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梁祖花, 潘春柳, 汪俊华, 黄延, 白璐璐, 陈洪, 张彬兵, 张敏, 张颢严. 2021－2022年贵州省贵阳市肺结核患者灾难性支出及影响因素研究[J]. 疾病监测, 2024, 39(5): 647-654. DOI: 10.3784/jbjc.202309180461
引用本文: 梁祖花, 潘春柳, 汪俊华, 黄延, 白璐璐, 陈洪, 张彬兵, 张敏, 张颢严. 2021－2022年贵州省贵阳市肺结核患者灾难性支出及影响因素研究[J]. 疾病监测, 2024, 39(5): 647-654. DOI: 10.3784/jbjc.202309180461
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Liang Zuhua, Pan Chunliu, Wang Junhua, Huang Yan, Bai Lulu, Chen Hong, Zhang Binbing, Zhang Min, Zhang Haoyan. Investigation of catastrophic health expenditure of pulmonary tuberculosis patients and influencing factors in Guiyang, Guizhou, 2021−2022[J]. Disease Surveillance, 2024, 39(5): 647-654. DOI: 10.3784/jbjc.202309180461
Citation: Liang Zuhua, Pan Chunliu, Wang Junhua, Huang Yan, Bai Lulu, Chen Hong, Zhang Binbing, Zhang Min, Zhang Haoyan. Investigation of catastrophic health expenditure of pulmonary tuberculosis patients and influencing factors in Guiyang, Guizhou, 2021−2022[J]. Disease Surveillance, 2024, 39(5): 647-654. DOI: 10.3784/jbjc.202309180461
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2021－2022年贵州省贵阳市肺结核患者灾难性支出及影响因素研究

Investigation of catastrophic health expenditure of pulmonary tuberculosis patients and influencing factors in Guiyang, Guizhou, 2021−2022

    摘要
  • 摘要:
    目的 评估贵州省贵阳市肺结核患者家庭灾难性支出发生情况及其影响因素，为减轻肺结核患者经济负担提供建议和依据。
    方法 采用问卷调查与查询医院信息系统相结合的方式对患者进行回顾性调查，灾难性支出采用率描述，通过χ2检验和Log-binomial回归分析其影响因素。
    结果 贵阳市471例患者因治疗肺结核所支出的平均自付总费用为8201.00（3900.02, 14809.33）元，53.72%（49.22%～58.22%）的肺结核患者发生了灾难性支出。多因素分析显示，人均年收入高（≥18000元）发生灾难性支出的风险低［患病率比（PR）=0.78, 95%置信区间（CI）：0.66～0.93］，确诊延迟（PR=1.17, 95%CI：1.02～1.35）、首诊机构为非结核病定点医院（PR=1.21, 95%CI：1.04～1.40）、就诊次数≥3次（PR=1.42, 95%CI：1.16～1.74）及住院次数≥2次（PR=2.37, 95%CI：1.86～3.04）是患者发生灾难性支出的危险因素。分层分析结果显示，住院≥2次是城乡及不同职业、不同年龄段患者共有的危险因素，医保是农村患者特有的保护因素。
    结论 贵阳市肺结核患者灾难性支出的发生率较高，需进一步加强人均年收入低、确诊延迟、首诊机构为非定点医院、多次就诊及住院患者的社会保障措施和健康教育宣传力度。针对农村患者要做好医保与其他救助政策的配合，同时实施主动筛查保证患者早发现、早诊断、早治疗，从而降低患者经济负担，减少发生灾难性支出情况。

     

    Abstract:
    Objective To evaluate the incidence of catastrophic health expenditure of pulmonary tuberculosis (TB) patients and influencing factors in Guiyang, Guizhou province, and provide suggestions and evidence for reducing the economic burden of pulmonary TB patients.
    Methods A retrospective survey was conducted by using the data from questionnaire survey and hospital information system, and the rate of catastrophic health expenditure was described. The influencing factors were analyzed by χ2 and Log-binomial regression.
    Results The average total payment for the treatment of pulmonary TB in 471 patients in Guiyang was 8201.00 yuan (3900.02, 14809.33). Up to 53.72% (49.22%−58.22%) of the patients had catastrophic health expenditure. Multivariate analysis showed that the patients with high annual income (≥18000 yuan) had low risk for catastrophic health expenditure prevalence ratio (PR)=0.78, 95% confidence interval (CI): 0.66–0.93. Diagnosis delay (PR=1.17, 95%CI: 1.02–1.35), the first visit to non-TB designated hospital (PR=1.21, 95%CI=1.04–1.40), multiple hospital visits (≥3) (PR=1.42, 95%CI: 1.16–1.74) and multiple hospitalizations (≥2 ) (PR=2.37, 95%CI: 1.86–3.04) were the risk factors for catastrophic health expenditure. The results of stratified analysis showed that ≥2 times of hospitalization was a common risk factor for both urban and rural patients in different occupation and age groups, and medical insurance was a unique protective factor for rural patients.
    Conclusion The incidence of catastrophic health expenditure in pulmonary TB patients was relatively high in Guiyang, and it is necessary to further strengthen the social security and health education for the patients with low annual income, delayed diagnosis, the first visit to non-designated hospital, and multiple hospital visits and hospitalizations. For the rural patients, it is necessary to take integrated measures, including medical insurance and others, and conduct active screening for the early detection, diagnosis and treatment of pulmonary TB patients to reduce the economic burden and reduce catastrophic health expenditure of the patients.

     

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