Zhongguo quanke yixue (Mar 2025)
Analysis of the Development Trajectory of Health-related Quality of Life in Middle-aged and Elderly Patients with Cardiometabolic Diseases and the Influencing Factors
Abstract
Background As the aging of the population, the burden of chronic diseases in China has increased significantly. The majority of chronic disease patients suffer from cardiometabolic diseases (CMD) like hypertension and diabetes. The health-related quality of life (HRQoL) is a subjective evaluation index that reflects both the physical health level and mental health of patients with chronic diseases. Existing research on HRQoL in patients with CMD primarily focuses on influencing factors and the assessment of their current status. Compared to the research on the static status of HRQoL, research on its dynamic trends over time, however, remains somewhat limited. Objective To analyze the development trajectory of HRQoL in middle-aged and elderly patients with CMD and influencing factors, as well as to explore the contribution of each influencing factor, thus providing a scientific basis for improving HRQoL in patients with CMD. Methods Using time-series data from field surveys, a baseline survey in 2016 (T0) was conducted using a typical sampling in eligible patients with primary hypertension or type 2 diabetes mellitus (T2DM) from 3 urban communities and 2 rural communities in a certain division of the Xinjiang Production and Construction Corps. Four follow-up surveys were conducted in 2017 (T1), 2018 (T2), 2019 (T3), and 2021 (T4). A total of 1 599 subjects were surveyed in the baseline period, and 565 subjects completed the follow-up visits. Of them, 389 had hypertension, and 176 had T2DM. After excluding samples with missing data like HRQoL and demographic characteristics, data from 563 subjects were included in the analysis. A self-designed questionnaire was used for the survey, composing of five parts of personal basic information, social and psychological status, lifestyle, disease status, and health service utilization. The HRQoL of patients was measured using the European Quality of Life 5-Dimension 5-Level version (EQ-5D-5L). The heterogeneous HRQoL development trajectories were explored using a growth mixture model, and the influencing factors and evaluation of the development trajectories were analyzed using a logistic regression model and Shapley value decomposition, respectively. Results Three distinct types of heterogeneous development trajectories were identified, including a 452 (80.28%) cases in the significant growth group, 81 (14.39%) cases in the moderate decline group, and 30 (5.33%) cases in the significant attenuation group. Multivariate Logistic regressions analysis indicated that, patients who do not engage in physical exercise, possess impaired self-care abilities, experience deteriorating health conditions, have non-urban employee medical insurance, and express dissatisfaction with the outpatient chronic disease policy were more likely to enter the moderate decline group (P<0.05) ; patients who do not participate in physical exercise and express general satisfaction with the outpatient chronic disease policy were more likely to belong to the significant attenuation group (P<0.05). The Shapley value decomposition results revealed that the contribution of each influencing factor to the prediction of HRQoL varied among the different trajectory groups. In the significant growth group, the factors with the greatest contribution were changes in health status and self-care ability. In the moderate decline group, the predominant influencing factors were physical exercise and self-care ability. In the significant attenuation group, satisfaction with the outpatient chronic disease policy ranked first in the contribution analysis, followed by physical exercise. Conclusion Patients with CMD exhibit varying trajectories in HRQoL, which are influenced by distinct factors associated with each trajectory. Intervention measures can be dynamically tailored in response to the evolving HRQoL trajectories and their influencing factors, thereby offering more precise medical and health services to patients with CMD. We should concentrate on CMD patients whose health status has deteriorated, whose self-care ability has impaired, and who do not engage in physical exercise. Concurrently, efforts should be made to promote awareness of chronic disease policies, medical insurance, and other pension policies. Additionally, it is essential to continue enhancing the quality of outpatient chronic disease medical services and to improve patient satisfaction with the outpatient chronic disease policies, thereby further enhancing HRQoL.
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