背景：多重慢性疾病與健康相關的生活質量被認為是醫療保健中的一個關鍵臨床與公共衛生問題。回顧過去文獻發現，健康相關的生活品質會因為每一個國家盛行的疾病、文化、生活習慣及經濟而有所差異，但是目前亞洲地區較少有文獻在探討慢性病數量、種類與健康相關的生活品質之關係。過去其他國家的文獻大多僅探討特定之慢性疾病、或是研究的樣本來自醫院或診所；即便探討多重慢性疾病與健康相關的生活品質之文獻亦多著重於臨床個案，較少針對社區個案進行多重慢性疾病以及不同的健康行為對其生活品質之影響探討。

目的：本研究目的有三：(一)比較有多重慢性病與沒有慢性病之65歲以上老年人，其健康狀態及健康相關的生活品質之差異、(二)比較有慢性病者，其共病數量、疾病種類與其健康狀態和健康相關的生活品質之差異。(三)納入兩種健康行為(正向行為-規律身體活動、負向行為-吸菸)，分析其對於多重慢性病者的健康相關的生活品質之差異。

方法：本研究為橫斷面研究，採用2013年「國民健康訪問調查」資料庫(NHIS)，研究排除問卷填答非本人、研究變項之EQ-5D和14種慢性病未回答、漏答者，最後納入研究樣本人數共2775人。依變項為健康相關之生活品質(HRQoL)採用EQ-5D問卷，共有5題，並且每題分為3種程度，再以台灣EQ-5D health utility index score逕行換算得EQ-5D utility 分數及EQ-VAS進行評估。自變項為台灣常見的14種慢性病，並區分個案為:有無慢性病及含有1種、2種及3種以上慢性病組別，並再依其疾病區分其種類(例：高血壓、糖尿病、高血脂、關節炎等)，最後納入兩項健康行為分析，健康行為區分正向健康行為及負向健康行為，目的為探討在具有疾病狀況下不同的健康行為對生活品質所造成影響。

結果：本研究結果分三部分描述。第一部分，沒有慢性病者有最高之EQ-5D utility分數平均數(0.93)，隨著具有1種慢性病(0.87)、2種慢性病(0.83)及3種以上慢性病(0.72)，EQ-5D utility分數平均數隨之遞減，經統計分析達顯著之差異，EQ-VAS也是隨著慢性病數量越多而遞減。第二部分，在14種台灣常見的慢性病中，除了肝膽疾病及癌症未達統計顯著，其他罹患各種慢性病者EQ-5D utility分數及EQ-VAS均比沒有罹病者較低。第三部分，經回歸分析，納入所有慢性病與社會人口學變項後，研究發現有中風、精神疾病、COPD、關節炎、骨質疏鬆或癌症者，以及較高齡女性、教育程度較低、婚姻狀況為未婚或未同住、經濟狀況有困難及仍在工作者，其健康相關生活品質較差。如果再將負向及正向健康行為與慢性病及健康相關生活品質共同探討，本研究發現負向健康行為以吸菸為例，不論慢性病個案是否有吸菸對於健康相關生活品質均無影響；但是正向健康行為以規律身體活動為例，研究顯示，相較於沒有慢性病者或是多重慢性病個案，只要個案有身體活動，不論是否每週規律，都可以提升個案健康相關生活品質(EQ-5D utility及EQ-VAS)。

討論：老年人罹患多重慢性病容易導致有較低的健康相關生活品質(HRQoL)，並且教育程度、經濟有困難的女性老年人，甚至有更差的健康相關生活品質；健康相關生活品質不僅和罹病的數量有關，亦和疾病的種類及病患的特徵有所影響。建議衛生行政部門可針對容易導致不良健康相關生活品質的疾病加強管理及早監測、預防，並加強民眾衛生教育宣導，以提升防治知能。其次，針對已經罹患慢性病的個案，可強化社區支持性環境，讓民眾養成規律身體活動的習慣，以降低慢性病所導致的健康相關生活品質不良。

The purpose of the study was to examine the associations of multiple chronic diseases and health behaviors and health-related quality of life in older adults in Taiwan. This study found that older adults who suffered from multiple chronic diseases were more likely to lower their health-related quality of life (HRQoL). HRQoL is related to not only the number of diseases but also the types of diseases and the characteristics of patients. In particular, females with educational and financial difficulties have had worse HRQoL.Therefore, the future policy should strengthen management, education, and publicity for diseases that lead to poor HRQoL. Also, enhancing the supportive environments for regular physical activity in the community can help improve HRQoL.

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