Effects Of Quality Of Life And Perceived Discrimination In Patients With Chronic Hepatitis B Related Diseases

Background and objectives:World Health Organization is promoting the implementation of the global action plan for the eliminate of hepatitis B(HB),which aims to achieve treatment coverage of 80%of patients with hepatitis B virus(HBV)by 2030.The number of cases and deaths associated with chronic hepatitis B(CHB)decreased by 90%and 65%,respectively,compared to 2015.Achieving this goal will require a significant investment of public health resources,which poses a serious challenge to us.China has the highest burden of hepatitis B.HBV infection is associated with higher mortality from chronic hepatitis B-related diseases,such as hepatocellular carcinoma and liver cirrhosis.Many aspects of quality of life(QoL),including physiological and psychological aspects,are affected in patients with CHB-related diseases.Facing the goal and task of global elimination of hepatitis B,further research on QoL in patients with CHB-related diseases is needed.Perceived Discrimination of HBV infected persons(HB Discrimination)is another challenge to eliminate HBV HB discrimination may be associated with lower QoL in patients with CHB-related diseases.The purpose of this study was to investigate QoL in patients with CHB-related diseases,and to identify the influencing factors of QoL in patients.The subordinate purpose of this study is to evaluate the status of HB discrimination in patients with CHB-related diseases,and to explore the impact of HB discrimination on patients’QoL.Methods:Subjects:A cross-sectional survey was conducted among patients with CHB-related diseases admitted to Henan Provincial People’s Hospital from September to December 2019.The Short Form 36 Health Survey Version 2(SF-36v2)and the chronic HBV-infections related perceived discrimination scals(HB Discrimination Scale)were used for the Survey.Sociodemographic characteristics and clinical marker information were collected.Statistical analysis:Cronbach’s α,Spearman correlation coefficient and factor analyses were calculated for reliability and validity of the scale.Mean and standard deviation,median and quartile spacing were calculated for each dimension and items.Higher SF-36v2 scores indicating better health.The higher the score of the HB discrimination scale(the total score of dimension divided by the number of dimension items)indicating the higher the level of HB discrimination.And the severity of discrimination is expressed by the percentage of discrimination.Rank-sum test was used to compare the scores of each scale.Multivariate regression was used to explore the influencing factors of QoL and HB discrimination.The criterion for entry into the models was with P<0.05,and for removal from the models,the criterion was P>0.1.To explore the impact of HB discrimination on patients’ QoL,the Spearman correlation coefficient scores of each dimension and the correlation between physical composite summary(PCS)and mental composite summary(MCS)were calculated.Exploratory regression models were conducted to determine whether stigma(total and individual)was an independent predictor of PCS and MCS scores based on the initial regression model which takes the PCS and MCS as the dependent variables.Results:1.A total of 576 SF-36v2 scales and 552 HB discrimination scales were collected,with effective response rates of 87.14%and 83.51%,respectively.The survey results were reliable because internal Cronbach’s α in all dimensions varied of the the SF-36v2 were between 0.66 to 0.94,the success rate of the convergent validity test was 97.22%,the success rate of the discriminant validity test was 100.00%,and the cumulative contribution rate of the variance of the two factors was 70.42%;the internal Cronbach’s α in all dimensions varied of the the HB discrimination scale were between 0.81 to 0.94,the success rate of both the convergent and discriminant validity test were 100%,and the cumulative variance contribution rate of the 5 factors was 72.96%.2.Among 576 SF-36v2 scale,the median age of the respondents was 37.00 years old,and 62.3%were younger than 40 years old.There were 391 males(67.9%)and 185 females(32.1%).The mean and standard deviation of PCS scores in patients with CHB,compensated cirrhosis,decompensated cirrhosis and hepatocellular carcinoma were 53.02±6.81,48.57±10.63,43.23±11.01 and 41.36±11.21,respectively;the median and quartile intervals of PCS scores were 54.01(49.56～57.78),51.26(43.39～55.49),44.06(37.22～52.54)and 41.05(34.86～50.97),respectively.The mean and standard deviation of MCS scores in patients with CHB,compensated cirrhosis,decompensated cirrhosis and hepatocellular carcinoma were 43.39±11.51,42.51±11.60,41.00±11.80 and 10.78±13.39,respectively;the median and quartile intervals of MCS scores were 44.16(36.77～51.92),42.33(35.00～50.96),40.17(34.30～49.34),41.77(38.09～50.15),respectively.Multivariate regression results showed that age and severity of disease were the influencing factors of the PCS;age wae the influencing factors of the MCS.3.Among 552 HB discrimination scale,the median age of the respondents was 37.00 years old,and 62.3%were younger than 40 years old.There were 378 males(68.5%)and 174 females(31.5%).The scores of external discrimination,negative self-evaluation,perceived stigma,confidentiality,and secondary discrimination were 2.64±0.85,2.80±1.04,2.82±0.97,3.54±0.96,and 2.50±1.00,respectively.The proportion of hepatitis B discrimination were 56.7%,63.8%,65.8%,90.0%,and 40.7,respectively.The results of multivariate regression showed that the discrimination of female patients was more serious.4.Adding HB discrimination scale score to the original regression model,the variation in MCS and PCS explained by the model increased from 4.9%to 18.5%and from 22.9%to 23.8%,respectively.And there are negative partial regression coefficients of HB discrimination in all dimensions.It is suggested that HB discrimination has a negative impact on QoL in patients with CHB-related diseases,and the impact on the MCS is greater than the PCS.Conclusions:1.Patients with CHB-related diseases in China have significant damage to QoL,which is mainly manifested in the psychological damage in the initial stage of the disease,and the physical damage gradually aggravates with the progress of the disease.Our study suggests that there is an urgent need for psychological interventions in patients with CHB-related diseases to improve QoL in patients with chronic hepatitis B.2.In the survey of hepatitis B discrimination,female patients with CHB should be paid more attention.3.Patients with CHB-related diseases are affected by HB discrimination,and the impact of HB discrimination on the MCS of patients is greater than that on the PCS,which suggests that we should pay attention to the discrimination of patients.Reducing perceived discrimination against HB by health education can improve patients’ QoL.There is an urgent need for health care providers and policy makers to implement psychological interventions for patients with CHB-related diseases to reduce HB discrimination while improving the QoL of patients with CHB-related diseases.