만성폐쇄성폐질환 환자의 건강관련 삶의 질 trajectory 영향 요인

Abstract

PURPOSE. Health-Related Quality of life (HR-QoL) is an important issue in patients with chronic obstructive pulmonary disease (COPD) as in other chronic illness group. However, there are limited information on longitudinal changes of HR-QoL over time with the illness trajectory model. This study is to identify different patterns of HR-QoL changes in longitudinal data, and reveal potential predictors affecting these trajectories. METHODS. Longitudinal data was obtained from the ''Korean Obstructive Lung Disease'' cohort, which was conducted from 2005 to 2012. A total of 249 participants met COPD inclusion criteria. Baseline data of HR-QoL measured with the St. George''s Respiratory Questionnaire were collected at the point of cohort entry and follow up at every 12 months over five years. Latent growth modeling was used to identify the pattern of QoL over time. Growth mixture modeling was used to estimate distinct patterns and binary, ordinal and multinomial logistic regression were used to determine factors affecting different trajectory patterns of HR-QoL using STATA 12.0. RESULTS. Five distinct patterns of HR-QoL were identified: 1) consistently good (total of 20.1%), 2) steadily worsen from mild to moderate (42.6%), 3) steadily improved from moderate to mild (6.8%), 4) steadily worsen from moderate to sever (21.3%), and 5) consistently bad (9.2%) (all p<.05). Result shows that the level of baseline HR-QoL associated with age(OR=2.02, 95%CI=1.18-3.44), BODE index (1.80, 1.45-2.24), sleep disturbance (2.26, 1.00-5.09), experience of exacerbation in last year over 2 times (4.31, 1.02-18.2), depression level (1.09, 1.03-1.16). Multinomial logistic regression showed that affecting factors of the consistently good versus consistently bad trajectories were age (4.40, 1.09-14.9), BODE index (4.96, 2.69-9.15), sleep disturbance (8.99, 1.17-16.8) depression level (1.29, 1.12-1.49) and perceived self-rate health status (4.12, 1.03-16.5). Distinct patterns in HR-QoL (improved versus worsen) are significantly associated with BODE index (3.76, 1.26-11.1), number of respiratory symptoms (1.40, 1.08-1.80), depression level (1.28, 1.00-1.64). CONCLUSIONS. Five latent classes of HR-QoL trajectory patterns were inherent in COPD patients. Baseline level of demographic, physical/functional, environmental, symptomatic and psychological variables were associated with longitudinal changes of HR-QoL. Comprehensive assessment and individualized management programs are needed to improve HR-QoL in COPD patients.