Sesso Ricardo, Rodrigues-Neto João F, Ferraz Marcos B
Division of Nephrology and Clinical Epidemiology Unit, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Am J Kidney Dis. 2003 Jan;41(1):186-95. doi: 10.1053/ajkd.2003.50003.
Socioeconomic status (SES) has been associated with the incidence of end-stage renal disease (ESRD); however, the impact of SES on the quality of life (QOL) of these patients has not been clearly defined.
One hundred eighteen patients were prospectively evaluated at the beginning of dialysis treatment and reassessed (n = 90) after an average of 7 months. QOL was measured by means of the Medical Outcomes Survey 36-Item Short Form (SF-36). Classification of SES was according to validated criteria of the Brazilian Association of Research Institutes.
Mean scores for SF-36 dimensions were decreased in patients with low compared with high SES, with greater differences noted during follow-up. At this time, mean scores for SF-36 scales for the low- and high-SES groups were as follows: Functional Capacity, 43 +/- 31 versus 68 +/- 26 (P < 0.01); Physical Aspect, 34 +/- 36 versus 56 +/- 38; Pain, 55 +/- 31 versus 80 +/- 28 (P < 0.01); General Health Status, 60 +/- 21 versus 67 +/- 19; Vitality, 42 +/- 25 versus 59 +/- 16 (P < 0.05); Social Aspect, 53 +/- 32 versus 81 +/- 21 (P < 0.01); Emotional Aspect, 49 +/- 44 versus 70 +/- 41; and Mental Health, 51 +/- 27 versus 70 +/- 22 (P < 0.05), respectively. These differences were more pronounced than expected for an age- and sex-matched sample of the Brazilian general population. Multivariate analysis showed that SES continued to significantly affect all QOL dimensions, explaining 5.5% to 14.1% of variation in scales.
SES is an important factor associated with QOL in patients with ESRD. Further studies to determine optimum interventions and measures in groups with lower SES may be important to improve QOL outcomes and reduce their morbidity.
社会经济地位（SES）与终末期肾病（ESRD）的发病率相关；然而，SES对这些患者生活质量（QOL）的影响尚未明确界定。
118例患者在透析治疗开始时进行前瞻性评估，并在平均7个月后重新评估（n = 90）。生活质量通过医学结局调查简表36项（SF - 36）进行测量。SES分类依据巴西研究机构协会的有效标准。
与高SES患者相比，低SES患者的SF - 36维度平均得分降低，随访期间差异更大。此时，低SES组和高SES组的SF - 36量表平均得分如下：功能能力，43±31对68±26（P < 0.01）；身体状况，34±36对56±38；疼痛，55±31对80±28（P < 0.01）；总体健康状况，60±21对67±19；活力，42±25对59±16（P < 0.05）；社会状况，53±32对81±21（P < 0.0）；情感状况，49±44对70±41；心理健康，51±27对70±22（P < 0.05）。这些差异比巴西普通人群年龄和性别匹配样本预期的更为明显。多变量分析表明，SES继续显著影响所有生活质量维度，解释量表变异的5.5%至14.1%。
SES是与ESRD患者生活质量相关的重要因素。进一步研究确定低SES群体的最佳干预措施和方法，对于改善生活质量结果和降低其发病率可能很重要。
