北京市通州区手足口病轻症门诊病例经济负担分析  

Financial burden of outpatients with mild hand,foot and mouth disease in Tongzhou district of Beijing

作　　者：崔燕[1] 李秋虹[2] 李洪军[1] 杨艳娜[1] 郑燃燃 邹林[3] 白连军 张海鹃 吴建军 张国峰 CUI Yan;LI Qiu-hong;LI Hong-jun;YANG Yan-na;ZHENG Ran-ran;ZOU Lin;BAI Lian-jun;ZHANG Hai-juan;WU Jian-jun;ZHANG Guo-feng(Institute for Infectious Disease and Endemic Disease Control,Tongzhou District Center for Disease Control and Prevention,Beijing 101100,China)

机构地区：[1]北京市通州区疾病预防控制中心传染病与地方病控制科,北京101100 [2]北京市通州区疾病预防控制中心办公室 [3]北京市通州区疾病预防控制中心微生物检验室 [4]北京市通州区第二医院 [5]北京市通州区妇幼保健院 [6]首都医科大学附属北京潞河医院

出　　处：《中国预防医学杂志》2021年第5期372-377,共6页Chinese Preventive Medicine

基　　金：北京市通州卫生发展科研专项基金资助项目(TFZXPT-20180301)。

摘　　要：目的监测2018—2019年北京市通州区手足口病(hand, foot and mouth disease, HFMD)轻症门诊病例病原学特征,评估通州区HFMD轻症门诊病例经济负担。方法选取通州区妇幼保健院、潞河医院、通州区第二医院作为监测医院,每个月采集首次就诊的临床诊断为HFMD的普通门诊病例咽拭子样本10人份进行病原学监测,对征得家长知情同意和配合的监测病例开展经济负担问卷调查。结果 2018年HFMD监测以柯萨奇病毒A6(coxsackievirus A16,CVA6)型为主(63.47%),2019年以CVA16型为主(54.18%)。通州区HFMD轻症门诊病例总体经济负担中位数为552.20元/人;3~<5岁儿童因HFMD而产生的费用较高,主要体现在间接经济负担;感染CVA6型儿童经济负担较高,主要体现在直接经济负担;无医保的病例总体经济负担较高,主要是由于间接经济负担较高;出现发热症状、就诊时长≥3 d、就诊次数≥3次的病例直接经济负担、间接经济负担和总体经济负担都比较高;就诊医疗机构级别越高,HFMD病例直接经济负担越高。结论通州区HFMD轻症门诊病例经济负担与病例年龄、医保状态、发热情况、就诊时长、就诊频次、病原学分型及就诊医疗机构有关。Objective To describe the financial burden of outpatients with mild hand, foot and mouth disease(HFMD) in Tongzhou District of Beijing during 2018 and 2019, and to understand the etiological characteristics of, the disease. Methods Outpatients with mild HFMD were enrolled into the study from 3 hospitals in Tongzhou district.Throat swabs were collected from 10 outpatients confirmed with mild HFMD during the first clinic visit for pathogen identification in each month.Meanwhile, a questionnaire survey was conducted among cases with parents′ informed consents to collect study related information. Results Pathogen identification showed that the predominant pathogen for HFMD was CVA6(63.47%) in 2018 and CVA16(54.18%) in 2019.The median medical cost was 552.20 yuan, and it was higher in children aged 3-5 years due to higher indirect economic burden.The economic burden was heavier in children infected with CVA6 due to increased direct financial burden and in uninsured children due to increased indirect economic burden.Patients with fever, not seeing doctors for at least 3 days after disease onset or having doctor visits ≥3 times had higher total, direst and indirect economic burden.The direct economic burden increased with elevated levels of medical institutions. Conclusions The economic burden of outpatient with mild HFMD in Tongzhou district is related to age,insurance status,fever,waiting time for doctor visit,visit frequency,pathogen type and level of medical institution.

关 键 词：手足口病 监测 轻症门诊病例 经济负担 

分 类 号：R183.4[医药卫生—流行病学]