As the aging of the population, the burden of chronic diseases in China has increased significantly. The majority of chronic disease patients suffer from cardiometabolic diseases (CMD) like hypertension and diabetes. The health-related quality of life (HRQoL) is a subjective evaluation index that reflects both the physical health level and mental health of patients with chronic diseases. Existing research on HRQoL in patients with CMD primarily focuses on influencing factors and the assessment of their current status. Compared to the research on the static status of HRQoL, research on its dynamic trends over time, however, remains somewhat limited.

To analyze the development trajectory of HRQoL in middle-aged and elderly patients with CMD and influencing factors, as well as to explore the contribution of each influencing factor, thus providing a scientific basis for improving HRQoL in patients with CMD.

Using time-series data from field surveys, a baseline survey in 2016 (T0) was conducted using a typical sampling in eligible patients with primary hypertension or type 2 diabetes mellitus (T2DM) from 3 urban communities and 2 rural communities in a certain division of the Xinjiang Production and Construction Corps. Four follow-up surveys were conducted in 2017 (T1), 2018 (T2), 2019 (T3), and 2021 (T4). A total of 1 599 subjects were surveyed in the baseline period, and 565 subjects completed the follow-up visits. Of them, 389 had hypertension, and 176 had T2DM. After excluding samples with missing data like HRQoL and demographic characteristics, data from 563 subjects were included in the analysis. A self-designed questionnaire was used for the survey, composing of five parts of personal basic information, social and psychological status, lifestyle, disease status, and health service utilization. The HRQoL of patients was measured using the European Quality of Life 5-Dimension 5-Level version (EQ-5D-5L). The heterogeneous HRQoL development trajectories were explored using a growth mixture model, and the influencing factors and evaluation of the development trajectories were analyzed using a logistic regression model and Shapley value decomposition, respectively.

Three distinct types of heterogeneous development trajectories were identified, including a 452 (80.28%) cases in the significant growth group, 81 (14.39%) cases in the moderate decline group, and 30 (5.33%) cases in the significant attenuation group. Multivariate Logistic regressions analysis indicated that, patients who do not engage in physical exercise, possess impaired self-care abilities, experience deteriorating health conditions, have non-urban employee medical insurance, and express dissatisfaction with the outpatient chronic disease policy were more likely to enter the moderate decline group (P<0.05) ; patients who do not participate in physical exercise and express general satisfaction with the outpatient chronic disease policy were more likely to belong to the significant attenuation group (P<0.05). The Shapley value decomposition results revealed that the contribution of each influencing factor to the prediction of HRQoL varied among the different trajectory groups. In the significant growth group, the factors with the greatest contribution were changes in health status and self-care ability. In the moderate decline group, the predominant influencing factors were physical exercise and self-care ability. In the significant attenuation group, satisfaction with the outpatient chronic disease policy ranked first in the contribution analysis, followed by physical exercise.

Patients with CMD exhibit varying trajectories in HRQoL, which are influenced by distinct factors associated with each trajectory. Intervention measures can be dynamically tailored in response to the evolving HRQoL trajectories and their influencing factors, thereby offering more precise medical and health services to patients with CMD. We should concentrate on CMD patients whose health status has deteriorated, whose self-care ability has impaired, and who do not engage in physical exercise. Concurrently, efforts should be made to promote awareness of chronic disease policies, medical insurance, and other pension policies. Additionally, it is essential to continue enhancing the quality of outpatient chronic disease medical services and to improve patient satisfaction with the outpatient chronic disease policies, thereby further enhancing HRQoL.

随着人口老龄化程度进一步加深，我国慢性病负担明显加剧，其中大部分患者患有高血压、糖尿病等心血管代谢性疾病。健康相关生命质量（HRQoL）作为主观评价指标，能够反映慢性病患者生理健康水平与心理健康状态。目前有关心血管代谢性疾病患者的HRQoL研究主要集中在影响因素及其现状评估，然而，相较于对HRQoL静态现状的研究，对其随时间变化的动态趋势的研究稍显不足。

分析中老年心血管代谢性疾病患者HRQoL的发展轨迹及其影响因素，并探讨各影响因素的贡献程度，为提高心血管代谢性疾病患者HRQoL提供科学依据。

利用现场调查的时间序列数据，本研究于2016年（T0）采用典型抽样方法选取新疆生产建设兵团某师3个城市社区和周边的2个团场社区进行基线调查，随机抽取符合纳入标准的原发性高血压病或2型糖尿病患者进行调查。并分别在2017年（T1）、2018年（T2）、2019年（T3）和2021年（T4）进行4轮随访调查。基线时期共调查1 599例，完成后期4轮随访过程的共有565例，其中高血压389例、糖尿病176例。在排除HRQoL和人口学特征等关键指标缺失的样本后，最终有563例研究对象的数据纳入分析。采用自行设计的问卷进行调查，问卷内容主要包括个人基本情况、社会心理状况、生活方式、疾病情况以及卫生服务利用5部分内容。采用五级的欧洲五维健康量表（EQ-5D-5L）对患者的HRQoL进行测量。运用增长混合模型探索异质化HRQoL发展轨迹，通过Logistic回归模型分析和Shapley值分解进行发展轨迹的影响因素分析和评估。

本研究共识别3类异质化发展轨迹：显著增长组452例（80.28%）、适度下降组81例（14.39%）和显著衰减组30例（5.33%）。多元Logistic回归分析结果显示，以显著增长组为参照，不进行体育锻炼、生活自理能力受损、健康状况恶化、非城镇职工医保以及对门诊慢性病政策不满意的患者更容易进入适度下降组（P<0.05）；不进行体育锻炼以及对门诊慢性病政策满意程度一般的患者更容易进入显著衰减组（P<0.05）。Shapley值分解结果显示，各影响因素对患者HRQoL的预测贡献程度在各类别轨迹组间不同。在显著增长组中，贡献程度较大的影响因素为健康状况变化和生活自理能力；在适度下降组中，贡献程度较大的影响因素为体育锻炼和生活自理能力；在显著衰减组中，对门诊慢性病政策的满意程度在贡献程度分析中排名第一，其次则是体育锻炼。

心血管代谢性疾病患者HRQoL存在不同的变化轨迹，且不同轨迹的影响因素不尽相同。可根据心血管代谢性疾病患者HRQoL变化轨迹及影响因素动态调整干预措施，为其提供更为精准的医疗卫生服务。应重点关注健康状况恶化、生活自理能力受损以及不进行体育锻炼的CMD患者。同时，应开展有关慢性病政策和医疗保险等养老政策的宣传，持续提高门诊慢性病医疗服务质量，提升患者对门诊慢性病政策的满意度，从而进一步改善HRQoL。