Analysis of medical cost of echinococcosis cases and influencing factors in Henan Province during 2017—2019

doi:10.12140/j.issn.1000-7423.2021.03.005

Abstract

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

CLC Number:

R532.32

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.

Figures/Tables 6

Table 1

The associated factors for medical expenses on echinococcosis in Henan Province from 2017 to 2019

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

Table 1

Table 2

Fig. 1

Table 3

Table 4

Table 5

References 17

[1]	Zhu XP, Su C. Human parasitology[M]. 8th ed. Beijing: People’s Medical Publishing House, 2013: 141-147. (in Chinese).
[1]	( 诸欣平, 苏川. 人体寄生虫学[M]. 8版. 北京: 人民卫生出版社, 2013: 141-147.)
[2]	Wu WT, Wu WP. Research on the prevalence of echinococcosis in humans and factors influencing that infection[J]. J Pathog Biol, 2018,13(4):440-442, 445. (in Chinese)
[2]	( 吴文婷, 伍卫平. 包虫病人群患病情况及影响因素研究[J]. 中国病原生物学杂志, 2018,13(4):440-442, 445.)
[3]	Cadavid Restrepo AM, Yang YR, McManus DP, et al. The landscape epidemiology of echinococcoses[J]. Infect Dis Poverty, 2016,5:1-13.
[4]	Zhang MY, Wu WP. Advances in study of the burden of echinococcosis in China and elsewhere around the world[J]. J Pathog Biol, 2017,12(5):473-475. (in Chinese)
[4]	( 张梦媛, 伍卫平. 国内外包虫病疾病负担研究进展[J]. 中国病原生物学杂志, 2017,12(5):473-475.)
[5]	Wang TP, Cao ZG. Current status of echinococcosis control in China and the existing challenges[J]. Chin J Parasitol Parasit Dis, 2018,36(3):291-296. (in Chinese)
[5]	( 汪天平, 操治国. 中国棘球蚴病防控进展及其存在的问题[J]. 中国寄生虫学与寄生虫病杂志, 2018,36(3):291-296.)
[6]	Ma YX, Xue XL, Lu JZ, et al. The investigation report of hydatidiosis epidemic in Henan Province for the first time[J]. Henan J Prev Med, 1993,4(5):269-270, 312. (in Chinese)
[6]	( 马云祥, 薛晓玲, 陆金钟, 等. 首次证实包虫病在河南局部地区流行的调查报告[J]. 河南预防医学杂志, 1993,4(5):269-270, 312.)
[7]	He W, Wang Q, Huang Y, et al. Analysis of the incidence of echinococcosis(hydatidosis) in areas of Sichuan Province from 2007 to 2012[J]. J Pathog Biol, 2014,9(1):68-70, 91. (in Chinese)
[7]	( 何伟, 王谦, 黄燕, 等. 2007—2012年四川省包虫病流行区网络直报疫情分析[J]. 中国病原生物学杂志, 2014,9(1):68-70, 91.)
[8]	Wang LY, Wu WP, Zhu XH. The endemic status of hydatidosis in China from 2004 to 2008[J]. Chin J Zoonoses, 2010,26(7):699-702. (in Chinese)
[8]	( 王立英, 伍卫平, 朱雪花. 2004—2008年全国包虫病疫情分析[J]. 中国人兽共患病学报, 2010,26(7):699-702.)
[9]	Qi XH, Li BL, Yin XF, et al. Analysis of influencing factors for hospitalization and related expenses for hydatid patients receiving surgical treatment in Xinjiang[J]. Chin J Parasitol Parasit Dis, 2018,36(2):196-198. (in Chinese)
[9]	( 齐新红, 李波霖, 殷雪峰, 等. 新疆棘球蚴病外科救助患者住院及相关费用影响因素分析[J]. 中国寄生虫学与寄生虫病杂志, 2018,36(2):196-198.)
[10]	Gao C. Influencing factors of hospital expenses in 952 echinococcosis patients from 2012 to 2016[D]. Xining: Qinghai University, 2017. (in Chinese)
[10]	( 高超. 2012—2016年952例包虫病患者住院费用及影响因素分析[D]. 西宁: 青海大学, 2017.)
[11]	Zhang MY, Wu WP, Guan YY, et al. A survey on medical expenditure of hepatic echinococcosis surgery in a Tibetan Region and the related influencing factors[J]. Chin J Parasitol Parasit Dis, 2017,35(3):250-253. (in Chinese)
[11]	( 张梦媛, 伍卫平, 官亚宜, 等. 藏区肝棘球蚴病患者手术医疗费用及其相关影响因素分析[J]. 中国寄生虫学与寄生虫病杂志, 2017,35(3):250-253.)
[12]	Adalaiti·Tuoliuhan, Mangeguli·Hatimulati, Ahelijiang·Kayiduola, et al. Prevalence of echinococcosis in Tacheng Prefecture, Xinjiang Uygur Autonomous Region, China[J]. Chin J Parasitol Parasit Dis, 2018,36(6):565-570. (in Chinese)
[12]	( 阿达来提·托留汉, 漫格库丽·哈提木拉提, 阿合里江·卡依多拉, 等. 新疆塔城地区棘球蚴病流行现状调查[J]. 中国寄生虫学与寄生虫病杂志, 2018,36(6):565-570.)
[13]	An YD, Zhu WJ, Guo YM, et al. Advances in surgical operation treatment of hepatic echinococcosis[J]. Chin J Schisto Control, 2018,30(1):104-107. (in Chinese)
[13]	( 安永德, 朱文君, 郭亚民, 等. 肝包虫病外科手术治疗进展[J]. 中国血吸虫病防治杂志, 2018,30(1):104-107.)
[14]	Duan XY, Wei JJ, Wang L, et al. Direct economic burden of inpatients with echinococcosis in primary hospitals in Xinjiang[J]. Pract Prev Med, 2015,22(10):1164-1166. (in Chinese)
[14]	( 段新宇, 魏晶晶, 王乐, 等. 新疆基层医院包虫病住院患者直接经济负担分析[J]. 实用预防医学, 2015,22(10):1164-1166.)
[15]	Wang L, Feng XH, Duan XY, et al. Direct and indirect economic burden of 999 cystic echinococcosis patients in a tertiary hospital[J]. Chin J Epidemiol, 2010,31(7):835-836. (in Chinese)
[15]	( 王乐, 冯晓辉, 段新宇, 等. 999例包虫病住院患者经济负担分析[J]. 中华流行病学杂志, 2010,31(7):835-836.)
[16]	Liu Y, Zhang YL, Gao LJ, et al. Medical costs on malaria in Henan Province and analysis of the influential factors[J]. Chin J Parasitol Parasit Dis, 2016,34(1):11-15. (in Chinese)
[16]	( 刘颖, 张雅兰, 高丽君, 等. 河南省疟疾患者医疗费用及其相关影响因素分析[J]. 中国寄生虫学与寄生虫病杂志, 2016,34(1):11-15.)
[17]	Zhang F, Shen LJ, Liu Z, et al. Direct medical expenses and its influencing factors of patients with pulmonary tuberculosis in Wuhan[J]. Chin J Dis Control Prev, 2019,23(10):1279-1283, 1292. (in Chinese)
[17]	( 张帆, 申丽君, 刘昭, 等. 武汉市肺结核患者直接医疗费用及其影响因素[J]. 中华疾病控制杂志, 2019,23(10):1279-1283, 1292.)

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