广东省耐多药结核病灾难性支出发生情况及其影响因素分析  

Incidence and risk factors of catastrophic expenditure for multidrug-resistant tuberculosis in Guangdong Province

作　　者：余美玲 梁鸿迪 周芳静 陈亮 伍亚[3] 高丽洁 温文沛 朱穗 吴惠忠 Yu Meiling;Liang Hongdi;Zhou Fangjing;Chen Liang;Wu Ya;Gao Lijie;Wen Wenpei;Zhu Sui;Wu Huizhong(Department of Tuberculosis Reference Laboratory,Centre for Tuberculosis Control of Guangdong Province,Guangzhou 510610,China;Department of Tuberculosis Control and Prevention,Center for Tuberculosis Control of Guangdong Province,Guangzhou 510610,China;Department of Medical Statistics,School of Basic Medicine and Public Health,Ji’nan University,Guangzhou 510632,China)

机构地区：[1]广东省结核病控制中心结核病参比实验室,广州510610 [2]广东省结核病控制中心结核病防治科,广州510610 [3]暨南大学基础医学与公共卫生学院卫生统计教研室,广州510632

出　　处：《中国防痨杂志》2022年第12期1262-1272,共11页Chinese Journal of Antituberculosis

基　　金：国家重点研发计划(2019YFC0840602);广东省医学科学技术研究基金(A2019429)。

摘　　要：目的:研究广东省耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)患者灾难性支出发生率现状及其影响因素,为降低MDR-TB患者经济负担提供基础数据和参考依据。方法:以广东省2018-2019年9个地级市11家定点医疗机构和确诊的MDR-TB患者为研究对象,通过问卷收集医疗机构、MDR-TB患者和地市的基本情况,以及患病就诊情况、经济负担和医疗保障政策,分析影响广东省MDR-TB患者发生灾难性支出的因素。结果:研究共纳入广东省MDR-TB患者398例,直接医疗费用为5.11(2.26,9.82)万元,直接非医疗费用为1.46(0.71,3.33)万元,间接费用为0.51(0.31,0.73)万元,总费用为8.43(4.29,14.76)万元,人均经济负担为5.84(2.97,11.18)万元。259例患者发生了灾难性支出,发生率为65.08%。两水平logistic回归模型显示,有债务患者家庭发生灾难性支出的风险是无债务患者的2.57倍(95%CI:1.43~4.62);随着住院时间的增加,患者家庭灾难性支出发生风险逐渐上升,住院1个月的患者发生灾难性支出的风险是未住院患者的4.38倍(95%CI:2.38~8.06),住院≥2个月的患者发生灾难性支出的风险是未住院患者的31.37倍(95%CI:11.09~88.74)。结论:广东省MDR-TB患者灾难性支出发生率较高,有债务、住院时间长是导致患者灾难性支出发生风险升高的因素,应多措并举降低MDR-TB患者灾难性支出的发生率。Objective:To investigate the incidence and risk factors of catastrophic expenditure among patients with multidrug-resistant tuberculosis(MDR-TB)in Guangdong Province.Methods:The MDR-TB patients diagnosed in 11 designated medical institutions in 9 prefecture-level cities in Guangdong Province from 2018 to 2019 were selected.Questionnaires for surveying basic characteristics,patients’disease and medical visit history,financial burden,and health insurance policies of medical institutions,individuals and cities were collected.A two-level logistic regression model was used to explore the risk factors of catastrophic expenditure in MDR-TB patients.Results:A total of 398 patients were included in this study.The median direct medical expenses was 51100(22600,98200)yuan;the median direct non-medical expenses was 14600(7100,33300)yuan;the median indirect costs was 5100(3100,7300)yuan;the median total costs was 84300(42900,147600)yuan;and the median total out-of-pocket expenses was 58400(29700,111800)per case.A total of 259 MDR-TB patients suffered with catastrophic expenditure,with an incidence of 65.08%.The two-level logistic regression model showed that the risk of catastrophic expenditure for households with debt was 2.57 times of that for households without debt(95%CI:1.43-4.62).The incidence of catastrophic expenditure increased gradually with the patients’hospitalization length,and the incidence for patients hospitalized for 1 month and≥2 months were 4.38(95%CI:2.38-8.06)times and 31.37(95%CI:11.09-88.74)times of that for non-hospitalized patients.Conclusion:A high incidence of catastrophic expenditure for MDR-TB patients was found in Guangdong Province.Debt and length of hospitalization were the risk factors for incidence of catastrophic expenditure.Multiple measures should be taken to reduce the incidence of catastrophic expenditure in MDR-TB patients.

关 键 词：结核 抗多种药物性 药费支出 因素分析 统计学 

分 类 号：R521[医药卫生—内科学]