基于分位数回归模型的2型糖尿病住院患者生命质量影响因素分析

张静; 孙仙; 张文玲; 李金霞; 田小丽

doi:10.16462/j.cnki.zhjbkz.2020.02.012

基于分位数回归模型的2型糖尿病住院患者生命质量影响因素分析

doi: 10.16462/j.cnki.zhjbkz.2020.02.012

1.
750004 银川, 宁夏医科大学公共卫生与管理学院流行病与卫生统计学系
2.
753600 石嘴山, 石嘴山市第一人民医院医务科

基金项目: 宁夏医科大学校级科研项目(XY201732);大学生创新训练项目(NXCX2017115)

详细信息

通讯作者:
孙仙, E-mail:sunxvic@126.com

中图分类号: R181.3
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出版历程
- 收稿日期: 2019-08-28
- 修回日期: 2019-12-01
- 刊出日期: 2020-02-10

Quantile regression model-based analysis of influencing factors on quality of life of inpatients with type 2 diabetes

1.
Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
2.
Department of Medical, Shizuishan First People's Hospital, Shizuishan 753600, China

Funds: Ningxia Medical University Scientific Research Project(XY201732); Innovation Training Program for College Students(NXCX2017115)

More Information

Corresponding author: SUN Xian, E-mail:sunxvic@126.com

摘要

摘要: 目的了解银川市2型糖尿病((type 2 diabetes mellitus, T2DM)住院患者健康相关生命质量(health-related quality of life, HRQOL)现状, 分析影响T2DM住院患者HRQOL的因素; 探讨分位数回归分析HRQOL影响因素的应用价值。方法使用横断面调查的方法获得480例T2DM住院患者的资料, 采用中文版糖尿病相关生命质量(Chinese normal audit of diabetes-dependent quality of Life, CN-ADDQoL)量表评估患者的HRQOL状况, 比较应用传统线性回归和分位数回归模型分析T2DM住院患者HRQOL影响因素的结果。结果 T2DM住院患者平均加权影响得分(average weight impact, AWI)为-2.7(-3.6, -1.9), 得分最低的条目是“工作生涯”(AWI, -4(-6, -2)), “吃东西随意性”(AWI, -4(-6, -2))和“喝东西随意性”(AWI, -4(-6, -2))。线性回归结果显示, 年龄18~59岁(β=0.465, P=0.001)、有肾脏(β=-0.375, P=0.012)和循环系统并发症(β=-0.287, 0.036)是T2DM住院患者HRQOL的危险因素。分位数回归进一步发现, 生命质量越好, 年龄对其影响越弱(β₁=0.931, P₁=0.001;β₂=0.699, P₂=0.001;β₃=0.370, P₃=0.012;β₄=0.313, P₄=0.035);农村居民(β₅=-0.421, P₅ < 0.001)、接受胰岛素治疗(β₃=-0.325, P₃=0.024)、眼部(β₁=-0.546, P₁=0.008;β₅=-0.352, P₅=0.008)、肾脏(β₅=-0.358, P₅=0.025)及循环系统并发症(β₁=-0.803, P₁ < 0.001;β₅=-0.302, P₅=0.011)在个别百分位点上对HRQOL有影响。结论年龄、城乡居住地、是否接受胰岛素治疗、合并并发症是T2DM住院患者HRQOL的影响因素, 分位数回归模型可以分析在不同百分位点上影响患者生命质量的因素, 为不同HRQOL患者生命质量的提高提供有针对性的合理建议。
- T2DM住院患者 /
- 健康相关生命质量 /
- 中文版糖尿病相关生命质量量表 /
- 分位数回归 /
- 影响因素
Abstract: Objective This study aimed to understand the status of health-related quality of life(HRQOL) among the hospitalized patients with type 2 diabetes(T2 DM) in Yinchuan, so as to analyze the factors associated with HRQOL of hospitalized T2 DM patients. The applied value of quantile regression in analysis of HRQOL was explored. Methods A cross-sectional study was conducted to obtain data of 480 hospitalized T2 DM patients. The Chinese Normal Audit of Diabetes-Dependent Quality of Life(CN-ADDQoL) scale was used to assess the HRQOL status of patients. Traditional linear regression and quantile regression were used to analyze the influencing factors of HRQOL in hospitalized T2 DM patients. Results The average weight impact(AWI) of hospitalized T2 DM patients was-2.7(-3.6, -1.9), and the items with lowest score were in the dimension of "work life"(AWI, -4(-6, -2)), "eat" AWI, -4(-6, -2)) and "Anything of Drinking"(AWI, -4(-6, -2)). Linear regression results showed that 18-59 years old or the renal and circulatory complications were risk factors for HRQOL in T2 DM hospitalized patients. Quantile regression further found that the better the quality of life, the weaker the effect on age(β₁=0.931, P₁=0.001; β₂=0.699, P₂=0.001; β₃=0.370, P₃=0.012; β₄=0.313, P₄=0.035), the rural residents(β₅=-0.421, P₅ < 0.001), insulin treatment(β₃=-0.325; P₃=0.024), the ocular(β₁=-0.546, P₁=0.008; β₅=-0.352, P₅=0.008), renal(β₅=-0.358, P₅=0.025) and circulatory complications(β₁=-0.803, P₁ < 0.001; β₅=-0.302, P₅=0.011) had effect on HRQOL at different quantiles. Conclusions Age, urban and rural residence, whether receive insulin therapy and complications are the influencing factors of HRQOL in hospitalized T2 DM patients. The quantile regression model can show different factors affecting the quality of life of patients at different quintiles. The results from quantile regression can provide the targeted and reasonable recommendations for improvement of HRQOL of T2 DM patients.
- Inpatients with T2DM /
- Health-related quality of life /
- CN-ADDQoL /
- Quantile regression /
- Influencing factor

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表 1 T2DM住院患者ADDQoL各条目加权得分情况

Table 1. Weighted scores of ADDQoL entries in hospitalized patients with T2DM

条目	加权得分
条目	P₂₅	P₅₀	P₇₅
休闲活动	-4	-2	-1
工作生涯	-6	-4	-2
短/长途旅程	-4	-2	0
度假	-4	-2	-1
体力活动	-4	-2	-1
家庭生活	-6	-3	0
朋友/社交生活	-3	-1	0
最亲近的个人关系	-4	-2	0
性生活	-4	-2	0
身体外表	-4.0	-2.0	-0.8
自信心	-4.0	-2.5	-1.0
动力	-4	-3	-1
人们对我的反应	-2	0	0
对未来的感觉	-4	-4	-2
经济状况	-4	-4	-2
不愿但不得不依赖他人	-4	-4	-2
生活状况/条件	-4	-2	-1
吃东西随意性	-6	-4	-2
喝东西随意性	-6	-4	-2
注:P₂₅:第25百分位数; P₅₀中位数; P₇₅第75百分位数。

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表 2 不同基本特征T2DM住院患者AWI得分

Table 2. AWI scores of T2DM hospitalized patients with different basic characteristics

变量	人数[n(%)]	AWI [M(P₂₅, P₇₅)]	W/H值	P值
性别^a			0.409	0.523
男	268(55.8)	-2.8(-3.8, -1.9)
女	212(44.2)	-2.7(-3.5, -1.9)
年龄^a			3.838	0.050
18~	240(50.0)	-3.0(-4.1, -1.9)
≥60	240(50.0)	-2.6(-3.4, -1.9)
文化程度^a			0.195	0.659
初中及以下	314(65.4)	-2.7(-3.6, -2.0)
高中及以上	166(34.6)	-2.6(-3.9, -1.8)
职业^b			2.510	0.474
无工作	71(14.8)	-2.7(-3.8, -2.0)
农民	89(18.5)	-2.7(-3.4, -2.2)
其他	142(29.6)	-3.0(-4.1, -1.9)
退休	178(37.1)	-2.6(-3.5, -1.9)
城乡^a			0.068	0.068
城市	311(64.8)	-2.7(-3.6, -1.9)
农村	169(35.2)	-2.9(-3.9, -2.1)
现居住地^a			0.300	0.584
银川市内	211(44.0)	-2.7(-3.6, -2.0)
银川市外	269(56.0)	-2.8(-3.8, -1.9)
个人月收入(元)^b			3.211	0.201
0~	181(37.7)	-2.7(-3.4, -2.1)
2 000~	170(35.4)	-3.0(-3.8, -2.0)
≥4 000	129(26.9)	-2.5(-3.6, -1.8)
注:^a采用Wilcoxon rank sum test进行统计学检验; ^b采用Kruskal-Wallis H test进行统计学检验。

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表 3 不同健康相关行为的T2DM住院患者AWI得分

Table 3. AWI scores of T2DM hospitalized patients with different health-related behaviors

变量	人数[n(%)]	AWI [M(P₂₅, P₇₅)]	H/W值	P值
吸烟^a			0.959	0.619
否	322(67.1)	-2.7(-3.5, -1.9)
是	106(22.1)	-2.9(-3.8, -2.2)
以前吸	52(10.8)	-2.7(-4.1, -1.9)
饮酒^a			0.431	0.806
否	358(74.6)	-2.7(-3.6, -2.0)
是	84(17.5)	-2.6(-3.8, -1.9)
已戒酒	38(7.9)	-2.8(-4.0, -1.9)
日常体育锻炼^a			1.923	0.382
基本不锻炼	111(23.1)	-2.9(-3.6, -2.1)
偶尔锻炼	104(21.7)	-2.7(-3.7, -2.1)
经常锻炼	265(55.2)	-2.6(-3.6, -1.9)
进食高胆固醇或高脂肪食物^b			26 582	0.680
否	165(34.4)	-2.7(-3.6, -1.9)
是	315(65.6)	-2.7(-3.8, -2.0)
进食五谷杂粮^b			27 438	0.573
否	272(56.7)	-2.8(-3.6, -1.9)
是	208(43.3)	-2.6(-3.7, -1.9)
进食高糖食物^b			17 264	0.195
否	99(20.6)	-2.8(-3.8, -2.2)
是	381(79.4)	-2.7(-3.6, -1.9)
注:^a采用Kruskal-Wallis test进行统计学检验; ^b采用Wilcoxon rank sum test进行统计学检验。

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表 4 不同临床特征T2DM患者AWI得分情况

Table 4. AWI scores of T2DM hospitalized patients withdifferent clinical features

变量	[n(%)]/[M(P₂₅, P₇₅)]	AWI [M(P₂₅, P₇₅)]	P值
T2DM患病时间(年)^a	9.0(5, 15)	-	0.205
糖化血红蛋白水平(%)^a	8.9(7.5, 10.4)	-	0.305
胰岛素治疗^b			0.014
否	210(43.8)	-2.6(-3.4, -1.8)
是	270(56.6)	-3.0(-3.8, -2.1)
近一年门诊就诊次数^a	11(3, 12)	-	0.144
近一年T2DM住院次数^a	1(1, 1)	-	0.052
并发症数目^c			0.018
无	76(15.8)	-2.5(-3.2, -1.6)
一种	94(19.6)	-2.7(-3.6, -1.8)
多种	310(64.6)	-2.9(-3.8, -2.1)
眼部病变^b			0.005
否	293(61.0)	-2.6(-3.5, -1.8)
是	187(39.0)	-2.9(-4.1, -2.2)
神经病变^b			0.277
否	215(44.8)	-2.7(-3.5, -1.9)
是	265(55.2)	-2.8(-3.8, -2.1)
糖尿病性肾病^b			0.002
否	343(71.5)	-2.7(-3.5, -1.8)
是	137(28.5)	-3.1(-4.2, -2.2)
皮肤病变^b			0.413
否	377(78.5)	-2.7(-3.6, -1.9)
是	103(21.5)	-2.9(-3.8, -2.0)
循环系统并发症^b			0.014
否	209(43.5)	-2.6(-3.5, -1.8)
是	271(56.5)	-2.9(-3.8, -2.1)
注:^a采用Spearman’s rank correlation进行统计学检验; ^b采用Wilcoxon rank sum test进行统计学检验; ^c采用Kruskal-Wallis H test进行统计学检验。

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表 5 T2DM住院患者线性回归与多分位数回归分析结果比较

Table 5. Comparison of linear regression and multi-quantile regression analysis in hospitalized patients with T2DM

变量	LR		QR-10		QR-25		QR-50		QR-75		QR-90
变量	β (95% CI)值	P值	β (95% CI)值	P值	β (95% CI)值	P值	β (95% CI)值	P值	β (95% CI)值	P值	β (95% CI)值	P值
截距	-2.604(-2.868~-2.340)	< 0.001	-4.409(-5.867~-3.740)	< 0.001	-2.931(-3.544~-2.687)	< 0.001	-2.337(-2.626~-1.991)	< 0.001	-1.469(-1.840~-1.103)	< 0.001	-0.708(-1.004~-0.627)	< 0.001
年龄(岁)		0.001		0.001		0.001		0.012		0.035		0.074
18~	1.000		1.000		1.000		1.000		1.000		1.000
≥60	0.465(0.203~ 0.727)		0.931(0.521~1.492)		0.699(0.376~1.036)		0.370(0.169~0.689)		0.313(0.056~0.625)		0.148(-0.088~0.309)
居住地		0.112		0.103		0.231		0.296		0.176		< 0.001
农村	1.000		1.000		1.000		1.000		1.000		1.000
城市	-0.214(-0.477~0.050)		-0.327(-1.064~0.232)		-0.272(-0.608~0.088)		-0.162(-0.462~0.138)		-0.182(-0.390~0.103)		-0.421(-0.515~-0.258)
胰岛素治疗		0.061		0.690		0.129		0.024		0.711		0.059
是	1.000		1.000		1.000		1.000		1.000		1.000
否	-0.254(-0.520~0.012)		0.097(-0.479~0.522)		-0.337(-0.670~0.002)		-0.325(-0.576~-0.115)		-0.052(-0.360~0.138)		-0.131(-0.342~0.069)
眼部并发症		0.071		0.008		0.583		0.120		0.130		0.008
有	1.000		1.000		1.000		1.000		1.000		1.000
无	-0.248(-0.516~0.021)		-0.546(-0.940~-0.015)		-0.127(-0.710~0.140)		-0.263(-0.452~0.052)		-0.238(-0.430~-0.036)		-0.352(-0.527~-0.094)
糖尿病肾病		0.012		0.062		0.055		0.080		0.173		0.025
有	1.000		1.000		1.000		1.000		1.000		1.000
无	-0.375(-0.668~-0.082)		-0.702(-1.625~0.051)		-0.453(-0.720~-0.089)		-0.333(-0.511~-0.001)		-0.218(-0.461~0.008)		-0.358(-0.594~-0.131)
循环系统并发症		0.036		< 0.001		0.172		0.117		0.233		0.011
有	1.000		1.000		1.000		1.000		1.000		1.000
无	-0.287(-0.555~-0.019)		-0.803(-1.189~-0.108)		-0.313(-0.797~0.108)		-0.296(-0.479~0.140)		-0.193(-0.411~0.108)		-0.302(-0.710~-0.105)
注:LR: linear regression; QR: quantile regression; β: regression coefficient。

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