摘要目的 研究高血压、糖尿病、冠心病和脑卒中四种常见慢性病(四病)对农村中老年人生命质量的影响,探讨其主要影响因素与特点.方法 采取整群抽样方法,对北京市房山区中老年人进行健康体检和流行病学问卷调查,采用欧洲五维度健康量表(EQ-5D)进行生命质量测量.应用Probit回归模型,以人群归因危险度百分比(PAR％)为核心指标,分析四病对生命质量各维度的影响及其控制的公共卫生学意义.结果 共调查5345名研究对象,72.1％患四病,慢性病患者的平均EQ-5D健康指数低于非患者,差异有统计学意义(t=15.082,P＜0.001).慢性病患者在各健康维度的生命质量问题比例均高于不患慢性病者(P＜0.001),主要问题集中于疼痛不适维度(20.4％).与不患慢性病者相比,冠心病患者在疼痛不适维度的相对危险升高了31.6％(RR=1.316,95％CI:1.205～ 1.436),脑卒中患者在自我照顾和平常活动维度相对危险分别升高了30.4％(RR=1.304,95％CI:1.104～1.541)和33.8％(RR=1.338,95％CI:1.151～1.555).四病对人群生命质量影响程度的PAR％分别为高血压31.05％、糖尿病4.84％、冠心病23.39％和脑卒中4.44％.结论农村社区中老年人冠心病患者在疼痛不适维度发生问题的风险最高,患脑卒中在自我照顾和平常活动维度发生问题的风险最高,冠心病患者发生健康状态不良的风险最大,对该地区控制高血压可以较大程度提高人群生命质量.

abstractsObjective To evaluate the health related quality of life (HRQoL) and to explore the influencing factors related to the prevalence of the essential hypertension,diabetes,coronary heart disease (CHD) and stroke in middle-aged and elderly people from rural communities.Methods A total of 5345 individuals were chosen from a 2010 Health Survey in Fangshan,Beijing.Self-designed questionnaire was applied to collect the information on general health-related behaviors,chronic conditions,self-rated health,blood pressure and HRQoL with the EuroQoL questionnaire (EQ-5D) were measured.Probit regression model was used to identify the influencing factors on HRQoL,adjusting age,marriage status,education level,smoking,alcohol intake,physical activity and control of blood pressure.Population Attributable Risk Proportion (PARP) for estimating the influence of chronic disease on HRQoL was also calculated.Results The average EQ-5D index was 0.923 ±0.145,with 72.1％ of the overall respondents in the status of having chronic diseases.Participants with chronic diseases had significantly lower EQ-5D index (0.907 ± 0.155 ) than those without (0.963 ±0.105 ) (t =15.082,P＜ 0.001 ).Significant relations were found between a lower HRQoL and chronic diseases.Relative risk (RR) and 95％ confidence interval (95％ CI) of poor HRQoL in populations with hypertension,diabetes,CHD and stroke were 1.686 (95％CI: 1.519-1.871),1.725 (95％CI:1.502-1.981 ),1.869 (95％CI: 1.663-2.099),and 1.759 (95％CI: 1.474-2.089) respectively.The most influential disease appeared to be stroke in male (RR=1.929,95％CI: 1.462-2.546),whereas CHD in female individuals (RR=1.926,95％CI: 1.671-2.220).Rates of PARP (PAR％) for poor HRQoL in chronic disease subgroups were as follow: hypertension 31.05％,CHD 23.39％,diabetes 4.84％ and stroke 4.44％,respectively.Conclusion This study suggested that stroke,at individual level,was the major influential factor to HRQoL.However,hypertension remained the leading preventable influential factor to HRQoL at the population level.