To Explore The Applicability Of EQ-5D Bolt-on Cognition In General Population And Elderly Patients With Chronic Disease Based On Population In Guizhou Province

Objective:To explore the applicability of adding four cognitive dimensions of attention,memory,calculation and learning to the EQ-5D in the general population and elderly patients with chronic disease in China.Providing reference for accurately measuring the health status of the population,carrying out Health Economics evaluation and guiding the allocation of health resources.Methods:The principle of quota and convenient sampling is adopted.Five administrative villages and five administrative communities were selected from rural and urban areas under the jurisdiction of Guiyang City,Zunyi City,Bijie City,Liupanshui City,Qianxi and Qiandongnan Autonomous Prefectures in Guizhou Province from July2020 to September 2021.A total of 1,280 general populations were selected based on the sex ratio(male:female=1.05:1),age ratio(<30 years:30 to 59 years:≥60years=1.37:2.93:1)and education(elementary school and below:junior high school and secondary school:university and above=1:1:1)quota of the population as shown in the results of the sixth national census.A total of 400 elderly chronic patient groups were selected for a questionnaire survey based on equal proportion of gender(male:female=1:1),education(elementary school and below:junior high school and secondary school:university and above=1:1:1)and type of chronic disease(hypertension:diabetes:hyperlipidemia=1:1:1).The questionnaire included the sociodemographic information and general health information,EQ-5D+C,MMSE,SF-6D_V2,ICECAP-A and SCT4.To verify the measurement characteristics Properties(feasibility,ceiling/floor effect,reliability and validity,discriminating validity and consistency)of EQ-5D+C,investigate the impact of new dimensions on the quality of life of respondents,and explore other potentially important quality of life dimensions of the EQ-5D.Results:A total of 1,700 questionnaires were distributed and 1,680 valid questionnaires were returned in the study,including 1,280 general population and 400 elderly patients with chronic disease.The average age of respondents in the general population was(45.30±21.11)years.The average age of respondents in the elderly patients with chronic diseases was(70.91±6.61)years,164 patients with hypertension,120 patients with diabetes,and 116 patients with hyperlipidemia.The scores of EQ-5D-3L+C and EQ-5D-5L+C scales in the general population were(25.00±2.00)and(40.19±4.82),respectively,and the scores of EQ-5D-3L+C and EQ-5D-5L+C scales in the elderly patients with chronic disease were(23.83±1.88)and(38.10±4.60),respectively.In the general population,the completion rates of both EQ-5D-3L+C and EQ-5D-5L+C were 100.00%,the recovery rates were 99.22%and 97.71%,the ceiling effects were 25.00%and 19.22%,the test-retest reliability coefficients were 0.825 and0.803,the split-half reliability coefficients were 0.686 and 0.781,and the overall internal consistency Cronbach’s a were 0.743 and 0.842.The correlation coefficients between EQ-5D+C score and MMSE,SF-6D,ICECAP-A and SCT4 scores were0.198～0.693.4 and 3 common factors were extracted from the factor analysis results of EQ-5D-3L+C and EQ-5D-5L+C and MMSE,SF-6D,ICECAP-A and SCT4,respectively,and the cumulative variance contribution rates were 36.246%and38.365%,respectively.The agreement results of EQ-5D-3L+C and MMSE,SF-6D,ICECAP-A,and SCT4 were 6.09%,4.06%,5.94%,and 5.31%of respondents,respectively,which were not in the 95%agreement limit.The agreement results of EQ-5D-5L+C were 5.31%,4.69%,6.25%,and 6.56%of respondents,respectively,which were not in the 95%agreement limit.The EQ-5D+C score was statistically significant in respondents’residence,ethnicity,age,marital status,education level,practice status,medical insurance,personal monthly income level,and whether they were ill.In the elderly chronic patient group,the recovery and completion rates of EQ-5D-3L+C and EQ-5D-5L+C were 100%,and the ceiling effects were 6.00%and1.00%,respectively;the test-retest reliability coefficients were 0.806 and 0.780,the split-half reliability coefficients were 0.339 and 0.736,and the overall internal consistency Cronbach’sαwere 0.553 and 0.817.The correlation coefficients between EQ-5D+C scores and MMSE,SF-6D,ICECAP-A and SCT4 scores were0.388～0.623.4 and 3 common factors were extracted from the factor analysis results of EQ-5D-3L+C and EQ-5D-5L+C and MMSE,SF-6D,ICECAP-A and SCT4,respectively,and the cumulative variance contribution rates were 40.481%and39.484%,respectively.The agreement between EQ-5D-3L+C and MMSE,SF-6D,ICECAP-A,and SCT4 was 5.50%,4.50%,6.50%,and 5.50%of respondents,respectively,which was not within the 95%agreement limit;the agreement between EQ-5D-5L+C was 7.50%,5.00%,5.50%,and 6.00%of respondents,respectively.There were significant differences in EQ-5D+C in marital status,education level,and personal monthly income level.When any new cognitive dimension is added into the EQ-5D model alone,the explanatory ability of EQ-VAS,MMSE,SF-6D,ICECAP-A and SCT4 score models is improved by 0.21%～157.14%.When four dimensions are combined into one dimension of"cognition",it is improved by 2.07%～77.39%.When four dimensions are added,it is improved by 5.38%～206.25%.In addition to the 9 dimensions of the EQ-5D+C and"no health problems",the health problems that currently afflict respondents most are the 12 most troublesome categories of health problems:stress,sleep,diet,vision,hearing,obesity,exercise,smoking/drinking,environment,skin,breathing,cognition.In addition,there are four most troublesome health problems:fatigue,sedentary,mood,and sexual function in the general population,and medication health problems in the elderly chronic patient population.Conclusions:EQ-5D+C has high feasibility,low ceiling/floor effect,good reliability and discrimination in the general population and elderly patients with chronic disease.It is sensitive to the evaluation of the quality of life of the population and can better evaluate the quality of life of the population.It can be considered that this scale can be widely used in the study of quality of life in the future to measure the health status of the population and evaluate the economy of intervention measures,so as to guide the allocation and utilization of health resources.