2017—2019年河南省棘球蚴病患者医疗费用及影响因素分析

doi:10.12140/j.issn.1000-7423.2021.03.005

摘要/Abstract

摘要：

目的了解2017—2019年河南省棘球蚴病患者的医疗费用,并分析其影响因素,为棘球蚴病的诊疗提供参考。方法通过国家传染病报告信息管理系统收集2017—2019年河南省棘球蚴病病例信息,通过流行病学调查及电话回访收集报告病例的一般信息和诊疗信息。采用SPSS 22.0软件对报告病例进行描述性流行病学分析,采用两（多）独立样本秩和检验分析患者医疗费用的影响因素。结果 2017—2019年河南省共报告棘球蚴病病例51例,以新疆输入为主（34例）。报告病例主要分布在周口（25.5%,13/51）,其次为南阳（17.7%,9/51）、商丘（11.8%,6/51）、驻马店（9.8%,5/51）;报告病例中男女比例为1.8 ∶ 1;发病年龄主要集中在40~60岁年龄组。提供诊疗费用的40位棘球蚴病患者,最低花费0元,最高60.0万元,中位数为6.0万元;单因素分析结果显示,对诊疗费用差异有统计学意义的变量为：性别、疾病类型、病灶数量、是否复发、发病-确诊时间、确诊医院级别、转诊次数和手术次数（P < 0.05）。结论河南省棘球蚴病患者的医疗费用与疾病进展、就医行为等相关。

关键词: 河南省, 棘球蚴病, 医疗费用, 影响因素

Abstract:

Objective To analyze the medical cost of echinococcosis patients and the influencing factors in Henan Province from 2017 to 2019. Methods The general information of echinococcosis cases of Henan Province was collected through the Chinese National Infectious Diseases Reporting System during 2017—2019. The clinical information was collected by epidemiological investigation and telephone follow-up. The epidemiological characteristics of the reported cases were analyzed with SPSS 22.0, and the rank sum test for two or multi independent samples was used to analyze the influential factors for medical expenses of echinococcosis cases.Results From 2017 to 2019, 51 echinococcosis cases were reported in Henan, of which 34 cases were imported from Xinjiang. For area distribution, the cases were predominantly distributed in Zhoukou (25.5%, 13/51), followed by Nanyang (17.7%, 9/51), Shangqiu (11.8%, 6/51) and Zhumadian (9.8%, 5/51). The male-to-female ratio was 1.8 : 1, and the age of patients was mainly in the range of 40-60 years. By analyzing the medical expenses of 40 echinococcosis cases, the medical expense ranged 0-0.6 million, with a median of 60 000 yuan. Factors that were significantly associated with medical expenses were gender, type of echinococcosis, lesion number, the occurrence of relapse, the time from onset to confirmed diagnosis, level of hospital offering diagnosis, time of referring and time of operation ( P < 0.05). Conclusion The medical cost of echinococcosis patients was related to disease progression and hospital visits in Henan Province.

Key words: Henan Province, Echinococcosis, Medical expense, Influential factor

中图分类号:

R532.32

张雅兰, 邓艳, 陈伟奇, 朱岩昆, 蔺西萌, 张红卫. 2017—2019年河南省棘球蚴病患者医疗费用及影响因素分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(3): 321-326.

ZHANG Ya-lan, DENG Yan, CHEN Wei-qi, ZHU Yan-kun, LIN Xi-meng, ZHANG Hong-wei. Analysis of medical cost of echinococcosis cases and influencing factors in Henan Province during 2017—2019[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2021, 39(3): 321-326.

图/表 6

表1

2017—2019年河南省棘球蚴病报告病例医疗费用的相关因素

编码Code	变量Variable	赋值Assignment
X₁	医疗费用/万元Medical cost/Ten thousand yuan	调查所得实际花费 Actual cost
X₂	性别Gender	女 = 0,男 = 1;Femal = 0,Male = 1
X₃	年龄/岁Age/Years	实际年龄Actual age
X_3-1	年龄/等级 Age/Classification	< 20 = 1,20~40 = 2,40~60 = 3,≥ 60 = 4
X₄	职业Occupation	农民 = 1,儿童及学生= 2,其他 = 3;Farmer = 1,Children and student = 2,Others = 3
X₅	现居住地 Current living place	城市 = 0,农村 = 1;Urban = 0,Village = 1
X₆	流行病学史 History of epidemiology	无 = 0,有 = 1;No = 0,Yes = 1
X₇	疾病类型 Species for echinococcosis	细粒棘球蚴病 = 1,多房棘球蚴病 = 2;Cystic echinococcosis = 1, Alveloar echinococcosis = 2
X₈	病灶数量Lesion number	病灶的数量 The number of lesions
X_8-1	病灶数量/等级 Lesion number/Classification	1 = 1,2 = 2,≥ 3 = 3
X₉	复发Relapse	否 = 0,是 = 1;No = 0,Yes = 1
X₁₀	发病-确诊时间/d Time from onset to confirmed diagnosis/d	发病-确诊的实际天数Actual days from onset to be diagnosed
X_10-1	发病-确诊时间/等级 Time from onset to confirmed diagnosis/classification	≤30 = 1,31~90 = 2,91~365 = 3,> 365 = 4
X₁₁	初诊医院级别 Hospital level of the first visit	社区及以下级医院 = 1,市/县级医院 = 2,省级医院 = 3;The community and lower level hospital = 1,County-level hospital = 2, Provincial hospital = 3
X₁₂	确诊医院级别Level of hospital offering diagnosis	市/县级医院 = 1,省级医院 = 2;County-level hospital = 1,Provincial hospital = 2
X₁₃	转诊次数Visit number	实际就诊的次数Actual number of visits
X_13-1	转诊次数/等级Visit number/classification	0 = 0,1~2次 = 1,3次及以上 = 2;One to two times =1,Three times and more = 2
X₁₄	手术次数Operation number	实际手术次数Actual number of operations
X_14-1	手术次数/等级Operation number/classification	0 = 0,1次 = 1,2次 = 2,3次及以上= 3;Once = 1,Two times = 2,Three times and more = 3

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参考文献 17

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医疗费用/万元 Medical cost/ Ten thousand yuan	频数 Frequency	百分比/% Percent/%	累积百分比/% Cumulative percent/%
< 1.0	5	12.5	12.5
1~	11	27.5	40.0
5~	15	37.5	77.5
10~	5	12.5	90.0
15~	4	10.0	100

特征 Features	因素 Factors	例数/例 Cases	构成比/% Constituent ratio/%	诊疗疗费用中位数/万元 Median of medical cost/Ten thousand yuan
性别Sex	男Male	25	62.5	12.0
	女Female	15	37.5	4.0
年龄Age	0~	5	12.5	6.0
	20~	7	17.5	9.0
	40~	23	57.5	4.0
	60~	5	12.5	5.0
职业Occupation	农民Farmer	25	62.5	4.0
	儿童及学生Children and Student	5	12.5	6.0
	其他Others	10	25.0	5.5
现居住地 Current living place	城市Urban	8	20.0	5.0
现居住地 Current living place	乡村Village	32	80.0	6.0
流行病学史 History of epidemiology	无No	6	15.0	5.5
流行病学史 History of epidemiology	有Yes	34	85.0	6.0
疾病类型 Species for echinococcosis	细粒棘球蚴病Cystic echinococcosis	37	92.5	5.0
疾病类型 Species for echinococcosis	多房棘球蚴病Alveloar echinococcosis	3	7.5	14.0
病灶数量Lesion number	1	23	57.5	5.0
	2	5	12.5	6.0
	≥ 3	12	30.0	10.5
复发Relapse	否No	35	87.5	5.0
复发Relapse	是Yes	5	12.5	15.0
发病-确诊时间/天 Time from onset to confirmed diagnosis	≤ 30	19	47.5	4.0
	31~90	8	20.0	8.5
	91~365	8	20.0	5.0
	> 365	5	12.5	8.0
初诊医院级别 Hospital level of the first visit	社区及以下医院 The community and lower level hospitals	10	25.0	4.5
	市/县级医院County-level hospital	22	55.0	6.0
	省级医院Provincial hospital	8	20.0	7.5
确诊医院级别 Hospital level of diagnosis	市/县级医院County-level hospital	15	37.5	3.2
确诊医院级别 Hospital level of diagnosis	省级医院Provincial hospital	25	62.5	8.0
转诊次数Visit number	0次None	11	27.5	4.0
	1~2次One to two times	13	32.5	3.0
	3次及以上Three times and more	16	40.0	8.0
手术次数 Operations number	0次None	5	12.5	0.3
	1次Once	28	70.0	6.0
	2次Two times	5	12.5	8.0
	3次及以上Three times and more	2	5.0	42.5

变量Variable	Z值Zvalue	卡方χ²	自由度df	P值Pvalue
性别Sex	-2.090			< 0.05
年龄Age		7.551	3	> 0.05
职业Occupation		3.756	3	> 0.05
现居住地Current living place	-0.306			> 0.05
流行病学史History of epidemiology	-0.114			> 0.05
疾病类型Species for echinococcosis	-2.449			< 0.05
病灶数量Lesion number		9.579	2	< 0.01
复发Relapse	-2.402			< 0.05
发病-确诊时间/天Time from onset to confirmed diagnosis/d		9.691	3	< 0.05
初诊医院级别Hospital level of the first visit		0.924	2	> 0.05
确诊医院级别Hospital level of diagnosis	-2.384			< 0.05
转诊次数Visit number		14.916	2	< 0.01
手术次数Operation number		17.253	3	< 0.01