新疆维吾尔自治区2017-2019年布鲁氏菌病患者医疗费用分析  

Medical costs of brucellosis patients in Xinjiang Uygur Autonomous Region,2017-2019

作　　者：张翠红 木合塔尔·艾山 高辉 林胜红 黄硕 邓源 刘才兄 郑亚明[1] 王丽萍[1] Zhang Cuihong;Muhtar·Hasan;Gao Hui;Lin Shenghong;Huang Shuo;Deng Yuan;Liu Caixiong;Zheng Yaming;Wang Liping(Division of Infectious Disease/Key Laboratory of Surveillance and Early Warning on Infectious Disease Chinese Center for Disease Control and Prevention,Beijing 102206,China;Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention,Urumqi 830000,China;The Eighth Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]中国疾病预防控制中心传染病管理处/传染病监测预警重点实验室,北京102206 [2]疆维吾尔自治区疾病预防控制中心,乌鲁木齐830000 [3]新疆医科大学第八附属医院,乌鲁木齐830000

出　　处：《中华流行病学杂志》2022年第10期1575-1581,共7页Chinese Journal of Epidemiology

基　　金：国家科技重大专项(2018ZX10713001-001)。

摘　　要：目的分析新疆维吾尔自治区(新疆)布鲁氏菌病(布病)患者的医疗费用及影响因素。方法收集2017年1月1日至2019年12月31日期间首要诊断为布病患者的人口学信息、就诊信息和费用信息。通过非参数检验分析不同性别、年龄组、临床分期、并发症对患者医疗资源利用及医疗费用的影响。使用中位数描述布病患者的门诊和住院费用。结果共13532例纳入分析,其中门诊8113例,住院5419例,男性占67.8%(9176/13532),年龄(42.7±15.4)岁,以18~44岁(46.6%,6304/13532)和45~59岁(34.2%,4622/13532)年龄组为主。住院患者年龄(43.3±15.7)岁,高于门诊患者年龄(42.3±15.1)岁(Z=-3.85,P<0.001)。住院患者就诊时,全身症状以发热(36.9%,1997/5419)和乏力(36.6%,1983/5419)常见,局部症状以关节/肌肉疼痛(68.9%,3735/5419)常见;急性期患者占79.1%(4289/5419),慢性期患者占20.9%(1130/5419);患者有并发症占46.5%(2519/5419),主要为骨骼系统并发症。门诊患者人均门诊次数(1.6±1.4)次。住院患者次均住院天数为(11.3±4.2)d,慢性期和有并发症患者住院天数较长(P<0.05)。住院患者同年也有门诊记录占89.3%(4840/5419),人均门诊次数(3.6±2.6)次。门诊患者医疗费用以化验费和药物费为主(75.1%),住院患者以药物费、化验费和其他费用为主(74.4%)。2017-2019年门诊患者医疗费用M(Q1,Q3)分别为61(52,497)、61(51,346)和58(46,318)元,住院患者医疗费用M(Q1,Q3)分别为8214(6355,10721)、9095(7018,12155)和9492(7530,12351)元。患者年龄、临床分期、并发症和关节/肌肉疼痛症状为住院患者医疗费用的影响因素(P<0.001)。结论2017-2019年新疆布病住院患者经济负担较重,特别是高年龄组、慢性期、合并骨骼和神经系统并发症的患者。提高患者早期就诊和规范治疗意识,减少慢性化和并发症发生,可降低布病诊治所导致的经济负担。Objective To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Xinjiang Uygur Autonomous Region(Xinjiang).Methods Information on demographics,medical visits,and costs of patients diagnosed with Brucellosis were collected between January 1,2017 and December 31,2019.The effects of different genders,age groups,clinical stages,and comorbidities on patients'health care utilization and medical costs were analyzed by nonparametric tests.The median was used to describe the outpatient and inpatient costs of patients with Brucellosis.Results A total of 13532 patients(8113 outpatient and 5419 inpatient cases)were included in the analysis.A total of 67.8%(9176/13532)were male,with an average age of(42.7±15.4)years;age between 18-44 years(46.6%,6304/13532)and 45-59 years(34.2%,4622/13532)were the dominant groups.The mean age of inpatients[(43.3±15.7)years]was higher than that of outpatients[(42.3±15.1)years,Z=-3.85,P<0.001].When hospitalized patients are treated,systemic symptoms were common with fever(36.9%,1997/5419)and fatigue(36.6%,1983/5419),and with joint/muscle pain(68.9%,3735/5419)being the highest proportion of local symptoms.A total of 79.1%(4289/5419)of inpatients were diagnosed with acute Brucellosis.A total of 46.5%(2519/5419)of inpatients had complications;skeletal system complications ranked the highest.The average number of outpatient visits per outpatient was(1.6±1.4)times.The duration of hospitalization was(11.3±4.2)days,with longer days for patients in the chronic phase and with complications(P<0.05).A total of 89.3%(4840/5419)of inpatients had outpatient records in the same year,and the average number of outpatient visits per patient was(3.6±2.6)times.Outpatient medical costs were dominated by laboratory and drug costs(75.1%),and inpatient costs were dominated by drug,laboratory,and other costs(74.4%).Outpatient medical expenses M(Q1,Q3)were 61(52,497)Yuan,61(51,346)Yuan and 58(46,318)Yuan,respectively.Inpatients'medical expenses M(Q1,Q3)were 8214(6355,10721)

关 键 词：布鲁氏菌病 卫生资源 医疗费用 并发症 

分 类 号：R516.7[医药卫生—内科学] R197.3[医药卫生—临床医学]