School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, Hubei, China.
Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, 430030, Hubei, China.
Health Qual Life Outcomes. 2020 May 26;18(1):153. doi: 10.1186/s12955-020-01409-w.
The association between poverty and health has been widely assessed. However, whether the association between poverty and health-related quality of life (HRQOL) holds among different groups is unknown. This study aimed to 1) assess the association between poverty and HRQOL among rural residents in China and 2) examine whether the association holds among different populations, thereby supporting policy-making and implementation.
A multistage, stratified, random household survey was conducted with self-administered questionnaires. Matched samples were generated by the censored exact matching method to reduce selection bias between the poverty and comparison groups. We applied Tobit and ordinal logit regression models to evaluate the association between poverty and HRQOL measured by the EQ-5D-3 L among different groups.
The health utility score of the poverty group was 6.1% lower than that of comparison group (95% CI = - 0.085, - 0.037), with anxiety/depression being most common (95% CI = 1.220, 1.791). The association between poverty and HRQOL was significantly stronger among residents from central China, males, people who were middle-aged, elderly, highly educated, married, or widowed, those living far from healthcare facilities, and those without chronic disease. Male and highly educated subjects reported worse mobility, self-care, usual activities, pain/discomfort and anxiety/depression dimensions than the other respondents. Middle-aged (95% CI = 1.692, 2.851) and married respondents (95% CI = 1.692, 2.509) and respondents with chronic diseases (95% CI = 1.770, 2.849) were most affected in the anxiety/depression.
The HRQOL of individuals living in poverty is lower than that of the general population, and the mental health dimension is most affected by poverty among respondents who are middle-aged or married and respondents with chronic diseases. The identification of populations that are more affected by poverty is critical to improve their HRQOL. Various associations have indicated the need for integrated policies and specific decision-making.
贫困与健康之间的关系已得到广泛评估。然而，贫困与健康相关生活质量（HRQOL）之间的关联在不同人群中是否存在尚不清楚。本研究旨在：1）评估中国农村居民贫困与 HRQOL 之间的关系；2）检验这种关联在不同人群中的存在情况，从而为决策和实施提供支持。
采用多阶段、分层、随机入户问卷调查。采用删失精确匹配法生成匹配样本，以减少贫困组和对照组之间的选择偏差。我们应用 Tobit 和有序逻辑回归模型评估不同组别中 EQ-5D-3L 测量的贫困与 HRQOL 之间的关系。
贫困组的健康效用评分比对照组低 6.1%（95%CI=−0.085，−0.037），其中焦虑/抑郁最常见（95%CI=1.220，1.791）。在来自中部地区、男性、中年、老年、高学历、已婚或丧偶、离医疗机构较远和无慢性病的居民中，贫困与 HRQOL 之间的关联更为显著。男性和高学历者在行动能力、自我照顾、日常活动、疼痛/不适和焦虑/抑郁维度上的报告比其他受访者差。中年（95%CI=1.692，2.851）和已婚受访者（95%CI=1.692，2.509）以及患有慢性病的受访者（95%CI=1.770，2.849）在焦虑/抑郁方面受影响最大。
生活贫困的个体的 HRQOL 低于一般人群，在中年或已婚人群以及患有慢性病的人群中，贫困对心理健康维度的影响最大。确定受贫困影响更大的人群对于提高他们的 HRQOL 至关重要。各种关联表明需要制定综合政策和具体决策。
