Association between Health-Related Quality of Life and Access to Chronic Disease Management by Primary Care Facilities in Mainland China: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Access to CDM Services Provided by Primary Care Facilities
2.3. Health-Related Quality of Life
2.4. Covariates
2.5. Statistical Analysis
2.6. Ethical Considerations
3. Results
3.1. Sociodemographic Characteristics and HRQoL
3.2. Comparison of HRQoL between Easy-Access and Not-Easy-Access Groups
3.3. Association between Easy Access to CDM Services and HRQoL
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | All (n = 5525) | Not Easy-Access Group | Easy-Access Group | p-Value |
---|---|---|---|---|
Gender, No (%) | 0.028 | |||
Female | 2659 (48.1) | 833 (50.4) | 1826 (47.1) | |
Male | 2866 (51.9) | 819 (49.6) | 2047 (52.9) | |
Age, median (IQR), y | 55.0 (42–67) | 55.0 (42.0–67.0) | 55.0 (43.0–67.0) | 0.360 |
BMI, mean (95% CI) | 22.1 (22.0–22.3) | 22.1 (21.8–22.3) | 22.2 (22.0–22.3) | 0.510 |
Region, No (%) | ≤0.001 | |||
Eastern region | 1772 (32.1) | 457 (27.7) | 1315 (34.2) | |
Central region | 1079 (19.5) | 331 (20.1) | 748 (19.4) | |
Western region | 2383 (43.1) | 766 (46.4) | 1617 (42.0) | |
Northeast region | 266 (4.8) | 95 (5.8) | 171 (4.4) | |
Living area, No (%) | 0.010 | |||
Urban | 3644 (66.0) | 1048 (63.4) | 2596 (67.0) | |
Rural | 1881 (34.0) | 604 (36.6) | 1277 (33.0) | |
Education, No (%) | 0.008 | |||
Elementary school or lower | 1549 (28.0) | 510 (30.9) | 1039 (26.8) | |
Middle school | 1230 (22.3) | 362 (21.9) | 868 (22.4) | |
High school | 695 (12.6) | 212 (12.8) | 483 (12.5) | |
College/Bachelor’s degree or higher | 2051 (37.12) | 568 (34.4) | 1483 (38.3) | |
Work, No (%) | ≤0.001 | |||
Working or studying | 2202 (39.9) | 645 (39.0) | 1557 (40.2) | |
Retirement processed | 1546 (28.0) | 403 (24.4) | 1143 (29.5) | |
Unemployed or without a regular job | 1777 (32.2) | 604 (36.6) | 1173 (30.3) | |
Suffered injury, No (%) | ≤0.001 | |||
Yes | 1078 (19.5) | 364 (22.0) | 714 (18.4) | |
No | 4447 (80.5) | 1288 (78.0) | 3159 (81.6) | |
Subjective socioeconomic status, No (%) | ≤0.001 | |||
Level 1 | 95 (1.7) | 41 (2.5) | 54 (1.4) | |
Level 2 | 310 (5.6) | 137 (8.3) | 173 (4.5) | |
Level 3 | 914 (16.5) | 320 (19.4) | 594 (15.3) | |
Level 4 | 1905 (34.5) | 579 (35.1) | 1326 (34.2) | |
Level 5 | 1419 (25.7) | 367 (22.2) | 1052 (27.2) | |
Level 6 | 596 (10.8%) | 146 (8.8) | 450 (11.6) | |
Level 7 | 286 (5.2) | 62 (3.7) | 224 (5.8) | |
Monthly income, No (%) | ||||
0–2000 yuan | 1183 (21.4) | 446 (27.0) | 737 (19.0) | ≤0.001 |
2001–4000 yuan | 1820 (32.9) | 581 (35.2) | 1239 (32.0) | |
4001–6000 yuan | 1296 (23.5) | 314 (19.0) | 982 (25.4) | |
6000 yuan or higher | 1226(22.2) | 311 (18.8) | 915 (23.6) | |
Have medical insurance, No (%) | ≤0.001 | |||
Yes | 5310 (96.1) | 1560 (94.4) | 3750 (96.8) | |
No | 215 (3.9) | 92 (5.6) | 123 (3.2) | |
Drinking, No (%) | 0.105 | |||
Yes | 1297 (22.8) | 353 (21.4) | 905 (23.4) | |
No | 4267 (77.2) | 1299 (78.6) | 2968 (76.6) | |
Smoking, No (%) | 0.009 | |||
Never smoking | 3968 (71.8) | 1217 (73.7) | 2751 (71.0) | |
Quitted smoking | 403 (7.3) | 131 (7.9) | 272 (7.0) | |
Smoking | 1154 (20.9) | 304 (18.4) | 850 (22.0) | |
Social support—family, No (%) | ≤0.001 | |||
Very strongly disagree | 103 (1.9) | 24 (1.5) | 79 (2.0) | |
Strongly disagree | 148 (2.7) | 65 (3.9) | 83 (2.1) | |
Mildly disagree | 410 (7.4) | 134 (8.1) | 276 (7.1) | |
Neutral | 1196 (21.7) | 399 (24.1) | 797 (20.6) | |
Mildly agree | 1188 (21.5) | 378 (22.9) | 810 (20.9) | |
Strongly agree | 1754 (31.8) | 474 (28.7) | 1280 (33.1) | |
Very strongly agree | 726 (13.1) | 178 (10.8) | 548 (14.2) | |
EQ-VAS score, median (IQR) | 73.0 (59.0–84.0) | 70.0 (53.0–81.0) | 75 (60.0–85.0) | ≤0.001 |
Utility index of EQ-5D-5L, median (IQR) | 0.942 (0.876–1.000) | 0.942 (0.827–1.000) | 0.951 (0.893–1.000) | ≤0.001 |
Coefficient [95% CI] | ||
---|---|---|
EQ-VAS Score | Utility Index of EQ-5D-5L | |
Degree of easy access to the CDM service | ||
Not at all | Reference | Reference |
Somewhat | 2.96 ** [0.62, 5.31] | 0.0388 ** [0.0187, 0.0589] |
Mostly | 5.71 ** [3.49, 7.93] | 0.0634 ** [0.0443, 0.0825] |
Definitely | 8.10 ** [5.76, 10.43] | 0.0844 ** [0.0644, 0.1045] |
Gender | ||
Female | Reference | Reference |
Male | 0.02 [−1.03, 1.06] | −0.0031 [−0.0122, 0.0059] |
Region | ||
Eastern region | Reference | Reference |
Central region | 1.37 * [−0.13, 2.87] | 0.0019 [−0.0110, 0.0148] |
Western region | −1.87 ** [−3.08, −0.65] | 0.0036 [−0.0069, 0.0141] |
Northeast region | 0.63 [−1.93, 3.19] | −0.0118 [−0.0338, 0.0101] |
Living area | ||
Urban | Reference | Reference |
Rural | −1.58 ** [−2.69, −0.48] | −0.0086 * [−0.0181, 0.0009] |
Education | ||
Elementary school or lower | Reference | Reference |
Middle school | 3.51 ** [2.04, 4.99] | 0.0321 ** [0.0193, 0.0448] |
High school | 5.37 ** [3.61, 7.13] | 0.0296 ** [0.0144, 0.0449] |
College/Bachelor’s degree or higher | 5.86 ** [4.56, 7.16] | 0.0360 ** [0.0248, 0.0472] |
Work | ||
Working or studying | Reference | Reference |
Retirement processed | −2.47 ** [−3.76, −1.19] | −0.0454 ** [−0.0565, −0.0344] |
Unemployed or without a regular job | −3.63 ** [−4.87, −2.40] | −0.0269 ** [−0.0375, −0.0163] |
Suffered injury | ||
No | Reference | Reference |
Yes | −3.41 ** [−4.73, −2.10] | −0.0880 ** [−0.0991, −0.0768] |
Subjective socioeconomic status of family | ||
Level 1 | Reference | Reference |
Level 2 | 3.96 * [−0.55, 8.46] | 0.0350 * [−0.0042, 0.0742] |
Level 3 | 5.56 ** [1.42, 9.70] | 0.0404 ** [0.0044, 0.0764] |
Level 4 | 7.77 ** [3.73, 11.80] | 0.0606 ** [0.0255, 0.0957] |
Level 5 | 10.26 ** [6.19, 14.33] | 0.0706 ** [0.0352, 0.1060] |
Level 6 | 12.44 ** [8.20, 16.68] | 0.0451 ** [0.0082, 0.0820] |
Level 7 | 14.22 ** [9.66, 18.77] | 0.0644 ** [0.0248, 0.1039] |
Monthly income | ||
0–2000 yuan | Reference | Reference |
2001–4000 yuan | 2.85 ** [1.41, 4.30] | 0.0263 ** [0.0138, 0.0388] |
4001–6000 yuan | 4.25 ** [2.69, 5.81] | 0.0379 ** [0.0245, 0.0514] |
6000 yuan or higher | 5.10 ** [3.52, 6.68] | 0.0270 ** [0.0134, 0.0406] |
Have medical insurance | ||
No | Reference | Reference |
Yes | 4.00 ** [1.29, 6.70] | 0.0231 * [−0.0002, 0.0464] |
Drinking | ||
No | Reference | Reference |
Yes | 0.97 * [−0.28, 2.22] | −0.0053 [−0.0160, 0.0055] |
Smoking | ||
Never smoked | Reference | Reference |
Quitted smoking | −1.18 [−3.22, 0.85] | −0.0777 ** [−0.0951, −0.0604] |
Smoking | −3.64 ** [−4.94, −2.34] | −0.0489 ** [−0.0600, −0.0378] |
Social support—family | ||
Very strongly disagree | Reference | Reference |
Strongly disagree | −3.57 * [−8.30, 1.16] | 0.0054 [−0.0369, 0.0478] |
Mildly disagree | 0.78 [−3.28, 4.85] | −0.0032 [−0.0396, 0.0332] |
Neutral | 5.20 ** [1.41, 8.98] | 0.0408 ** [0.0069, 0.0747] |
Mildly agree | 9.27 ** [5.49, 13.06] | 0.0495 ** [0.0156, 0.0834] |
Strongly agree | 15.79 ** [12.06, 19.53] | 0.0899 ** [0.0564, 0.1234] |
Very strongly agree | 18.56 ** [14.68, 22.44] | 0.0856 ** [0.0509, 0.1204] |
Coefficient [95% CI] | ||
---|---|---|
EQ-VAS Score | Utility Index of EQ-5D-5L | |
Degree of easy access to the CDM service | ||
Not at all | Reference | Reference |
Somewhat | 2.15 [−0.38, 4.68] | 0.0310 * [0.0049, 0.0572] |
Mostly | 3.93 ** [1.51, 6.36] | 0.0513 *** [0.0260, 0.0766] |
Definitely | 4.76 *** [2.17, 7.34] | 0.0673 *** [0.0414, 0.0932] |
Region | ||
Eastern region | Reference | Reference |
Central region | 1.79 * [0.33, 3.25] | −0.0026 [−0.0149, 0.0096] |
Western region | −1.31 * [−2.49, −0.13] | 0.0023 [−0.0078, 0.0124] |
Northeast region | 1.62 [−1.02, 4.26] | −0.0040 [−0.0271, 0.0191] |
Living area | ||
Urban | Reference | Reference |
Rural | 0.03 [−1.01, 1.07] | 0.0003 [−0.0090, 0.0097] |
Education | ||
Elementary school or lower | Reference | Reference |
Middle school | 1.92 ** [0.53, 3.31] | 0.0238 *** [0.0109, 0.0367] |
High school | 3.68 *** [1.98, 5.39] | 0.0160 * [0.0002, 0.0318] |
College/Bachelor’s degree or higher | 3.33 *** [1.71, 4.95] | 0.0129 [−0.0018, 0.0275] |
Work | ||
Working or studying | Reference | Reference |
Retirement processed | −1.67 * [−3.03, −0.32] | −0.0483 *** [−0.0607, −0.0359] |
Unemployed or without a regular job | −0.31 [−1.85, 1.22] | −0.0199 ** [−0.0326, −0.0073] |
Suffered injury | ||
No | Reference | Reference |
Yes | −1.90 ** [−3.20, −0.60] | −0.0761 *** [−0.0901, −0.0621] |
Subjective socioeconomic status | ||
Level 1 | Reference | Reference |
Level 2 | 3.83 [−2.33, 9.99] | 0.0329 [−0.0162, 0.0820] |
Level 3 | 4.46 [−1.31, 10.23] | 0.0315 [−0.0153, 0.0783] |
Level 4 | 5.92 * [0.22, 11.62] | 0.0460 * [0.0002, 0.0919] |
Level 5 | 6.97 * [1.25, 12.70] | 0.0497 * [0.0037, 0.0956] |
Level 6 | 9.54 ** [3.70, 15.37] | 0.0270 [−0.0208, 0.0748] |
Level 7 | 10.94 *** [4.74, 17.13] | 0.0416 [−0.0084, 0.0916] |
Monthly income | ||
0–2000 yuan | Reference | Reference |
2001–4000 yuan | 1.44 [−0.01, 2.89] | 0.0183 ** [0.0049, 0.0318] |
4001–6000 yuan | 1.68 * [0.04, 3.32] | 0.0250 *** [0.0107, 0.0393] |
6000 yuan or higher | 1.61 [−0.16, 3.39] | 0.00721 [−0.0086, 0.0230] |
Have medical insurance | ||
No | Reference | Reference |
Yes | 1.01 [−1.88, 3.92] | −0.0003 [−0.0247, 0.0240] |
Drinking | ||
No | Reference | |
Yes | 1.63 * [0.34, 2.91] | |
Smoking | ||
Never smoked | Reference | Reference |
Quitted smoking | −1.36 [−3.34, 0.62] | −0.0700 *** [−0.0917, −0.0483] |
Smoking | −2.75 *** [−4.11, −1.39] | −0.0369 *** [−0.0487, −0.0252] |
Social support—family | ||
Very strongly disagree | Reference | Reference |
Strongly disagree | −2.85 [−9.94, 4.24] | 0.0009 [−0.0578, 0.0595] |
Mildly disagree | 1.93 [−4.29, 8.15] | −0.0032 [−0.0545, 0.0481] |
Neutral | 6.02 * [0.01, 12.02] | 0.0309 [−0.0173, 0.0790] |
Mildly agree | 9.92 ** [3.94, 15.91] | 0.0380 [−0.0104, 0.0865] |
Strongly agree | 15.72 *** [9.77, 21.68] | 0.0694 ** [0.0219, 0.1170] |
Very strongly agree | 17.81 *** [11.72, 23.90] | 0.0632 * [0.0149, 0.1114] |
Observation | 5471 | 5500 |
R2 | 0.14 | 0.12 |
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Wang, Y.; Wu, Y.; Chu, H.; Xu, Z.; Sun, X.; Fang, H. Association between Health-Related Quality of Life and Access to Chronic Disease Management by Primary Care Facilities in Mainland China: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2023, 20, 4288. https://doi.org/10.3390/ijerph20054288
Wang Y, Wu Y, Chu H, Xu Z, Sun X, Fang H. Association between Health-Related Quality of Life and Access to Chronic Disease Management by Primary Care Facilities in Mainland China: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2023; 20(5):4288. https://doi.org/10.3390/ijerph20054288
Chicago/Turabian StyleWang, Yang, Yibo Wu, Hongling Chu, Zhijie Xu, Xinying Sun, and Hai Fang. 2023. "Association between Health-Related Quality of Life and Access to Chronic Disease Management by Primary Care Facilities in Mainland China: A Cross-Sectional Study" International Journal of Environmental Research and Public Health 20, no. 5: 4288. https://doi.org/10.3390/ijerph20054288