宁波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 the direct economic burden of chronic obstructive pulmonary disease patients and its influencing factors in the communities of Ningbo city

目的了解宁波市社区慢性阻塞性肺疾病患者的直接经济负担及影响因素,为卫生决策者制定相应的卫生策略和卫生服务计划提供依据。方法随机抽取宁波市1个城乡结合部（鄞州区）慢性病防控示范区,2个城市（海曙、江东区）慢性病防控示范区中的24个社区,在每个社区中随机抽取慢性阻塞性肺疾病患者,共803例慢性阻塞性肺疾病患者纳入调查。采用逐户走访填写问卷,结合查阅健康档案的方法对803例患者进行调查,调查内容涉及患者的一般社会人口学特征,疾病相关内容,直接经济负担相关费用和人均收入等。结果宁波市社区慢性阻塞性肺疾病患者年直接经济负担的中位数为3 600元,各年龄组、男女性别间差异均无统计学意义（P〉0.05）。社区慢性阻塞性肺疾病患者的全年直接经济负担中,住院医保费用占全年总费用的50.37%,住院及门诊费用及额外花费合计占90%以上。logistic回归分析结果表明,影响慢性阻塞性肺疾病患者直接经济负担的因素有与子女同住（OR=0.68,95%CI：0.105～0.855）,年消费水平在10万以下各段（OR值为1.62～2.75）及目前存在饮酒情况（OR=0.62,95%CI：0.092～0.895）。结论慢性阻塞性肺疾病给宁波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的政策医疗,并对患者医疗费用及其他疾病相关费用的影响因素进行干预与调节。

Objective To understand the direct economic burden of chronic obstructive pulmonary disease（COPD） patients and its influencing factors in the communities of Ningbo city. Methods The random clustering sampling method was used to select 803 COPD patients from 24 communities of Ningbo city as the subjects. The investigation was performed by a a self-designed questionnaire and health records. The collected data included the general social and demographic characteristics, contents related to COPD, direct economic burden and average income. Results The median of annual direct economic burden was 3 600 yuan for each COPD patient in communities of Ningbo city. There were no significant differences between males and females, and among various age groups. The proportion of annual medical cost of hospitalization was 50.37% of annual total medical cost. The proportion of extra cost for clinic and hospitalization was above 90%. Logistic regression analysis showed that the main influencing factors for the direct economic burden of COPD patients were living with sons or daughters（OR =0.68, 95% CI： 0.105-0.855）,annual consumption level〈100 000 yuan（ORs were 1.62-2.75）and drinking（OR=0.62, 95%CI：0.092-0.895）. Conclusion The direct economic burden of COPD patients is heavy for the communities of Ningbo. Therefore, the measures should be made by government, and the influencing factors should be intervened so that the direct economic burden of community COPD patients will be decreased in this city.