Abstract: Objective　To study the current situation of health-related quality of life of patients with chronic diseases in Sichuan，Hebei and Gansu and to find out its influencing factors by Tobit model.Methods　 A total of 745 patients with chronic diseases were selected from 9 hospitals in Sichuan，Hebei and Gansu provinces by stratified sampling and random sampling in May，July and November 2017.Questionnaires were used to collect information about patients' household registration，gender，age，height，body mass，marital status，occupation，medical insurance type，financial sources，physical examination in the past year，and chronic diseases.The EQ-5D-5L scale was used to investigate the patients' health-related quality of life.Health-related quality of life （HRQOL） of chronic disease patients with different characteristics was compared，and Tobit regression model was used to analyze the influencing factors of HRQOL.Results　A total of 745 questionnaires were distributed，and 721 recovered，with 96.8% of recovery rate.Health utilities index of chronic diseases in Sichuan，Hebei and Gansu provinces were （0.75±0.28）．Difficulties of five dimensions were ranked by severity：pain or discomfort （72.7%，524/721），anxiety or depression （61.6%，444/721），daily activities （39.5%，285/721），mobility （38.8%，280/721） and self-care （35.4%，255/721）．There were significant differences in health-related quality of life （daily activities，pain or discomfort，anxiety or depression） among patients with chronic diseases in Sichuan，Hebei and Gansu provinces （P<0.05）．Tobit model analysis showed that age，marital status，occupation，and types of chronic diseases （respiratory diseases，cerebrovascular diseases and cancer） were the influencing factors of health-related quality of life （P<0.05） of patients with chronic diseases in Sichuan，Hebei and Gansu；marital status and economic sources were the influencing factors of health-related quality of life of patients with chronic diseases in Sichuan （P<0.05）; age，BMI type，marital status，occupation，and medical insurance type were the influencing factors of health-related quality of life of patients with chronic diseases in Hebei （P<0.05）；age，body mass index（BMI）type，marital status，occupation，medical insurance type，and types of chronic diseases （respiratory system disease，cerebrovascular disease and cancer） were the influencing factors of health-related quality of life of patients with chronic diseases in Gansu （P<0.05）．Conclusion　Patients with chronic diseases in Sichuan，Hebei and Gansu provinces had poor health-related quality of life in the dimensions of "pain or discomfort" and "anxiety or depression".Age，marital status，occupation，types of chronic diseases （respiratory diseases，cerebrovascular diseases and cancer） are the main factors affecting the health-related quality of life of patients with chronic diseases in three provinces.

Key words: Chronic diseases, Health-related quality of life, EQ-5D, Health utilities index

摘要： 目的　了解川冀甘3省慢性病患者健康相关生命质量，并采用Tobit模型探讨其影响因素。方法　于2017年5、7、11月，采用分层抽样与随机抽样结合的方法选取四川、河北、甘肃3省9家医院共745例慢性病患者。采用问卷调查收集患者户口、性别、年龄、身高、体质量、婚姻状况、职业、医疗保险类型、经济来源、过去1年体检情况、慢性病患病情况等信息，采用欧洲五维健康（EQ-5D-5L）量表调查患者健康相关生命质量。比较不同特征慢性病患者健康相关生命质量，采用Tobit回归模型分析健康相关生命质量的影响因素。结果　发放问卷745份，回收721份，回收率为96.8%。川冀甘3省慢性病患者健康效用值为（0.75±0.28）。在5个维度按有困难者占比排序为：疼痛或不舒服（72.7%，524/721），焦虑或沮丧（61.6%，444/721），日常活动（39.5%，285/721），行动能力（38.8%，280/721）以及自我照顾（35.4%，255/721）。川冀甘3省慢性病患者健康相关生命质量（日常活动、疼痛或不舒服、焦虑或沮丧）比较，差异有统计学意义（P<0.05）。Tobit模型分析结果显示，年龄、婚姻状况、职业、慢性病病种（呼吸系统疾病、脑血管疾病及癌症）是3省慢性病患者健康相关生命质量的影响因素（P<0.05）；婚姻状况、经济来源为四川省慢性病患者健康相关生命质量的影响因素（P<0.05）；年龄、BMI分类、婚姻状况、职业、医疗保险类型为河北省慢性病患者健康相关生命质量的影响因素（P<0.05）；年龄、BMI分类、婚姻状况、职业、医疗保险类型、慢性病病种（呼吸系统疾病、脑血管疾病以及癌症）为甘肃省慢性病患者健康相关生命质量的影响因素（P<0.05）。结论　川冀甘3省慢性病患者在“疼痛或不舒服”“焦虑或沮丧”维度健康相关生命质量较差。年龄、婚姻状况、职业、慢性病病种（呼吸系统疾病、脑血管疾病及癌症）是影响3省慢性病患者健康相关生命质量的主要因素。

关键词: 慢性病, 健康相关生命质量, 欧洲五维健康量表, 健康效应值