Ren H, Shi Y, Meng W, Hu J Y, Chen Y H, Pan Q C
Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China.
The Key Laboratory of Public Health Safety of Ministry of Education-Department of Epidemiology, Fudan University School of Public Health, Shanghai 200332, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2017 Jan 10;38(1):37-42. doi: 10.3760/cma.j.issn.0254-6450.2017.01.007.
To systemically analyze family burden, quality of life of chronic hepatitis B and C patients in Shanghai and related influencing factors. A representative sample of chronic hepatitis patients (=1 478) and their family members (=1 478) was randomly selected through a multi-stage cluster sampling from 30 communities in 10 districts of Shanghai. One patient and one family member of each family were interviewed using different questionnaires to collect related information. Based on Bronfenbrenner' s ecological systems, psychological measurement, two-level random intercept model and multivariable structural equation model were applied to determine the effects and directions of the factors between life quality of chronic hepatitis patients and family burden. The mean score of quality of life of chronic hepatitis patients in Shanghai was 78.70 ± 13.25, the score of " specific module" was highest and the score of " social function" was lowest. Additionally, the mean score of burden reported by the family members was 12.62±10.74, the score of " financial burden" was highest, and the score of " effect on family member' s health" was lowest. Multivariable structural equation model indicated that eight factors were related with life quality and family burden of patients with chronic hepatitis. Among them, HCV infection, elevated serum alanine aminotransferase level, average monthly cost for patient >3 000 yuan (RMB) and poor health of family members were the direct risk factors for the life quality of the patients as well as family burden. The factor of drinking more than once a week influenced the patients' life quality directly and family burden indirectly. On the contrary, the factors of local household registration, hospitalization and family member's indifferent attitude to hepatitis B vaccination influenced the family burden of the chronic hepatitis patients directly and the life quality of the patients indirectly. The findings could be used in the development of community based management and intervention of chronic hepatitis patients in Shanghai.
为系统分析上海慢性乙型和丙型肝炎患者的家庭负担、生活质量及相关影响因素。通过多阶段整群抽样，从上海10个区的30个社区中随机抽取了具有代表性的慢性肝炎患者样本（=1478例）及其家庭成员样本（=1478例）。使用不同问卷对每个家庭的一名患者和一名家庭成员进行访谈，以收集相关信息。基于布朗芬布伦纳的生态系统理论、心理测量方法，应用两级随机截距模型和多变量结构方程模型来确定慢性肝炎患者生活质量与家庭负担之间因素的影响及方向。上海慢性肝炎患者生活质量的平均得分为78.70±13.25，“特定模块”得分最高，“社会功能”得分最低。此外，家庭成员报告的负担平均得分为12.62±10.74，“经济负担”得分最高，“对家庭成员健康的影响”得分最低。多变量结构方程模型表明，八个因素与慢性肝炎患者的生活质量和家庭负担相关。其中，丙型肝炎病毒感染、血清丙氨酸氨基转移酶水平升高、患者每月平均费用>3000元（人民币）以及家庭成员健康状况不佳是患者生活质量和家庭负担的直接危险因素。每周饮酒超过一次的因素直接影响患者的生活质量，间接影响家庭负担。相反，本地户籍、住院治疗以及家庭成员对乙肝疫苗接种的冷漠态度等因素直接影响慢性肝炎患者的家庭负担，间接影响患者的生活质量。这些研究结果可用于上海社区慢性肝炎患者管理和干预措施的制定。
