Quality of life among chronic obstructive pulmonary disease patients aged 40 years and above and its associated factors in Shandong Province
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摘要:
目的 了解山东省40岁及以上慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者的生活质量, 并探索其相关因素, 以期为改善COPD患者的生活质量和降低疾病负担提供科学合理的建议。 方法 利用2019年中国居民COPD山东省监测数据, 用SAS 9.4软件对所得数据进行整理分析, 采用χ2检验进行单因素分析, 采用多因素无序多分类logistic回归分析模型筛选生活质量的相关因素。 结果 2019年山东省40岁及以上COPD患者(559人)中, 74.96%的患者COPD对其生活质量的影响为轻度影响, 16.64%的患者为中度影响, 8.41%的患者为重度及以上影响。多因素分析结果表明, 在模型1(COPD患者生活质量受中度影响与轻度影响相比)中, BMI≥28.0 kg/m2(OR=3.11, 95% CI: 1.34~7.23)、吸烟(OR=1.83, 95% CI: 1.12~2.97)、烹饪使用清洁燃料(OR=0.37, 95% CI: 0.24~0.56)与COPD患者生活质量受中度影响有关(均P < 0.05);在模型2(COPD患者生活质量受重度及以上影响与轻度影响相比)中, 烹饪使用清洁燃料(OR=0.47, 95% CI: 0.31~0.71)、COPD严重程度为重度及以上(OR=15.19, 95% CI: 5.75~40.15)与COPD患者生活质量受重度及以上影响相关(均P < 0.05)。 结论 在山东省40岁及以上COPD患者中, 预防病情恶化、烹饪时使用清洁燃料、降低BMI、保持良好体型均与COPD患者的高生活质量有关。 Abstract:Objective To understand the quality of life of chronic obstructive pulmonary disease (COPD) patients aged 40 years and above in Shandong Province, and to explore the factors related to quality of life, so as to provide scientific and reasonable suggestions for better improving quality of life of patients with COPD and reducing the burden of COPD. Methods Utilizing the data of COPD in Chinese residents in 2019 from Shandong Province.SAS 9.4 was used to sort and analyze the data.Single factor analysis was carried out by χ2 test while possible related factors were analyzed by multinomial logistic regression analysis. Results Among 559 COPD patients aged 40 years and above in Shandong Province in 2019, 75.0% had mild impact on quality of life, 16.6% had moderate impact, and 8.4% had severe and extremely severe impact.The analysis results showed that, In model 1(COPD has a moderate impact on patients'quality of life compared with a mild impact), BMI≥28.0 kg/m2(OR=3.11, 95% CI: 1.34-7.23), smoking (OR=1.83, 95% CI: 1.12-2.97), cooking use of clean fuels (OR=0.37, 95% CI: 0.24-0.56) and COPD moderate effects on patients'quality of life (all P < 0.05);In model 2(patients with severe or higher impact of COPD on quality of life compared with those with mild impact), clean fuels were used for cooking (OR=0.47, 95% CI: 0.31-0.71) and COPD severity was severe or higher (OR=15.19, 95% CI: 5.75-40.15) was associated with severe and above impact on quality of life in COPD patients (all P < 0.05). Conclusion s Preventing exacerbations, using clean fuel in cooking, reducing their BMI and keeping a good figure were all associated with the high quality of life in COPD patients. -
表 1 COPD患者生活质量相关因素的单因素分析
Table 1. The univariate analysis of quality of life among patients with COPD
变量Variable 合计
Total人数(占比/%)
Number of people (proportion/%)χ2值
valueP值
value轻度影响
Mild influence中度影响
Moderate influence重度及以上影响
Severe and above influence年龄组/岁Age group/year 9.38 0.025 40~＜50 29 27(93.10) 2(6.90) 0(0.00) 50~＜60 152 116(76.32) 25(16.45) 11(7.24) 60~＜70 226 168(74.34) 36(15.93) 22(9.73) ≥70 152 108(71.05) 30(19.74) 14(9.21) 性别Gender 1.34 0.543 男Male 407 304(74.69) 65(15.97) 38(9.34) 女Female 152 115(75.66) 28(18.42) 9(5.92) 城乡Residency 0.65 0.733 城市Urban 182 146(80.22) 22(12.09) 14(7.69) 乡村Rural 377 273(72.41) 71(18.83) 33(8.75) BMI/(kg·m-2) ① 11.50 0.026 < 24.0 230 181(78.24) 34(14.81) 15(6.94) 24.0~ < 28.0 242 175(72.31) 41(16.94) 26(10.74) ≥28.0 86 62(72.09) 18(20.93) 6(6.98) 文化程度Education 18.37 < 0.001 小学及以下Primary school and below 347 250(72.05) 65(18.73) 32(9.22) 初中Junior high school 164 129(78.66) 23(14.02) 12(7.32) 高中及以上High school and above 48 40(83.33) 5(10.42) 3(6.25) 职业Occupation 2.53 0.340 农民Farmer 332 247(74.40) 52(15.66) 33(9.94) 非农民Non-farmer 227 172(75.77) 41(18.06) 14(6.17) 婚姻状况Marital status 0.48 0.795 已婚With spouse 485 366(75.46) 78(16.08) 41(8.45) 其他Others 74 53(71.62) 15(20.27) 6(8.11) 取暖时通风Ventilate when heating 9.16 0.054 否No 251 171(68.13) 49(19.52) 31(12.35) 是Yes 301 244(81.06) 41(13.62) 16(5.32) 烹饪使用清洁燃料Clean fuels for cooking 16.94 0.005 否No 318 228(71.70) 60(18.87) 30(9.43) 是Yes 169 141(83.43) 19(11.24) 9(5.33) 取暖使用清洁燃料Clean fuel for heating 0.67 0.726 否No 416 330(79.33) 62(14.90) 24(5.77) 是Yes 5 3(60.00) 1(20.00) 1(20.00) 吸烟Smoking 5.06 0.025 否No 206 165(80.10) 28(13.59) 13(6.31) 是Yes 353 254(71.95) 65(18.41) 34(9.63) 接触二手烟Second-hand smoke exposure 0.82 0.808 否No 156 115(73.72) 28(17.95) 13(8.33) 是Yes 395 302(76.46) 62(15.70) 31(7.85) 接触职业粉尘Occupational dust exposure 0.01 0.993 否No 364 272(74.73) 62(17.03) 30(8.24) 是Yes 185 143(77.30) 27(14.59) 15(8.11) 接触有害气体Hazardous gases exposure 2.60 0.331 否No 372 280(75.27) 64(17.20) 28(7.53) 是Yes 175 134(76.57) 23(13.14) 18(10.29) COPD患病知晓情况Awareness of COPD 9.76 0.047 否No 529 411(77.69) 81(15.31) 37(6.99) 是Yes 7 1(14.29) 1(14.29) 5(71.40) 接种流行性感冒疫苗Getting the influenza vaccine 3.72 0.225 否No 525 396(75.43) 88(16.76) 41(7.81) 是Yes 32 21(65.63) 5(15.63) 6(18.75) COPD严重程度Severity of COPD 40.13 < 0.001 轻度Mild 416 326(78.37) 70(16.83) 20(4.81) 中度Moderate 115 80(69.57) 18(15.65) 17(14.78) 重度及以上Severe and above 27 12(44.44) 5(18.52) 10(37.04) 注：COPD，慢性阻塞性肺疾病；CAT，COPD评估量表。
① BMI中体重过轻(BMI < 18.5 kg/m2)者人数较少，因此，将体重过轻(BMI < 18.5 kg/m2)和体重正常(18.5≤BMI < 24.0 kg/m2)者合并为一组。
Note: COPD, chronic obstructive pulmonary disease; CAT, COPD assessment test.
① Because of the small number of people with BMI < 18.5 kg/m2, under-weight (BMI < 18.5 kg/m2) and normal-weight (18.5≤BMI < 24.0 kg/m2) individuals were combined into one group.
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表 2 COPD患者生活质量相关因素的Logistic回归分析模型分析
Table 2. Logistic regression analysis of factors related to quality of life in patients with COPD
变量Variable 模型1 Model 1 模型2 Model 2 β值
valuesx
(β)OR值value
(95% CI)P值
valueβ值
valuesx
(β)OR值value
(95% CI)P值
valueBMI /(kg·m-2)(ref: < 24.0) 24.0~ < 28.0 -0.12 0.10 1.48(0.73~2.97) 0.232 0.46 0.39 3.28(0.64~16.88) 0.246 ≥28.0 0.63 0.17 3.11(1.34~7.23) < 0.001 0.28 0.35 2.75(0.60~12.58) 0.427 吸烟(ref: 否) Smoking (ref: No) 是Yes 0.30 0.12 1.83(1.12~2.97) 0.015 0.18 0.12 1.45(0.90~2.32) 0.128 烹饪使用清洁燃料(ref: 否) Clean fuels for cooking(ref: No) 是Yes -0.50 0.11 0.37(0.24~0.56) < 0.001 -0.38 0.11 0.47(0.31~0.71) 0.001 COPD严重程度(ref: 轻度) Severity of COPD (ref: mild) 中度Moderate -0.41 0.21 0.62(0.41~0.93) 0.052 -0.14 0.28 3.14(1.32~7.50) 0.613 重度及以上Severe and above 0.33 0.40 1.30(0.38~4.42) 0.403 1.43 0.31 15.19(5.75~40.15) < 0.001 常数Constant -1.60 0.27 < 0.001 -1.86 0.45 < 0.001 注：1. COPD，慢性阻塞性肺疾病。
2. 模型1与模型2均将COPD患者生活质量受轻度影响设为参照，模型1为COPD患者生活质量受中度影响与轻度影响相比，模型2为COPD患者生活质量受重度及以上影响与轻度影响相比。
Note: 1. COPD，chronic obstructive pulmonary disease.
2. Both Model 1 and Model 2 set the mild impact of COPD on the quality of life of patients as the reference, model 1 compared the moderate impact of COPD on the quality of life of patients with mild impact, model 2 compared the severe and more severe impact of COPD on the quality of life of patients with mild impact.
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