School of Nursing and Health, Zhengzhou University, Zhengzhou, China.
Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China.
Front Public Health. 2022 Apr 5;10:810185. doi: 10.3389/fpubh.2022.810185. eCollection 2022.
Stroke is a major health threat and the leading cause of mortality and disability in China. The aims of this study were to identify the possible influencing factors of health-related quality of life (HRQoL) and its domain-specific contents in stroke patients in rural areas in China.
A total of 1,709 stroke patients aged 36-79 years from the baseline data of Henan Rural Cohort study ( = 39,259) were included in the cross-sectional study. The Chinese version of the European Quality of Life Five Dimension (including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) Five Level Scale (EQ-5D-5L) and visual analog scale (VAS) were used to evaluate HRQoL in stroke patients. Tobit regression models, generalized linear models and binary logistic regression models were constructed to determine potential influencing factors of the EQ-5D utility index, as well as influencing factors of each domain and VAS score.
The mean utility index and VAS scores of stroke patients were 0.885 (SD, 0.204), and 68.39 (SD, 17.31), respectively. Pain/discomfort (PD, 35.2%) and mobility (MO, 30.4%) were the most frequently reported issues. Regression models revealed that illiterate; a low monthly income; low physical activity intensity; and diabetes, anxiety, depression, or poor sleep quality were significantly associated with lower utility index and VAS scores among stroke patients. In addition, patients with stroke who were older, female, drinking, smoking, and consuming a high-fat diet, had a higher BMI, and lived with a stroke for a longer time, were also significantly associated with different dimensions of the EQ-5D.
Patients with stroke in rural areas in China had a low HRQoL. Factors associated with the EQ-5D utility index as well as each domain and VAS score, need to be considered by health providers in rural areas. Patients with stroke in rural areas need to be included in national basic public medical services and managed systematically by medical institutions.
脑卒中是中国主要的健康威胁，也是导致死亡和残疾的主要原因。本研究旨在确定中国农村地区脑卒中患者健康相关生活质量（HRQoL）及其特定领域内容的可能影响因素。
本研究共纳入了来自河南农村队列研究（n=39259）基线数据的 1709 名年龄在 36-79 岁的脑卒中患者。采用欧洲五维健康量表（EQ-5D-5L）中文版和视觉模拟评分（VAS）评估脑卒中患者的 HRQoL。采用 Tobit 回归模型、广义线性模型和二项逻辑回归模型确定 EQ-5D 效用指数的潜在影响因素，以及各领域和 VAS 评分的影响因素。
脑卒中患者的平均效用指数和 VAS 评分分别为 0.885（标准差，0.204）和 68.39（标准差，17.31）。疼痛/不适（PD，35.2%）和行动能力（MO，30.4%）是最常报告的问题。回归模型显示，文化程度低、月收入低、体力活动强度低、糖尿病、焦虑、抑郁或睡眠质量差与脑卒中患者的效用指数和 VAS 评分较低显著相关。此外，年龄较大、女性、饮酒、吸烟、高脂肪饮食、较高 BMI 以及与脑卒中共存时间较长的患者，在 EQ-5D 的不同维度上也存在显著差异。
中国农村地区脑卒中患者的 HRQoL 较低。农村地区的卫生保健提供者需要考虑与 EQ-5D 效用指数以及各领域和 VAS 评分相关的因素。需要将农村地区的脑卒中患者纳入国家基本公共医疗服务，并由医疗机构系统管理。
