中老年骨质疏松患者共病现状和住院费用研究  

Study on the current situation of comorbidities and hospitalization costs in middle-aged and elderly osteoporosis patients

作　　者：杨蓓蓓 巢健茜[1] 吴艳倩 杨世朔 杜永棋 周蔚 ANG Beibei;CHAO Jianqian;WU Yanqian;YANG Shishuo;DU Yongqi;ZHOU Wei(Department of Medical Insurance,School of Public Health,Southeast University,Nanjing 210009,Jiangsu Province,China)

机构地区：[1]东南大学公共卫生学院医疗保险系,江苏省南京210009

出　　处：《中国慢性病预防与控制》2024年第11期807-814,共8页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：国家社会科学基金重大项目(23&ZD188)。

摘　　要：目的 了解中老年骨质疏松患者共病现状和住院费用情况,并探究住院费用的影响因素,为政府部门合理控费提供思路。方法 选取2019年1月1日至2023年9月30日南京市某两家三甲医院1 503名≥45岁中老年骨质疏松患者的住院病案首页数据,收集人口学特征、临床特征、住院医疗资源使用情况和住院费用情况。用SPSS 26.0进行系统聚类分析,揭示中老年骨质疏松住院患者的共病模式。采用Stata 15.0进行分位数回归分析,挖掘不同分位点住院费用的影响因素。结果 1503名骨质疏松患者的共病患病率为87.76%,人均住院总费用为(15 303.40±21 329.58)元[中位数为7 414.71元(P_(25)~P_(75):4 999.67~19 934.99元)]。系统聚类将15类慢性病聚合成4类,包括骨折-代谢性风湿病-心脑综合征(高血压、糖尿病、关节炎或风湿病、脑梗死、慢性肺部疾病、心脏疾病和骨折)、神经或精神问题、内分泌-消化-泌尿生殖疾病(甲状腺疾病,肝脏疾病,肾脏疾病,生殖系统疾病,食管、胃和十二指肠疾病,血脂异常)、癌症或恶性肿瘤。分位数回归分析显示,年龄越大、患病数量越多、Charlson合并症指数越低、住院天数越长和住院次数越少的患者住院总费用越高(P<0.05);患病数量越多、住院天数越长和住院次数越少的患者诊断类费用越高(P<0.05);住院天数越长的患者综合医疗服务类费用和药品类费用越高(P<0.05)。结论 中老年骨质疏松患者的共病负担较重,住院费用支出较高,尤其是年龄大、患病数量多、Charlson合并症指数低、住院天数长和住院次数少的患者,建议加强共病防控意识,落实住院费用精益化管理,优化医疗资源配置,实现合理控费。Objective To understand the current situation of comorbidities and hospitalization costs in middle-aged and elderly osteoporosis patients,and explore the influencing factors of hospitalization costs,and provide the ideas for controlling reasonably the cost of the government departments.Methods From January 1,2019 to September 30,2023,the homepage data of 1503(≥45 years old)middle-aged and elderly osteoporosis patients from two third-grade hospitals in Nanjing were collected for demographic characteristics,clinical characteristics,use of inpatient medical resources and hospitalization costs.SPSS 26.0 software was utilized to perform the systematic cluster analysis,delineating the comorbidity patterns among these inpatients.Stata 15.0 software was used to perform the quantile regression analysis for realizing the influencing factors of hospitalization costs at different sites.Results The comorbidity rate among the 1503 patients with osteoporosis was 87.76%,the average per capita total hospitalization cost was(15303.40±21329.58)yuan[median was 7414.71 yuan(P25~P75:4999.67~19934.99 yuan)].Through systematic clustering,15 chronic diseases were divided into four groups:Fractures-Metabolic Rheumatism-Cardio-Cerebral Syndrome(encompassing hypertension,diabetes,arthritis or rheumatism,cerebral infarction,chronic lung disease,heart disease and fractures);Neurological or Psychiatric Problems;Endocrino-Gastro-Urogenital Diseases(thyroid disease,liver disease,kidney disease,reproductive system disease,esophageal,stomach and duodenal diseases,dyslipidemia);and Cancer or Malignant Tumor.Quantile regression analysis revealed that the patient number increased with age,Charlson comorbidity index(CCI)score decreased with age;the patients with longer and fewer hospitalization had higher total hospitalization costs(P<0.05);the patients with more number of diseases,longer number of days and fewer hospital admissions had higher diagnostic costs(P<0.05);the patients with longer hospitalization days had higher costs for comprehensive

关 键 词：骨质疏松 共病 医疗费用 系统聚类分析 分位数回归分析 

分 类 号：R580[医药卫生—内分泌]