江苏省启东市HBV感染相关疾病住院患者的经济负担及对家庭经济的影响  

Economic burden of inpatients with hepatitis B virus infection-related diseases and its impact on family financial status in Qidong,Jiangsu Province,China

作　　者：姚红玉[1] 王宇婷[2] 唐红萍[1] 黄慧瑶[3] 张红健[1] 沙春霞 石菊芳[3] 代敏[3] 陈陶阳[5] 曲春枫[2,6] 

机构地区：[1]启东市人民医院&启东肝癌防治研究所科研科,江苏启东226200 [2]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院免疫学研究室,北京100021 [3]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院城市癌症早诊早治项目办公室,北京100021 [4]启东市传染病医院,江苏启东226200 [5]启东市人民医院&启东肝癌防治研究所病因室,江苏启东226200 [6]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院分子肿瘤学国家重点实验室,北京100021

出　　处：《临床肝胆病杂志》2017年第5期853-859,共7页Journal of Clinical Hepatology

基　　金："十二五"传染病国家科技重大专项(2012ZX10002008-001;003);江苏省科技支撑计划(BE2013657)

摘　　要：目的分析江苏省启东市HBV感染相关疾病住院患者(包括原发性肝癌、乙型肝炎肝硬化和慢性乙型肝炎)的经济负担以及患病对家庭经济的影响。方法采用时间段连续病例整群随机抽样方法,抽取江苏省启东市(县级市)人民医院及启东市传染病医院2014年5月1日-2015年3月31日收治的HBV感染相关疾病住院患者,通过问卷调查收集其人口社会学信息、临床信息、近3年的直接医疗费用、直接非医疗费用、因患病所致的误工损失及患病对家庭经济的影响。采用Wilcoxon秩和检验或KruskalWallis H秩和检验分析疾病临床分期、年龄、性别、受教育程度、职业、医保类型、家庭收入等因素对经济负担的影响。通过χ~2检验或Fisher精确检验分析HBV感染后不同疾病类型住院患者家庭经济压力的差异。结果 HBV相关原发性肝癌、乙型肝炎肝硬化、慢性乙型肝炎住院患者近3年的经济负担总和分别为94 001元、63 421元和39 360元;其中直接医疗费用分别占84.7%、83.6%和89.9%;近1年的自付费用分别占家庭年收入的99.6%、59.4%和16.7%。3组患者自述经济压力很大比例之间比较,差异有统计学意义(38.7%vs 43.1%vs 11.3%,χ~2=30.066,P<0.001);3年内的3组患者误工经济损失比较,差异亦有统计学意义(7903元vs 6280元vs 2600元,χ~2=68.601,P<0.001)。结论 HBV感染相关疾病住院给家庭带来沉重的经济负担,HBV感染相关疾病住院患者的病程越长、病情越严重,疾病所带来的经济负担就越高。随着慢性乙型肝炎向乙型肝炎肝硬化和原发性肝癌的进展,疾病给家庭带来的经济压力也在增加,患者本人及亲属因疾病产生的误工损失也越来越大。预防和控制HBV感染相关疾病具有较大的社会和经济效益。Objective To investigate the economic burden of inpatients with hepatitis B virus （HBV） infection - related diseases （ inclu- ding primary liver cancer, hepatitis B cirrhosis, and chronic hepatitis B） and its impact on family financial status in Qidong, Jiangsu Prov- ince, China. Methods Cluster random sampling was used to select consecutive cases of HBV infection - related diseases who were hospital- ized in The People＇s Hospital of Qidong and Qidong Hospital for Infectious Diseases from May 1, 2014 to March 31, 2015. A questionnaire survey was performed to collect their demographic data, clinical data, direct medical costs within the past three years, direct non - medical costs, loss of income due to missed work, and the impact of disease on family financial status. The Wilcoxon rank sum test or the Kruskal - Wallis H rank sum test was used to analyze the impact of various factors on economic burden, such as clinical stage, age, sex, educational level, occupation, type of medical insurance, and family income. The chi - square test or Fisher＇s exact test was used to analyze the difference in family economic pressure caused by different disease types after HBV infection. Results The total costs of primary liver cancer, hepatitis B cirrhosis, and chronic hepatitis B within the past three years were 94001 yuan, 63421 yuan, and 39360 yuan, respectively, and direct medical costs accounted for 84.7% , 83.6% , and 89.9%, respectively. The self- paid costs within the past one year accounted for 99.6% , 59.4% , and 16.7% , respectively, of the annual family income. There was a significant difference in the proportion of patients with great economic pressure between the three groups （38.7% vs 43.1% vs 11.3% , X2 = 30. 066, P 〈 0. 001 ）. There were also significant differences in the number of missed working days and loss of income due to missed work （7903 yuan vs 6280 yuan vs 2600 yuan, X2 = 68. 601, P 〈 0. 001 ）. Conclusion HBV infection - related diseases bring considerable burden to inpatients a

关 键 词：肝肿瘤 肝硬化 肝炎 乙型 慢性 肝炎病毒 乙型 患病代价 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]