Mackenbach J P, Borsboom G J, Nusselder W J, Looman C W, Schrijvers C T
Department of Public Health, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
J Epidemiol Community Health. 2001 Sep;55(9):631-8. doi: 10.1136/jech.55.9.631.
Declines in physical functioning are a common result of chronic illness, but relatively little is known about factors not directly related to severity of disease that influence the occurrence of disability among chronically ill persons. The aim of this study was to assess the effect of a large number of potential determinants (sociodemographic factors, health related behaviour, structural living conditions, and psychosocial factors).
Longitudinal study of levels and changes of physical functioning among persons suffering from four chronic diseases (asthma/chronic obstructive pulmonary disease (COPD), heart disease, diabetes, chronic low back pain). In 1991, persons suffering from one or more of these diseases were identified in a general population survey. Self reported disabilities, using a subset of the OECD disability indicator, were measured six times between 1991 and 1997. These data were analysed using generalised estimating equations, relating determinants measured in 1991 to disability between 1991 and 1997, and controlling for a number of potential confounders (age, gender, year of measurement, and type and severity of chronic disease).
Region of Eindhoven (south eastern Netherlands).
1784 persons with asthma/COPD, heart disease, diabetes mellitus and/or low back pain.
In a "repeated prevalence" model, statistically significant (p<0.05) and strong associations were found between most of the determinants and the prevalence of disabilities. In a "longitudinal change" model, statistically significant (p<0.05) predictors of unfavourable changes in physical functioning were low income and excessive alcohol consumption, while we also found indications for effects of marital status, degree of urbanisation, smoking, and external locus of control.
Other factors than characteristics of the underlying disease have an important influence on levels and changes of physical functioning among chronically ill persons. Reduction of the prevalence of disabilities in the population not only depends on medical interventions, but may also require social interventions, health education, and psychological interventions among chronically ill persons.
身体机能下降是慢性病的常见后果，但对于慢性病患者中影响残疾发生的、与疾病严重程度无直接关联的因素，我们了解得相对较少。本研究旨在评估大量潜在决定因素（社会人口学因素、健康相关行为、生活结构条件和心理社会因素）的影响。
对患有四种慢性病（哮喘/慢性阻塞性肺疾病（COPD）、心脏病、糖尿病、慢性腰背痛）的人群的身体机能水平及变化进行纵向研究。1991年，在一项普通人群调查中识别出患有上述一种或多种疾病的人群。在1991年至1997年间，使用经合组织残疾指标的一个子集对自我报告的残疾情况进行了六次测量。使用广义估计方程对这些数据进行分析，将1991年测量的决定因素与1991年至1997年间的残疾情况相关联，并控制一些潜在的混杂因素（年龄、性别、测量年份以及慢性病的类型和严重程度）。
埃因霍温地区（荷兰东南部）。
1784名患有哮喘/COPD、心脏病、糖尿病和/或腰背痛的患者。
在“重复患病率”模型中，大多数决定因素与残疾患病率之间存在统计学显著（p<0.05）且强烈的关联。在“纵向变化”模型中，身体机能出现不利变化的统计学显著（p<0.05）预测因素是低收入和过量饮酒，同时我们也发现婚姻状况、城市化程度、吸烟和外部控制点存在影响的迹象。
除了基础疾病的特征外，其他因素对慢性病患者的身体机能水平及变化也有重要影响。降低人群中残疾的患病率不仅取决于医疗干预，还可能需要对慢性病患者进行社会干预、健康教育和心理干预。
