| Objective:The purpose of this study was to explore the important complications of ischemic stroke patients over45 years old in a tertiary first-class hospital,and further to explore the related factors of HRQOL(EQ-5D)dimensions and health utility values,so as to provide reference basis for the management,prevention and control of ischemic stroke comorbidities.Methods:1.This study is a single-center cross-sectional study,including 1685 inpatients with ischemic stroke diagnosed by Henan people’s Hospital from 2021 to 2022.General data questionnaire and quality of life scale(EQ-5D-3L)were used to investigate and record 13 kinds of chronic diseases diagnosed by ICD.To analyze the prevalence of comorbidities,patterns of comorbidities,dimensions of EQ-5D and influencing factors of health utility in patients with ischemic stroke.2.The database is established by software Excel,the data is analyzed by SPSS26.0 software,the measurement data are expressed by mean±standard deviation,the classified variables are expressed by frequency and percentage,and the comparison between groups is expressed byχ~2test.Chi-square test and bivariate Logistic regression analysis were used for univariate and multivariate analysis,respectively.Systematic cluster analysis and K-medoids clustering algorithm were used to explore the co-disease model of patients with ischemic stroke,and multiple linear regression was used to analyze the influencing factors of health utility value.The fitting degree of Logistic regression model was tested by Hosmer-Lemeshaw test.The difference was statistically significant(P<0.05).Results:1.The prevalence rate of common diseases in patients with ischemic stroke was 90.0%,and the average number of patients with chronic diseases was 2.52±1.51.The prevalence rate of comorbidity in females(91.6%)was higher than that in males(87.5%),and the difference was statistically significant(P<0.05).The comorbidities of patients with ischemic stroke are as follows:13.6%of 2 chronic diseases,26.9%of 3 chronic diseases and 49.4%of 4 or more chronic diseases.The top three chronic diseases were hypertension(62.1%),dyslipidemia(44.8%)and diabetes or hyperglycemia(35.6%).2.The average health utility value of patients with ischemic stroke was(0.76±0.26).Among the five dimensions of the EQ-5D scale,daily activity was the most frequently reported problem(49.7%),and self-care was the least reported problem(29.2%).Among the influencing factors of specific dimensions of patients with ischemic stroke,we found that the problems reported in each dimension increased with age,but decreased with the increase of education level and family per capita monthly income;Employment is associated with a lower probability of problems in daily activities,pain/discomfort and anxiety/depression dimensions;compared with men,women are more likely to have anxiety/depression,but less self-care problems;regular exercise can reduce mobility,self-care and daily activity problems.Anxiety/depression problems increase with the increase of chronic number.3.Based on the analysis of 13 kinds of chronic diseases by systematic clustering,it was found that there were 4 co-disease models,namely,cardiovascular metabolism model,liver-lung-gastrointestinal-urinary disease model,mental-degenerative disease model,while cancer or malignant tumor was a single type.K-medoids clustering algorithm was used to analyze the five patterns of ischemic stroke,mental-degenerative disease,liver-lung-gastrointestinal-urinary disease,hypertension-dyslipidemia,diabetes or hyperglycemia-heart attack disease,while cancer or malignant tumor and liver-lung-gastrointestinal-urinary disease were combined into one group.Multiple linear regression model found that age was negatively correlated with health utility value(P<0.05),while education level,exercise situation,per capita monthly income and working condition were positively correlated with health utility value(P<0.05).Further subgroup analysis found that compared with the group with ischemic stroke only.Mental-degenerative diseases,hypertension-dyslipidemia,diabetes or hyperglycemia-heart attack diseases all showed a significant decrease in health utility(Theβvalues were-0.100,-0.154 and-0.125 respectively.P values are all<0.05).According to the absolute value of standardized regression coefficient,hypertension-dyslipidemia model has the greatest influence on HRQOL.Conclusion:The prevalence rate of comorbidities in patients with ischemic stroke is higher,and the healthy quality of life is poor.Four co-disease patterns were found by using two different analysis methods,which confirmed that there was a specific association between chronic diseases rather than accidental.Daily activities are the most frequently reported dimensional problems.The older the age,the lower the level of education,the lower the per capita monthly income of the family,unemployment and less exercise,the lower the value of health utility.At the same time,it also has a certain impact on the dimensions of EQ-5D. |
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