- 期刊
血液透析病患以存活調整之健康輪廓及預期終生存活期損失
Survival-weighted Health Profile and Expected Healthy Life Expectancy in Hemodialysis Patients
摘要
目的：結合血液透析病患的存活情形與健康狀態兩者，而建立「存活調整之健康輪廓」函數，並與年齡、性別配合之一般族群比較，計算「預期健康存活期損失」。 方法：以基隆長庚醫院從1996至2003年追蹤之血液透析病患歷年存活資料建立存活曲線。橫斷調查大台北及基隆地區13家透析中心512位血液透析病患健康狀態資料，健康狀態測量以世界衛生組織生活品質問卷，及標準賭博與等級評量兩種效用測量方法進行之。以黃景祥等人的方法結合存活函數及健康狀態函數而成為「存活調整之健康輪廓」函數。再以黃景祥及王榮德的方法外推此「存活調整之健康輪廓」函數至終生。此法所借用代表台灣一般族群之存活情況由行政院內政部統計局2002年生命表資料而得。代表台灣一般族群之健康狀態資料，是2001年國民健康局健康普查9107位健康民眾中隨機抽出年齡、性別、教育程度和此處的512位血液透析病患配合者而得。一般族群之「存活調整之健康輪廓」函數可以和血液透析病患作比較；一般族群和血液透析病患群，其「存活調整之健康輪廓」函數面積之差值即為「預期健康存活期損失」。 結果：血液透析病患未經健康狀態調整之存活期為54.6±1.6月，依此外推之原本終生存活期139.4±19.9月；而一般民眾原本之終生存活期為252.2±0.3月；血液透析病患原本之預期生活期損失計為112.8±20.1月。血液透析病患之健康狀態以標準賭博法代表時，計算之「品質調整後終生存活期」為113.3±19.8月。以等級評價法或世界衛生組織四範疇分數代表健康狀態時計算之「品質調整後終生存活期」比較接近，從68.2±16.1月至80.2±15.7月；以等級評價法代表生活品質得到之「品質調整後終生存活期」最高，而以環境範疇分數代表生活品質得到之「品質調整後終生存活期」最低。計算血液透析病患「預期健康存活期損失」則由94.5±14.6月至172.3±15.7月不等；其中以等級評價法代表生活品質來計算「預期健康存活期損失」數值最高，而以環境範疇分數來計算「預期健康存活期損失」數值最低。 結論：血液透析病患「品質調整後終生存活期」及「預期健康存活期損失」之計算可做為各式健康結果評估之基準。
並列摘要
Objective: Integration of quality of life measurement with survival to construct survival-weighted health profile [quality-adjusted survival (QAS) function] and estimate quality adjusted life expectancy (QALE) and loss of healthy life expectancy (LHLE) in maintenance hemodialysis patients in Taiwan. Methods: With survival data of 746 hemodialysis (HD) patients from Keelung Chang-Gun Memorial Hospital through 1996 to 2003, the survival function was established. Five hundred and twelve patients were surveyed from 13 dialysis centers in Metropolitan Taipei and Keelung city with QOL measures during June 1 through September 30, 2003. The QOL measures included questionnaire of World Health Organization quality-of-life, brief form, Taiwan version [WHOQOL-Bref (TW)], and utility values by standard gamble (SG) and rating scale (RS) methods. The QOL measures were integrated with survival by Hwang's method to construct a QAS function in HD population. The QAS function was extrapolated life long with Hwang and Wang's method. We compared the QAS function of HD population with age-, and gender-matched reference population, and estimate the QALE and LHLE in HD Patients. Results: The survival time in HD population was 54.6±1.6 months through 1996 to 2003 follow up period. The extrapolated life expectancy (LE) in HD population was 139.4±19.9 months. The life expectancy of reference general population was 252.2±0.3 months. The QALE adjusted by SG and RS method was 113.3±19.8 and 80.2±15.7 months, respectively. The QALE adjusted by the four domains of WHOQOL-BREF(TW) ranged from 68.2 to 79.9 months. The loss of LE was 112.8±20.1 months. While the LHLE ranged from 94.5±14.6 to 172.3±15.7 months, with those adjusted by RS methods as the highest value and those adjusted by environment domain of WHOQOL-BREF (TW) as the lowest value. Conclusions: The empirically estimated QALE and LHLE in HD patients could be a benchmark values for various outcome evaluation studies.