量关系中的中介效应呈增高趋势(见表6)。
3　讨论
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3.1　经济负担对老年慢性病共病患者健康相关生活质量的影响
本研究通过应用压力系统理论，深入探讨了经济负担对老年慢性病共病患者健康相关生活质量的影响。研究发现，高昂的医疗费用可能阻碍患者获得必要的医疗和药物治疗，导致就医延迟或选择较低成本的治疗方式[17]，进一步增加疾病恶化和健康状况下降的风险。此外，经济负担压力可能引发患者的负面情绪，如沮丧、焦虑和无助[18]，对其心理健康产生负面影响，最终影响他们的生活质量。经济负担还可能影响患者的社交互动和日常活动[19]，制约社交关系，减少社会支持和参与感，对生活质量造成不利影响。这一发现强调了经济负担对患者的重要影响，医护工作者应当重视患者经济负担，通过提供经济援助及优化医疗资源分配等方式，改善患者的整体生活状况。这不仅有益于患者的健康和福祉，还为医疗服务提供者和政策制定者提供了的指导，以更好地满足患者需求，推动整体健康水平的提升。
3.2　重视希望水平的中介作用
希望作为积极的心理状态，能够为患者提供心理支持和动力，有助于展望未来和保持对健康问题的控制感。研究结果显示，希望水平在经济负担与健康相关生活质量之间的关系中发挥了部分中介作用。高经济负担与较低的健康相关生活质量之间存在显著的相关关系，其中一部分影响通过患者的希望水平进行中介。这与压力系统理论相契合，即高经济负担可能引发患者心理和生理压力反应，导致其希望水平降低，从而影响健康相关生活质量。这种现象可能是由于经济负担引发的不确定性和压力使患者感到困惑和绝望，降低他们对未来的积极期待和信心。先前的研究也表明[20]，希望水平较高的患者更能调动积极情绪，有助于克服消极情绪，促进患者疾病管理参与度和自我效能感的提高，进而促进疾病康复。因此，它提示医护人员在提升个体健康相关生活质量的过程中，应重视培养和增强个体的希望水平。通过提高希望水平，个体可以更好地调整心态、面对挑战，并积极寻求改善和发展的机会，从而提升其健康相关生活质量。
3.3　增加全科医疗核心特征功能的调节作用
压力系统理论强调各个因素之间的相互作用，全科医疗核心特征功能则作为有力的社会支持因素，在经济负担与健康相关生活质量之间发挥关键性作用。通过运用压力系统理论构建的有调节的中介模型，深入探索全科医疗核心特征功能在经济负担、希望水平及健康相关生活质量之间的作用。结果表明，全科医疗核心特征功能不仅能够调节经济负担对健康相关生活质量的直接预测效应，还能够调节“经济负担—希望水平—健康相关生活质量”这一中介链条。全科医疗核心特征功能可以促进患者的综合治疗和管理，提高患者自我管理效能和治疗依从性[21]，降低入院率和重症天数，削减治疗费用和经济负担，减轻了经济负担对患者健康相关生活质量的直接影响，体现了其调节作用。此外，当患者面临较高的经济负担时，全科医疗核心特征功能能够提供全面的医疗服务和支持，这对改善患者的医疗体验和满意度至关重要，从而增强患者的希望水平[22]。相反，缺乏该支持，即使患者经济负担较低，也可能因为缺乏有效的医疗支持而感到绝望和无助，从而削弱希望水平的中介效应，使患者难以有效应对经济负担带来的压力，导致健康相关生活质量下降。
综上所述，本研究拓展了压力系统理论在健康心理学领域的应用，为深化经济负担与个体心理关系的研究提供了新的视角，强调了全科医疗核心特征功能在慢性病共病患者的健康管理和康复中的重要性。但本研究未深入探讨患者的患病模式，不同慢性病类型可能会对个体产生不同影响，其经济负担和健康相关生活质量也可能存在差异。因此，未来的研究可以进一步分析不同慢性病类型对结果的影响，以获得更加具体的结论。
基金
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  • 吉林省教育厅“十三五”科学技术项目(JJKH20200530KJ)
  • 延边大学校企合作项目(延大科合字（2019）26号)
文献
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参考文献 引证文献
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2024年第51卷第2期
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doi: 10.20043/j.cnki.MPM.202308275
  • 接收时间：2023-08-16
  • 首发时间：2026-03-19
  • 出版时间：2024-01-25
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  • 收稿日期：2023-08-16
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吉林省教育厅“十三五”科学技术项目(JJKH20200530KJ)
延边大学校企合作项目(延大科合字（2019）26号)
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    延边大学护理学院，吉林 延边朝鲜族自治州 133002

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吴善玉，E-mail：
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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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