Center for Value-Based Medicine®, Hilton Head, South Carolina; Retina Service, Wills Eye Hospital, Jefferson Medical University, Philadelphia, Pennsylvania; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
Center for Value-Based Medicine®, Hilton Head, South Carolina; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Research Department, Wills Eye Hospital, Jefferson Medical University, Philadelphia, Pennsylvania.
Am J Med Sci. 2019 Aug;358(2):121-126. doi: 10.1016/j.amjms.2019.04.007. Epub 2019 Apr 19.
Multiple studies have addressed ethnic diabetes mellitus (diabetes) care inequalities. But few have assessed whether ethnicity influences patient perceptions of diabetic quality-of-life (QOL). The authors therefore designed a cross-sectional study to quantify the overall QOL associated with diabetes in consecutive white (Caucasian) and black (African-American) participants.
A validated, time tradeoff utility instrument was consecutively administered by interview to 518 white and 92 African-American, adult, diabetic participants in an ambulatory setting. The instrument calculates QOL by quantifying a utility associated with their condition, with utility anchors of 1.00 (perfect health for that condition permanently) and 0.00 (death). Utility acquisition as used herein, first requires asking participants to estimate their theoretical remaining time of life, then subtracting from 1.00 the maximum proportion of their estimated remaining time of life they would be willing to hypothetically trade-if any-to permanently cure their condition (diabetes). Thus, a diabetic participant estimating 20 remaining years of life who will theoretically trade 3 of those years to cure their diabetes, has a diabetes-associated utility of [1.00 - (3/20) =)] 0.85. The closer the utility is to 1.00, the better the QOL associated with a condition, while the closer it is to 0.00, the poorer the associated QOL.
The mean diabetes utility (QOL) for the white, diabetic participant cohort was 0.87, while that for the black cohort was 0.86 (P = 0.95). The ethnic cohorts were matched for age (P = 0.70), sex (P = 0.64), level of education (P = 0.29), known years of having diabetes (P = 0.10), insulin use (P = 0.23), type of diabetes (P = 0.27) and the number of associated comorbidities (P = 0.23). There was no difference between the cohorts for the presence and severity of the individual, diabetes-related comorbidities of retinopathy (P = 0.15), nephropathy (P = 0.24), neuropathy (P = 0.52), depression (P = 0.23) and heart disease (P = 0.32). Multiple linear regression integrating both cohorts revealed no effect of ethnicity upon diabetes utility (P = 0.60).
Diabetes-related QOL was similar in matched cohorts of adult white and black participants with diabetes mellitus. This study suggests utilities for diabetes mellitus can be used in economic analyses without adjustment for white and black ethnicity.
多项研究已经探讨了不同种族之间糖尿病护理的不平等问题。但是，很少有研究评估种族是否会影响患者对糖尿病生活质量的感知。因此，作者设计了一项横断面研究，以量化连续白人（高加索人）和黑人（非裔美国人）糖尿病患者的整体糖尿病相关生活质量。
在门诊环境中，通过访谈连续向 518 名白人患者和 92 名黑人患者发放了一份经过验证的时间权衡效用工具。该工具通过量化与病情相关的效用来计算生活质量，效用锚点为 1.00（该条件下的永久完美健康）和 0.00（死亡）。本文中使用的效用获取首先要求参与者估计他们的预期剩余寿命，然后从 1.00 中减去他们愿意假设为永久性治愈其病情（糖尿病）而交易的最大预期剩余寿命比例（如果有）。因此，预计剩余 20 年寿命的糖尿病患者，如果理论上愿意用 3 年时间来治愈糖尿病，那么与糖尿病相关的效用为[1.00-（3/20）=]0.85。效用越接近 1.00，与病情相关的生活质量越好，而越接近 0.00，相关生活质量越差。
白人糖尿病患者队列的平均糖尿病效用（生活质量）为 0.87，而黑人队列的平均糖尿病效用为 0.86（P=0.95）。两个种族队列在年龄（P=0.70）、性别（P=0.64）、教育水平（P=0.29）、已知患有糖尿病的年限（P=0.10）、胰岛素使用（P=0.23）、糖尿病类型（P=0.27）和相关合并症的数量（P=0.23）方面相匹配。两组之间在糖尿病相关合并症的存在和严重程度方面没有差异，包括视网膜病变（P=0.15）、肾病（P=0.24）、神经病变（P=0.52）、抑郁（P=0.23）和心脏病（P=0.32）。整合两个队列的多元线性回归显示，种族对糖尿病效用没有影响（P=0.60）。
在患有糖尿病的白人患者和黑人患者的匹配队列中，糖尿病相关的生活质量相似。本研究表明，在进行经济分析时，可以使用糖尿病的效用，而无需针对白人和黑人种族进行调整。
