成都市社区慢性阻塞性肺疾病患者直接经济负担及其影响因素分析

Analysis on direct economic burden of community COPD patients and its influence factors in Chengdu

目的了解成都社区慢性阻塞性肺疾病(COPD)患者的直接经济负担及其影响因素。方法随机整群抽取成都市6个社区卫生服务试点社区的所有COPD患者作为调查对象,采用逐户走访填写问卷并结合查阅病案的方法对446名患者进行调查,调查内容涉及患者的一般社会人口学特征,疾病相关内容,对待疾病的态度,以及直接经济负担相关费用和人均收入等。结果(1)成都市社区COPD患者年直接经济负担的中位数为1280元,男女两性间以及各年龄组间差异无统计学意义(P>0.05)。首发患者的年直接经济负担中位数为1540元,既往患者的年直接经济负担中位数1090元,首发患者的年直接经济负担显著性高于既往患者(P<0.05)。中年组的门诊费、住院费、住院食宿费及上门诊治费显著性高于老年组(P<0.05),而长期自费用药费则显著性低于老年组(P<0.05)。(2)社区COPD患者全年的住院总费用、门诊总费用、长期自费用药总费用等3项费用为医疗总费用的91.77%;而患者在冬季的医疗总费用占全年医疗总费用的50.17%。(3)影响COPD患者直接经济负担的因素有住院次数、病情严重程度、对疾病的态度、职业和医疗费用负担形式。结论成都市社区COPD患者的直接经济负担是调查人群家庭平均年收入的近1/4,因此,COPD给该地区社区人口带来的直接经济负担是巨大的。国家应及时制定相应政策,并对患者医疗费用的影响因素进行干预和调节。

Objective To describe direct economic burden of chronic obstructive pulmonary disease （COPD） patients and its influence factors in the communities of Chengdu City. Methods 446 patients in 6 communities where community health service was trialed were selected by random clustering sampling as study object. Each patient was interviewed in their home by using a self-designed questionnaire, and medical records were abstracted as an assistant means. The main items involved in the questionnaire included general social and demographic characteristics, COPD related contents and attitude to COPD, as well as direct economic burden and average income in the past years. Results （1） The median of annum direct economic burden was 1280 Yuan for each community COPD patient. There were no significant differences between male and female patients, and among various age groups. The median of annual direct economic burden of first episode COPD was 1540 Yuan for each patient, and that of COPD was 1090 Yuan for each chronic patient. The annum direct economic burden of first episode was significantly higher than that of chronic patients （P 〈 0.05）. The costs of outpatient, hospitalization, accommodation of hospitalization and treatment at home of middle-aged patients were significant higher than that of old-aged patients （P 〈 0.05）, and that of long-term self-expended drugs were significant lower than that of old-aged patients （P 〈 0.05）. （2） The annual general medical cost of hospitalization, outpatient, and long-term self- expended drugs of community COPD patients were equal to 91.77% of annual general medical cost of all patients. The proportion of annum general medical cost of all patients in winter among the whole year was 50.17 %. （ 3 ） The main influence factors of medical cost for COPD patients were hospitalization visits, disease condition, attitude to COPD,occupation and the pattern of medical burden. Conclusion The direct economic burden of community COPD patients was heavy in Chengdu, which embodied in that the medical costs were close to 1/4 of average annual income of investigating population. Therefore, measures need to be made by our nation and the influence factors should be intervened so that the direct economic burden of community COPD patients will be decreased in this city.