Pan Yuzhe, Liu Qian, Zhang Nan, Peng Shuang, Li Xinqi, Zhou Fuling
School of Nursing, Wuhan University, Wuhan, Hubei, China.
Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
EClinicalMedicine. 2024 Dec 17;79:102996. doi: 10.1016/j.eclinm.2024.102996. eCollection 2025 Jan.
While advancements in leukemia care have been made, the global quality of care remains a concern. This study utilizes a modified quality of care index (QCI) to assess the global status of leukemia care.
We analyzed data from the global burden of disease (GBD) study spanning 1990-2021. The QCI was constructed using principal component analysis, based on the weighted variances of key indicators. We compared the original QCI with our modified version, analyzed QCI trends across different age groups and leukemia subtypes, identified key influencing factors using linear mixed models (LMM), and used spatial autocorrelation analysis to verify the autocorrelation of the socio-demographic index (SDI) region. Then we employed the bayesian age-period-cohort (BAPC) model to predict future QCI trends.
Between 1990 and 2021, both the age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) for leukemia exhibited a consistent decline. Our modified QCI method outperformed the original approach, particularly when the variance explained by the first principal component was below 80%, demonstrating higher correlation with the healthcare access and quality index (HAQI) (Pearson r = 0.91 vs. 0.89) and improved explanatory power (R = 0.82 vs. 0.79). Over past three decades, QCI was highest in San Marino (97.72%) and lowest in Fiji (3.51%), with significant regional variations across SDI levels ( = 133.40, < 2e-16). High-SDI regions had the highest QCI (78.50%; 95% confidence interval: 77.20%, 79.70%). QCI trends varied by age, peaking at 94.49% in the 15-19 age group in 2021 and declining to 0.44% in the 75-79 age group. LMM analysis identified sex, age, year, SDI region, and leukemia subtype as significant QCI determinants. Spatial autocorrelation analysis confirmed positive autocorrelation within SDI regions (Global = 0.87, < 2e-16). Projections suggest a generally fluctuating upward trend in QCI for leukemia, reaching 79.58% by 2046.
The QCI serves as an effective metric for evaluating the quality of leukemia care. Our findings reveal a strong association between leukemia QCI and regional economic and educational development. Age is a critical factor, with an aging population contributing to a potential decline in QCI. These results underscore the urgent need for targeted interventions to enhance health services for older adults and to improve care quality in economically disadvantaged regions.
This study was supported by the National Natural Science Foundation of China (General Program) (No. 82370176) and the Key Research and Development Program of Hubei Province (No. CZKYXM2023036JZ).
尽管白血病治疗已取得进展，但全球护理质量仍是一个令人担忧的问题。本研究采用改良的护理质量指数（QCI）来评估全球白血病护理状况。
我们分析了1990 - 2021年全球疾病负担（GBD）研究的数据。QCI是基于关键指标的加权方差，通过主成分分析构建的。我们将原始QCI与改良版本进行比较，分析不同年龄组和白血病亚型的QCI趋势，使用线性混合模型（LMM）确定关键影响因素，并使用空间自相关分析来验证社会人口指数（SDI）区域的自相关性。然后我们采用贝叶斯年龄 - 时期 - 队列（BAPC）模型预测未来QCI趋势。
1990年至2021年期间，白血病的年龄标准化发病率（ASIR）和年龄标准化死亡率（ASDR）均呈持续下降趋势。我们改良的QCI方法优于原始方法，特别是当第一主成分解释的方差低于80%时，与医疗保健可及性和质量指数（HAQI）的相关性更高（Pearson r = 0.91对0.89），解释力更强（R = 0.82对0.79）。在过去三十年中，QCI在圣马力诺最高（97.72%），在斐济最低（3.51%），不同SDI水平的区域存在显著差异（= 133.40，< 2e - 16）。高SDI区域的QCI最高（78.50%；95%置信区间：77.20%，79.70%）。QCI趋势因年龄而异，2021年在15 - 19岁年龄组达到峰值94.49%，在75 - 79岁年龄组降至0.44%。LMM分析确定性别、年龄、年份、SDI区域和白血病亚型是QCI的重要决定因素。空间自相关分析证实SDI区域内存在正自相关（全局= 0.87，< 2e - 16）。预测表明，白血病的QCI总体呈波动上升趋势，到2046年将达到79.58%。
QCI是评估白血病护理质量的有效指标。我们的研究结果揭示了白血病QCI与区域经济和教育发展之间的紧密关联。年龄是一个关键因素，人口老龄化可能导致QCI下降。这些结果强调了迫切需要采取针对性干预措施，以加强针对老年人的卫生服务，并提高经济欠发达地区的护理质量。
本研究得到了中国国家自然科学基金（面上项目）（编号82370176）和湖北省重点研发计划（编号CZKYXM2023036JZ）的支持。
