西安地区脑卒中患者直接经济负担及影响因素分析

doi:10.12183/j.scjpm.2023.0315

摘要/Abstract

摘要： 目的分析西安地区脑卒中患者直接经济负担及其影响因素。方法脑卒中患者资料收集自2019年10月至2022年6月在西安市心脑血管疾病监测系统中监测的2家三级医院及2家二级医院病历管理信息系统及收费系统。采用描述性分析方法对脑卒中患者直接经济负担进行分析,并采用单、多因素分析方法对影响直接经济负担的相关因素进行分析。结果门诊脑卒中患者直接经济负担中位数为983.27元,其中以检查费（58.32%）和药物费（19.34%）占比最高;住院脑卒中患者直接经济负担中位数为14 660.71元,以住院药物费用（58.19%）和检查费（14.60%）占比最高。多重线性回归分析结果显示家庭人均月收入（β’=0.104）、是否初次就诊（β’=0.354）、患有糖尿病（β’=0.214）、患有高血压（β’=0.368）、医疗保险类型（β’=0.351）是门诊脑卒中患者直接经济负担的影响因素;年龄（β’=0.265）、家庭人均月收入（β’=0.125）、脑卒中类型（β’=0.369、0.214）、是否初次就诊（β’=0.547）、患有糖尿病（β’=0.621）、患有高血压（β’=0.425）、住院天数（β’=0.658）、出院情况（β’=0.687）、急诊入院（β’=0.854）、手术（β’=0.852）及医疗保险类型（β’=0.862、0.241）均为住院脑卒中患者直接经济负担的影响因素。结论脑卒中患者直接经济负担最大的支出项目为医疗费用支出,可通过早期预防疾病发生、早期干预、早期治疗降低入院率,或优化诊疗程序、提升诊疗水平缩短住院时间等降低门诊及住院脑卒中患者直接经济负担,进而使卫生资源得到有效利用。

关键词: 脑卒中, 直接经济负担, 医疗费用, 影响因素

Abstract: Objective To analyze the direct economic burden and influencing factors of stroke patients in Xi'an. Methods The data of stroke patients were collected from two tertiary hospitals and two secondary hospitals' medical record management information systems and fee collection systems monitored in the Xi'an Cardiovascular Disease Monitoring System from October 2019 to June 2022. Descriptive analysis method was used to analyze the direct economic burden of stroke patients, and univariate and multivariate analysis methods were used to analyze the relevant factors affecting direct economic burden. Results The median direct economic burden of stroke patients in outpatient clinics was 983.27 yuan, with the highest proportion being examination expenses （58.32%） and drug expenses （19.34%）. The median direct economic burden of hospitalized stroke patients was 14 660.71 yuan, with the highest proportion being hospitalization drug expenses （58.19%） and examination expenses （14.60%）. Multiple linear regression analysis showed that per capita monthly income of households （β'=0.104）,whether or not first visit （β'=0.354）, diabetes （β'=0.214）, hypertension （β'=0.368）, and type of medical insurance （β'=0.351） were factors influencing the direct economic burden of outpatients with stroke. Age （β'=0.265）, per capita monthly income of households （β'=0.125）,stroke type （β'=0.369,0.214）, whether or not first visit （β'=0.547）, diabetes （β'=0.621）, hypertension （β'=0.425）, length of hospital stays （β'=0.658）, discharge （β'=0.687）, emergency admission （β'=0.854）, surgery （β'=0.852）, and type of medical insurance （β'=0.862, 0.241） were factors influencing the direct economic burden of hospitalized stroke patients. Conclusions The largest direct economic burden of stroke patients is medical expense. The direct economic burden of outpatient and hospitalized stroke patients can be reduced by early prevention, intervention, and treatment to reduce the admission rate, or by optimizing the treatment procedures and improving the level of treatment to shorten the hospitalization time, thus enabling the effective use of health resources.

Key words: Stroke, Direct economic burden, Medical expense, Influencing factor

中图分类号:

R197.32

李艳妮, 朱晴, 孙欢, 张花, 施艳, 彭阿丽, 王素娜. 西安地区脑卒中患者直接经济负担及影响因素分析[J]. 华南预防医学, 2023, 49(3): 315-320.

LI Yanni, ZHU Qing, SUN Huan, ZHANG Hua, SHI Yan, PENG Ali, WANG Suna. Analysis of direct economic burden and influencing factors of stroke patients in Xi'an[J]. South China Journal of Preventive Medicine, 2023, 49(3): 315-320.

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