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    炎症性肠病病人经济毒性现状及影响因素研究

    Current status and influencing factors of financial toxicity in patients with inflammatory bowel disease

      摘要
    • 摘要:
      目的 调查炎症性肠病（IBD）病人经济毒性现状，并分析其影响因素，为制定针对性的干预策略提供依据。
      方法 采用便利抽样法，选取285例IBD病人作为研究对象。采用一般资料调查表、中文版病人报告结局经济毒性综合评分量表（COST–PROM）、IBD病人自我管理行为量表（IBDQ）、中文版IBD残疾指数（IBD–DI）及医院焦虑抑郁量表中的焦虑分量表（HADS–A）进行问卷调查。采用单因素分析、随机森林模型、LASSO回归及多元线性逐步回归分析探讨经济毒性的影响因素。
      结果 IBD病人COST–PROM得分为（23.43 ± 7.26）分，处于中等偏低水平。相关分析显示，COST–PROM得分与IBDQ得分呈正相关（r = 0.527，P＜0.01），与IBD–DI（r = –0.411，P＜0.01）及HADS–A得分（r = –0.296，P＜0.05）呈负相关。随机森林模型显示，工作情况、IBDQ得分、近半年住院次数等因素对经济毒性影响显著。多元线性逐步回归分析显示，工作情况、IBDQ得分、有无生物制剂治疗、IBD–DI得分、疾病活动度、家庭平均月收入、HADS–A得分以及近半年住院次数是IBD病人经济毒性的主要影响因素（P＜0.01），共解释总变异的67.2%。
      结论 IBD病人的经济毒性处于中等偏高水平，受工作情况、自我管理行为、生物制剂使用、残疾程度、疾病活动度、家庭收入、焦虑情绪及住院次数等多重因素影响。医护人员应重视对高危人群的筛查，并通过优化治疗策略、加强心理支持及提供社会援助等方式，减轻病人的经济毒性。

       

      Abstract:
      Objective To investigate the current status of financial toxicity (FT) in patients with inflammatory bowel disease (IBD) and analyze its influencing factors, so as to provide evidence for developing targeted intervention strategies.
      Methods Using a convenience sampling method, a total of 285 patients with IBD were enrolled as study subjects. Surveys were conducted using a general information questionnaire, the Chinese version of comprehensive scores for financial toxicity based on the patient-reported outcome measures (COST-PROM), the inflammatory bowel disease questionnaire (IBDQ), the Chinese version of the IBD disability index (IBD-DI), and the hospital anxiety and depression scale (HADS-A). Univariate analysis, Random Forest model, LASSO regression, and multivariate linear stepwise regression analysis were employed to explore the influencing factors of financial toxicity.
      Results : The COST-PROM score for IBD patients was (23.43 ± 7.26) points, indicating a moderately low level. Correlation analysis revealed that the COST-PROM score was positively correlated with the IBDQ score (r=0.527, P ＜ 0.01), and negatively correlated with IBD-DI (r=-0.411, P ＜ 0.01) and HADS-A score (r=-0.296, P ＜ 0.05). showed a positive correlation between COST-PROM scores and IBDQ scores (r=0.527, P<0.01), while negative correlations were observed with IBD-DI (r=-0.411, P<0.01) and HADS-A scores (r=-0.296, P<0.05). The Random Forest model showed that factors such as employment status, IBDQ score, and number of hospitalizations in the past six months had significant impacts on financial toxicity. Multivariate linear stepwise regression analysis identified employment status, IBDQ score, biologic therapy, IBD-DI score, disease activity, average monthly family income, HADS-A score, and number of hospitalizations in the past six months as the main influencing factors of financial toxicity in IBD patients (P ＜ 0.01), explaining 67.2% of the total variance.
      Conclusions Financial toxicity among IBD patients is at a moderately high level, influenced by multiple factors including employment status, self-management behavior, use of biologics, disability level, disease activity, family income, anxiety, and number of hospitalizations. Healthcare professionals should focus on screening high-risk populations and implement strategies such as optimizing treatment plans, enhancing psychological support, and providing social assistance to alleviate financial toxicity in these patients.

       

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