天津市不同监测模式下百日咳经济负担的调查研究

Investigation of disease burden caused by pertussis threough different surveillance systems in Tianjin

目的对天津市不同监测模式下确诊的百日咳病例开展经济负担调查,评价免疫规划时期百日咳疾病的危害程度。方法连续3年在所选3家社区医院开展全人群百日咳症状监测,在2家三级医院开展百日咳被动监测,对确诊病例于21天开展入户调查,调查内容包括病例基本信息、就诊信息、因病支出的直接经济负担和间接经济损失。结果 233例百日咳病例的直接经济负担中位数为3364元,其中门诊病例850元,住院病例7282元。间接经济损失中位数为641.29元,误工天数的中位数为12 d。社区症状监测直接经济负担中位数为2800元,显著低于医院被动监测的4200元(P=0.035)。119例门诊病例平均治疗费用1450元;114例住院病例人均费用7105元,平均住院天数10.5 d,日均住院费用为676.67元。<1岁组病例平均费用为7250元,显著高于其他年龄组(P<0.001)。结论在免疫规划时期百日咳疾病负担依旧严重,<1岁患儿疾病负担最重,青少年及成年人病例增加的趋势不容忽视。社区医院百日咳症状主动监测将有效降低患者的直接经济负担。

Objective To investigate the disease burden caused by pertussis through different surveillance system in Tianjin and evaluate the harm of pertussis in immunization era. Methods There were two pertussis surveillance systems in Tianjin,one is based on the community and another one is based on sentinel hospital. The investigation was carried out on 21 st day after onset pf pertussis. The questionnaire included the basic information,medical information,the direct economic burden and indirect economic loss. Results The median of the direct economic burden caused by pertussis was 3364 yuan RMB. The outpatient cost was 850 yuan RMB,and hospitalization cost was 7282 yuan RMB. Indirect economic loss was 641. 29 yuan RMB. Missed work time was 12 days. The median of the direct economic burden was2800 yuan RMB indicated by community surveillance system,which was significantly lower than that indicated by sentinel hospital surveillance（P = 0. 035）. The average outpatient treatment cost was 1450 yuan RMB,and the average inpatient treatment cost was 7105 yuan RMB. The average hospitalization time was 10. 5 days,and average cost was676. 67 yuan RMB. The average costs for infants aged 〈1 year was 7250 yuan RMB,which was significantly higher than other age groups（Z = 69. 48,P 〈0. 001）. Conclusion The harm of pertussis has been greatly underestimated in immunization era.. The overall disease burden was heaviest in infants aged 〈1 year,but attention should be paid to the increase of incidence of pertussis in adolescents and adults The community based surveillance would facilitate the reduction of the economic burden caused by pertussis