山西省大同市2017-2019年布鲁氏菌病患者医疗费用分析  

Medical costs of brucellosis patients in Datong of Shanxi province,2017-2019

作　　者：张翠红 林胜红 刘新荣[2] 安树伟[3] 高叶 黄硕 邓源 王丽萍[1] 郑亚明[1] Zhang Cuihong;Lin Shenghong;Liu Xinrong;An Shuwei;Gao Ye;Huang Shuo;Deng Yuan;Wang Liping;Zheng Yaming(Division of Infectious Disease/Key Laboratory of Surveillance and Early Warning on Infectious Disease,Chinese Center for Disease Control and Prevention,Beijing 102206,China;Datong Center for Disease Control and Prevention,Datong 037000,China;Datong Fourth People's Hospital,Datong 037000,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]大同市疾病预防控制中心,大同037000 [3]大同市第四人民医院,大同037000

出　　处：《中华流行病学杂志》2022年第12期1965-1971,共7页Chinese Journal of Epidemiology

基　　金：国家科技重大专项(2018ZX10713001-001)。

摘　　要：目的分析山西省大同市布鲁氏菌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日期间诊断为布鲁氏菌病患者的人口学信息、就诊信息和费用信息。对患者3年内医疗资源使用情况和医疗费用进行分析;分析不同性别、年龄、基础性疾病、临床分期、并发症对患者医疗资源利用及医疗费用的影响。结果共2289例纳入分析,其中门诊1715例,住院574例;男性占72.0%(1649/2289),年龄(49.6±15.5)岁,45~59岁年龄组为主(36.2%,829/2289)。住院患者年龄(51.4±16.0)岁高于门诊(49.0±15.2)岁(Z=-4.01,P<0.001)。门诊患者年人均门诊次数(1.6±1.5)次。住院患者次均住院天数(14.6±9.9)d,患有中枢神经系统并发症[(20.8±11.4)d]和心血管系统和造血系统并发症[(16.6±9.5)d]的患者住院时间较长(均P<0.05)。在住院患者中,患有基础性疾病占51.0%(293/574),其中内分泌代谢疾病占30.3%(174/574);急性期患者占54.0%(310/574),慢性期占46.0%(264/574);患有并发症占64.3%(369/574),其中,消化系统、骨骼系统并发症分别占30.3%(174/574)和29.1%(167/574)。门诊患者中,年龄是医疗费用的影响因素(P<0.001);住院患者中,年龄、并发症和疗效是医疗费用的影响因素(P<0.05),合并骨骼系统和中枢神经系统并发症的患者医疗费用高于无此二系统并发症者(P<0.001)。结论2017-2019年山西省大同市布鲁氏菌病门诊病例的医疗费用负担尚可,住院患者特别是合并骨骼、神经系统并发症的患者其经济负担较重。病例的早发现、早诊断及早治疗,仍是避免并发症发生和进展,有效降低医疗费用的重要手段。Objective To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Datong of Shanxi province.Methods Information on demographics,medical visits,and costs of patients diagnosed with Brucellosis between January 1,2017,and December 31,2019,were collected.Health care utilization and medical costs were analyzed from different genders,age groups,underlying diseases,clinical stages,and comorbidities.Results A total of 2289 patients(1715 outpatient and 574 inpatient cases)were included in the analysis.72.0%(1649/2289)were male,with an average age of(49.6±15.5)years;age between 45-59 years was the dominant group(36.2%,829/2289).The mean age of inpatients(51.4±16.0)was higher than that of outpatients(49.0±15.2)(Z=-4.01,P<0.001).The average number of outpatient visits per outpatient was(1.6±1.5)times.The duration of hospitalization was(14.6±9.9)and(20.8±11.4)days for patients with central nervous system complications and(16.6±9.5)days for vascular system complications.Of the inpatients,51.0%(293/574)had underlying diseases,and 30.3%(174/574)had endocrine and metabolic diseases.54.0%(310/574)of inpatients were diagnosed with acute Brucellosis,and 46.0%(264/574)were diagnosed with chronic Brucellosis.A total of 64.3%(369/574)of inpatients had complications,30.3%(174/574)of digestive system complications,followed by skeletal system complications(29.1%,167/574).Among outpatients,age significantly affected medical costs(P<0.001).For inpatients,age and complications and treatment effect were influential factors(P<0.05).Patients with the combined skeletal system and central nervous system complications had significantly higher medical costs(P<0.001).Conclusions The medical costs for outpatient cases of Brucellosis were moderate.However,the economic burden was higher for inpatients,especially those with skeletal and neurological complications.Early detection,diagnosis,and treatment of cases were essential to avoid chronic Brucellosis and its complications and reduce medical costs.

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] R197.32[医药卫生—临床医学]