不同年龄、性别的冠心病患者住院费用分析

Effects of age and gender on hospitalization costs in patients with coronary artery disease

目的分析不同年龄、性别及其他临床情况对于冠状动脉造影患者住院费用的影响。方法研究对象为2001年1月1日至2006年12月3113北京协和医院心内科住院患者，年龄在40-79岁之间，有完整的各项住院费用记录。住院费用包括药费、检查费、治疗费、床位费、材料费、其他费用以及总费用。所有患者均进行了冠状动脉造影（CAG），部分患者进行了冠脉介入处理。结果40-59岁男性患者1130例，60－79岁男性患者1167例，40-59岁女性患者420例，60-79岁女性患者903例，各组患高血压病、心肌梗死、脑中风、糖尿病等疾病的比例差异有统计学意义（P〈0．01）。不同年龄性别组住院总费用在23237．11～47282．72元，从多到少排序分别为60－79岁男性患者、60～79岁女性患者、40～59岁男性患者和40～59岁女性患者。冠脉无明显狭窄患者以及CAG明显狭窄但未进行介入处理的患者，各组间总费用虽然有一定的差异，但无统计学意义。CAG明显狭窄并进行介入处理的患者，总费用在各组问差异有统计学意义，年龄大组的各项费用大于年轻组的费用。同一年龄性别组的不同冠脉处理情况的住院费用比较，有冠脉狭窄未介入处理亚组住院总费用为14771．99-21967．94元，冠状动脉无明显狭窄亚组住院总费用为8787．55—10757．86元，前者是后者的1．68－2．28倍，材料费是2．16-3．99倍，治疗费是1．12～2．51倍，检查费是1．31-1．56倍，药费是1．89~2．14倍，差异均有统计学意义（P〈0．01）；冠状动脉介入处理亚组住院总费用（57356．76-67420．77元）是冠状动脉无明显狭窄亚组的6．13-7．01倍，材料费是13．99-17．251倍，治疗费是3．53－4．50倍，检查费是1．40～1．87倍，药费是2．52～2．90倍，差异均有统计学意义（P〈0．01）。住院总费用与是否介入、性别、年龄、高血压、心肌梗死、中风病史、外周血管病史、糖尿病和肾功不全等均有一定相关性，住院总费用与以上各项参数进行多元逐步回归分析，住院费用与是否冠脉介入、心肌梗死史、年龄、高血压、糖尿病、是否有外周血管病和肾功能不全7项参数有独立相关性。结论年龄越大，住院费用越高，性别不是住院总费用的独立影响因素；影响住院总费用的其他独立因素包括是否进行冠脉介入，是否有心肌梗死史、高血压、糖尿病、外周血管病和肾功能不全。

Objective To investigate the effects of age, gender and other clinical situation on in-hospital medical expenses in patients who underwent coronary angiography and coronary artery intervention（PCI）. Methods Patients who were aged 40 to 79 years and admitted to the Cardiology ward of Peking Union Medical College Hospital during Jan 1,2001 to Dec 31, 2006 and had complete hospitalization cost records were studied. Hospitalization costs include medication, examination, treatment, bed, material and others. All patients had coronary angiography and some of them had coronary artery intervention. Results A total of 3620 patients were divided into four groups based on age and gender, （1）male and age 40-59（n=1130）, （2）male and age 60-79（n=1167）, （3）female and age 40-59（n=420）, （4）female and age 60-79（n=903 ）. There were differences in prevalence of hypertension, old myocardial infarction, stroke, diabetes （all P〈0.01 ）. The total hospitalization costs were higher in older patients in both sexes, with older male patient having highest costs and younger female patient lowest costs. In non- PCI patients, the cost differences were not statistical significant between normal and abnormal coronary artery groups. In PCI patients, the total costs were greater in the older group than that in the younger group. In the same age-sex group, the total cost was 1.68-2.28 times, material cost was 2.16-3.99 times, treatment cost was 1.12- 2.51 times, examination cost was 1.31-1.56 times, medication cost was 1.89-2.14 times in the patients with stenosis coronary artery compared to the no stenosis coronary artery, and the differences were significant（P〈0.01 ）. The total cost was 6.13-7.01 times, material cost was 13.99-17,25 times, treatment cost was 3.53-4.50 times, examination cost was 1.40-1.87 times, medication cost was 2.52-2.90 times in the PCI patients comparing to the non PC1 patients with stenosis coronary artery, and the differences were significant（P〈0.01 ）. PCI, older age, history of myocardial infarction, hypertension, diabetes, peripheral vascular disease and renal dysfunction were the independent predictors of hospitalization costs. Conclusion Hospitalization costs is higher in older patients. PCI, myocardial infarction, diabetes, hypertension, peripheral vascular disease and renal dysfunction further increase patients＇ economic burden.