疾病负担的失能权重研究：基于病伤费用比较的新方法

Research on Disability Weights of Disease Burden: A New Approach Based on Inpatient Expenditure Comparison

目的:提出疾病负担研究中失能权重的测算新思路和新方法,并基于北京市病例费用数据测算病伤之间的失能权重。方法:选取2015—2017年北京市三级医院的病案首页数据,依据疾病诊断和个体特征进行病伤分类,并对各病伤平均费用进行比较,以费用最高病伤组为标杆计算各病伤的相对权重,建立测算病伤负担相对权重的新方法。通过Pearson相关分析检验本方法的测算结果的稳定性。结果:通过近636万例病案纳入分析,得到385组病伤,依据其住院费用,计算得到失能权重表,值域为0.020~0.995。测算结果与2012—2014年北京市三级医院结果相关系数为0.90。本研究结果在总体与其他研究趋势一致,并使病伤分类进一步精细化,达到了国际同类研究中的最详细病伤分类水平。结论:本方法具有客观、简便、稳定、可重复、低成本的特点,为失能权重的测算提供了创新方法;首次得到了我国人群疾病谱的失能权重表,为中外疾病负担研究提供了关键参数;可供全球其他国家和地区开发本土化的失能权重表提供借鉴。

Objective： New approach and new methods on measuring disability weights of disease burden was developed and disability weights of diseases and injuries were calculated based on the sample of inpatient expenditure data in Beijing. Methods： Based on the inpatient medical records data of tertiary hospitals in Beijing from 2015-2017, diseases and injuries were classified according to the diagnosis and personal characteristics. Average expenditure of different diseases and injuries was calculated and relative disability weights were computed using the highest inpatient cost as the reference benchmark. The new methodology was developed for computing the relative weights of different diseases and injuries in burden of disease. Pearson correlation analysis was performed to test the consistency of the results. Results： The samples of 6.36 million inpatient medical records were analyzed and disability weights of 385 diseases and injuries were calculated with the results ranging from 0.020 to 0.995. The correlation coefficient between the results of 2012-2014 was 0.90. The results were consistent with the findings in other disability weights research, which made the classification of diseases and injuries more refined, reached to the most detailed classification level of diseases and injuries. Conclusions： The new apprnach was objective, simple, stable and repeatable with the low cost. It provided an innovative method for disability weights measurement. This was the first research to achieve the disability weights table of different diseases and injuries and it presented the key parameters for the research of burden of disease not only for China but also the other countries and regions. Furthermore, the new approach could be served as the significant reference for other countries and regions around the world to develop localized disability weights.