武汉市两所医院颅脑外伤住院患者经济负担及寿命损失分析

Economic Burden and Years of Lost in Traumatic Brain Injury Inpatients

目的了解武汉市两所医院颅脑外伤住院患者的临床流行病学分布特征及其经济负担和寿命损失情况,初步评估颅脑外伤所致的疾病负担。方法对武汉市两所部属三甲医院近四年的颅脑外伤病例进行回顾性病案资料分析,分析脑外伤所致的卫生资源消耗,利用潜在寿命损失年、潜在工作损失年、潜在价值损失年等指标评价脑外伤所致的寿命损失。结果两所医院2000～2003年脑外伤住院患者数量呈逐年增加的趋势,年平均增长率为11.8%。脑外伤患者的人均住院费用和日均住院费用均呈上升趋势,年增长率分别为6.84%和5.12%。总医疗费用、人均住院费用、日均住院费用均以交通事故居首位,交通事故导致的医疗费用占总费用的52.81%。住院期间病死率为6.79%,平均死亡年龄40.5岁,平均每例死亡带来的潜在寿命损失年数、潜在工作损失年数、平均潜在价值损失年数分别为36年、29年、5年。交通事故的YPLL、WYPLL居首位,VYPLL以高处坠落伤居首位。结论脑外伤所致的人群寿命损失远远高于其他的伤害类型,所带来的医疗费用亦高于其他类型的伤害。必须重视对道路交通伤害和高处坠落伤害的预防和研究,以降低脑外伤的发生率,才能有效地减少脑外伤所致的各种损失和负担。

Objective To analyze the clinical epidemiological character of TBI inpatients and to evaluate their economic burden and years of life lost. Methods Medical records of TBI inpatients in two hospitals, Wuhan, from 2000 to 2003 were analyzed. Years of Potential Life Lost （YPLL）, Working Years of Potential Life Lost （WYPLL）, Valued Years of Potential Life Lost（VYPLL） was calculated. Results There were 3901 traumatic brain injury inpatients during 2000 to 2003 in two hospitals, an- nual increasing rate was 11.8 percent. Traffic accident caused the highest total hospitalization cost, the highest hospitalization cost per person and the highest hospitalization cost per day. Traffic accident contributed to 52.81% of total hospitalization cost. The mean hospitalization cost per person and per day during 2000 to 2003 was 6.84% and 5.12 respectively. There were 265 patients died in hospital. Case fatality was 6.79%. The mean age of death was 40.5 years old. YPLL per person, WYPLL per person and VYPLL per person was 36 years, 29 years and 5 years. Traffic accident caused the highest YPLL and WYPLL, while falling off caused the highest VYPLL. Conclusion TBI led more medical cost than other types of injury. Traffic accident and falling off was the main leading causes of TBI. It is essential to reinforce prevention and control of traffic accident and falling off.