2007至2012年北京市居民冠心病住院天数及住院费用变化趋势

Trends in length of hospital stay and in-hospital cost for coronary heart disease from 2007 to 2012 in Beijing

目的:分析2007至2012年,北京市居民冠心病住院天数及住院费用在不同人群中的分布特征和变化趋势。方法:从"北京市心血管病监测系统"获取2007年1月1日至2012年12月31日,主要出院诊断为冠心病的病例,经过户籍地址整理、重报病例排查和数据完整性与准确性的审核,分析不同年龄、性别人群冠心病住院天数和住院费用的分布特征,并采用线性回归模型验证冠心病住院天数、住院费用的变化趋势。结果:2007至2012年间,北京市25岁及以上户籍居民中主要出院诊断为冠心病的病例共421 929例,冠心病住院天数几何均数为9.2d。调整年龄、性别后冠心病住院天数随时间呈下降趋势(P<0.001),从2007年的10.5d下降到2012年的8.4d。不同伴随疾病中,伴随心力衰竭者住院天数明显长于未伴随心力衰竭者。6年中冠心病次均住院费用几何均数为1.56万元,调整通货膨胀因素后随时间呈上升趋势(P<0.001)。结论:北京市冠心病住院天数呈下降趋势,但患有心力衰竭等伴随疾病患者住院天数仍较高,研究期间冠心病住院费用随时间呈上升趋势。结果提示政府和医疗机构应加强对冠心病及伴随疾病的控制,以进一步降低冠心病对医疗资源的占用。

Objective： To examine the distribution and trends of length of stay（ LOS） and in-hospital cost per hospitalization for coronary heart disease（ CHD） in Beijing during 2007-2012. Methods： Patients hospitalized for CHD in Beijing from 1 January 2007 to 31 December 2012 were identified from＂The Cardiovascular Disease Surveillance System in Beijing＂,after excluding non-permanent Beijing residents and duplicate records. The completeness and accuracy of the records were validated. LOS and in-hospital cost were analyzed by age and gender and the trends were analyzed with linear regression models. Results： In total,421 929 patients were admitted for CHD in Beijing during the 6 years. The geometric mean of LOS was 9. 2 days. A decreasing trend was observed in LOS after adjusting age and sex over the past 6 years（ P〈0. 001）,from 10. 5 days in2007 to 8. 4 days in 2012. LOS in patients with heart failure was longer than those without this comorbidity.The geometric mean of in-hospital cost per hospitalization was 15. 6 thousand yuan and it increased over the past6 years（ P〈0. 001）. Conclusion： A decreasing trend in LOS and an increasing trend in in-hospital cost per hospitalization were observed during 2007 to 2012 in Beijing. Besides,LOS in patients with heart failure was much longer than those without this comorbidity,indicating the urgent need in the prevention of CHD and its comorbidities in Beijing.