Research On Functional Impairment, Quality Of Life And Influencing Factors Of People Aged 50 And Over In China

ObjectBy analyzing data of chronic diseases risk factor surveillance in China from 2010 to 2011,disability and quality of life(QOL)of Chinese population over 50-years old are illustrated,and the impact factors are explored.This study is aiming to provide scientific basis for formulating health strategies and measures for the elderly.MethodThis study is based on the data of chronic diseases risk factor surveillance in China from 2010 to 2011.The data in 2011 were followed up by all the respondents in 2010.1.Relevant information collection.Basic classification information,prevalence of chronic diseases,major health problems,disability and quality of life scale data were collected through questionnaires,body measurements,and laboratory tests.2.Scale use.Short version of the World Health Organization Disability Rating Scale(12-item WHO Disability Assessment Schedule,WHODAS)was used to evaluate the disability status of the subjects.The total score of the scale was calculated using a simple scoring method and the degree of disability was divided into three levels:no(0 to 4 points),mild(5 to 25 points),moderate and above(26 to 100 points)according to the score.The quality of life of the subjects was evaluated using the World health organization on quality of life brief(WHOQOL-BREF).Scores in the fields of physiology,psychology,social relations and environment were calculated,and their average values were truncated to determine whether the quality of life in this field was impaired.If the quality of life is impaired in one field,the overall quality of life of the subjects is considered to be impaired.3.Data weighting adjustment.In this study,samples were collected by multi-stage stratified cluster random sampling.Each stage has a sampling weight.Therefore,sampling weighting and the post-stratification adjustment of the 2010 national census data are used to reduce the possible deviation of each link due to sampling.4.Statistical interpretation.Constituent ratio(%)was used to describe the following information of Chinese population over 50-years old:demographic characteristics,chronic diseases,main health issue,psychological health,disability degree and QOL impairment.Distribution of WHODAS 2.0 score and WHOQOL-BREF score were assessed with mean value and standard deviation(X±S).5.Statistical inference.Rao-Scott X2 test and logistic regression model based on complex sampling were used to compare and test the trend of counting data between groups.Factors,including gender,age,living urban/rural,living region,marriage,education,family gross income,self-report chronic diseases,main health issue and phycological health were independent variable in the complex sampling-based logistic regression.By calculating odds ratios(OR,95%CI),the relation between disability degree or QOL impairment and each variable was studied.Results1.Characteristics of people aged 50 and above in China:among the 35972 subjects of this study,16472 males(45.79%),females 19500(54.21%),49.67%population was 50-59 years old,58.13%population was rural residents.Among the chronic diseasesIn the observation,hypertension ratio was the highest(57.98%,95%CI =55.9 to 60.06%),followed by dyslipidemia(49.09%,95%CI=46.82-51.37%),diabetes(16.89%,95%CI=15.95-17.82%),and malignant tumor(0.47%,95%CI=0.36-0.58%).The prevalence of chronic obstructive pulmonary disease,asthma,stroke and myocardial infarction was 4.89%(95%CI=4.40-5.38),2.27%(95%CI=2.00-2.54),2.24%(95%CI=1.79-2.68)and 0.69%(95%CI=0.56-0.82),respectively.38.95%(95%CI=38.02 to 39.88%)subjects were single-disease reported.Among the major health problems,Ratios ratios of subjects with dyssomnia,dysosmia and constipation were 22.6%(95%CI=20.89 to 24.31%),2.95%(95%CI =2.41 to 3.48%),9.94%(95%CI=8.92 to 10.97%).Among subjects,7.84%(95%CI=6.84 to 8.84%)of them have fallen.2.The disability status and its influencing factors of people aged 50 and above in China:the average WHODAS score of Chinese people aged 50 and above was 8.25±0.29.The WHODAS score for men was 7.04 ± 0.25,and the WHODAS score for women was 9.46±0.36.Among patients with chronic disease,stroke patients had the highest WHODAS score(19.74±1.17).With the increase of age,multi-pathological coexistence,and the decrease of education level,family monthly income,the scores of WHODAS is increasing.The proportion of mild,moderate and above disability in Chinese people aged 50 years and above was 32.56%(95%CI=30.54 to 34.58)and 8.82%(95%CI=7.63 to 10.01).The proportion of mild,moderate and above disability in men was 28.96%(95%CI=26.87 to 31.05)and 7.2%(95%CI=6.12 to 8.27).The proportion of mild,moderate and above disability in women was 36.14%(95%CI=6.12 to 8.27)and 10.44%(95%CI=9.01 to 11.87).Among the patients with chronic diseases,the proportion of mild disability in myocardial infarction was the highest(44.34%,95%CI=34.67 to 54.01).The proportion of moderate and above disability in stroke patients was the highest(30.01%,95%CI=24.96 to 35.06).With the increase of age,multi-pathological coexistence,and the decrease of education level,family monthly income,the proportion of people with mild,moderate and above disability is increasing.The risk of mild,moderate and above disability in people aged 50 years old and above in China increases with the increase of age and the decrease of family monthly income.Women(mild disability OR1.28,95%CI=1.17 to 1.40%;moderate and above disability OR1.29,95%CI=1.10 to 1.50%)and low-educated people are at high risk of disability.Rural residents have a higher risk of moderate and above disability than urban residents(OR1.60,95%CI=1.21 to 2.10%).The risk of mild,moderate and above disability in patients with chronic disease is higher than non-patients.Among them,patients with stroke had the highest risk of mild(OR1.98,95%CI=1.45 to 2.69%),moderate and above disability(OR5.24.95%CI-3.45 to 7.97%).People with health problems are more prone to disability.Among them,sleep disorders had the greatest impact on mild(OR2.07,95%CI=1.87 to 2.29%),moderate and above disability(OR3.77,95%CI=3.11 to 4.58%).People who have fallen have a higher risk of mild(OR1.39,95%CI-1.21 to 1.59%),moderate and above(OI.98,95%CI=1.60 to 2.44%)disability than those who have not.3.The influence factors of life quality among Chinese population who aged 50 years old and above:the average score of overall life quality in the Chinese population who aged 50 years old and above is 3.33±0.02,and the average score of overall degree of life satisfaction is 3.32±0.02,the WHOOOL-BREF score in physiology is the highest(67.51±0.36)among all the fields,and the field of environment scores the lowest(53.35±0.54).With the increasing of age,and the decreasing of the educational level and monthly income,the WHODAS score of the population who aged 50 years old and above shows a declined tendency.The patients with stroke show the lowest scores in physiology(55.35±1.12),psychology(53.39±1.11),social relationship(57.49±0.89)and environment(50.21±1.29).The overall impaired percentage of Chinese population who aged 50 years old and above is 74.30%(95%CI=71.77 to 76.82),there-into,the impairment which caused by environment account for the highest percentage(56.26%,95%CI=52.74 to 59.77),and the physiology impairment is the lowest(44.68%,95%CI=42.16 to 47.19).With the increasing of age,and the decreasing of the educational level and monthly income,the impaired percentage of the population who aged 50 years old and above shows an increasing tendency.Patients with myocardial infarction account for the highest impaired percentage in physiological field(73.60%,95%CI=66.28 to 80.91),and the patients with asthma account for the highest impaired percentage in psychological field(66.95%,95%CI=62.02 to 71.87)and environmental field(66.97%.,95%CI=62.29 to 71.66).Patients with stoke shows the highest impaired percentage in the field of social relationship(62.83%,95%CI=55.96 to 69.69).Risk factors for impaired QOL in the physical domain included women(OR1.22,95%CI=1.13 to 1.31%),rural residents(OR1.28,95%CI=1.04 to 1.57%),single/widowed/divorced/separated(OR1.16,95%CI=1.00 to 1.34%),Low income(monthly income<833 yuan,OR 1.56,95%CI=1.23 to 1.98%),patients with chronic diseases(especially those with the highest risk of myocardial infarction,OR 12.42,95%CI=1.52 to 3.85%),dyssomnia(OR3.36,95%CI-2.98 to 3.79%),constipation(OR1.25,95%CI=1.06 to 1.46%)and fallen(OR1.30,95%CI=1.09 to 1.57%).In addition,the higher risk increased with aging,lower educational level and severity of disability in the physical domain of QOL.Risk factors for impaired QOL in the psychological domain included women(OR1.09,95%CI=1.02 to 1.17%),venerable age(80 years and above,OR 1.45,95%CI=1.11 to 1.90%)rural residents(OR 1.38,95%CI=1.13 to 1.70%),patients with asthma(OR 1.26,95%CI=1.04 to 1.53%)and stroke(OR1.26,95%CI=1.04 to 1.53%),dyssomnia(OR1.66,95%CI=1.48 to 1.85%)and constipation(OR1.20,95%CI=1.06 to 1.37%).In addition,the higher risk increased with lower educational level and family gross income,severity of disability in the psychological domain of QOL.Risk factors for impaired QOL in the social relationships domain included rural residents(OR1.34,95%CI=1..1 to 1.62%),singles/widowed/divorce/dividers(OR1.29,95%CI=1.15 to 1.44%),illiterate/semiliterate(OR1.22,95%CI=1.04 to 1.43%),dyssomnia(OR1.42,95%CI=1.30 to 1.55%)and constipation(OR1.17,95%CI=1.01 to 1.35%).In addition,the higher risk increased with aging,lower family gross income,severity of disability in the social relationships domain of QOL.Risk factors for impaired QOL in the environment domain included rural residents(OR1.32,95%CI=1.04 to 1.67%),patients with asthma(OR1.33,95%CI=1.10 to 1.61%)and dyssomnia(OR1.45,95%CI-1.31 to 1.59%).In addition,the higher risk increased with lower family gross income,severity of disability in the environment domain of QOL.ConclusionApproximately,41.38%of people who aged 50 and above in China are disability,thereinto,mild disability account for 3/4 in total.People who aged 50 and above are relatively satisfied with their life quality,while their overall impaired percentage are higher than common adults,meanwhile,the environmental field is the worst among all the fields of life quality.Elderly,women,rural residents,low income,single,low educational level,chronic diseases,health problems and fallen are all risk factors for disability.Living in rural areas,low income,health problems and disability are risk factors for damage in all domains of quality of life.Elderly and low educational are risk factors for damage in physical,psychological,social relationships domain.Women have a higher risk of impaired physical and psychological domain than men.Patients with chronic diseases have a higher risk of impaired quality of life in the physical,psychological and environmental domain than those without chronic diseases.Subjects who had fallen were more likely to have impaired quality of life in the physiological domain.Singles/widowed/divorce/dividers were more likely to have impaired quality of life in the physical and social relationship domain.In conclusion,it is necessary to provide policy support,improve health-related infrastructure construction,improve community the system of community-level medical and health services,improving basic public health services,actively implement health promotion and health promotion and so on,to reduce that level of disability and improve the QOL of the elderly population through the joint participation of the whole society.