尘肺病患者未就诊影响因素分析

Influencing factors of no seeking medical treatment among pneumoconiosis patients

目的研究尘肺病患者未就诊原因及其影响因素。方法于2017年3月至2018年1月,采用分层抽样调查和典型调查相结合的方法,在东部地区(浙江省、江苏省、山东省、河北省),中部地区(湖北省、湖南省、吉林省),西部地区(贵州省、云南省)以经过职业病诊断的尘肺病患者和仅临床诊断的尘肺病患者作为研究对象,以《尘肺病患者就医行为及其影响因素》问卷为调查工具,对其就医行为进行问卷调查,问卷回收率94.3%。用Epidate3.1进行数据录入,用SPSS 20.0进行统计分析。用χ2检验进行单因素分析,用二元logistic回归进行多因素分析。结果共调查1 037名尘肺病患者,以矽肺(70.0%,726/1 037)和煤工尘肺(21.9%,227/1 037)居多,年龄(55.9±11.2)岁,67.5%(700/1 037)的患者长期居住在农村,以小学(37.9%,393/1 037)和初中文化(33.1%,343/1 037)为主。32.6%(338/1 037)的调查对象没有个人收入,月收入中位数1 200元。434人(41.9%)的患者患尘肺病后未到医疗机构看过门诊,其中337人曾经直接住院治疗。患者患尘肺病后未就诊的原因主要包括:自感症状较轻(44.4%,233/525)、看病费用高且无法报销(24.6%,129/525)、药店买药(10.9%,57/525)等。患者户籍地区为西部地区(OR西部=2.18,95%CI:1.38~3.43)、75岁以上年龄(OR75岁以上=6.82,95%CI:2.04~22.9)、从业状态为待业或失业、打短工、长期工(OR待业或失业=1.90,95%CI:1.17~3.08;OR打短工=3.11,95%CI:1.57~6.14;OR长期工=2.10,95%CI:1.18~3.74)等人口社会学指标、健康状况自评分50分以上(OR自评分=70=2.04,95%CI:1.18~3.51;OR自评分=90=3.00,95%CI:1.97~5.37;OR自评分90以上=2.95,95%CI:1.74~8.07)等自我认知指标是尘肺病患者未就诊的主要影响因素;呼吸困难(OR=0.57,95%CI:0.41~0.78)、肺气肿(OR=0.48,95%CI:0.26~0.90)、因尘肺病住过院(OR=0.12,95%CI:0.07~0.20)是降低尘肺病患者未就诊的主要因素。结论应将未参加工伤保险的尘肺病患者有序纳入基本医疗保障体系,积极给予医疗救治;加强尘肺病患者健康管理,正确引导医疗服务利用。

Objective To study the causes and influencing factors of no seeking medical treatment among pneumoconiosis patients. Methods Using stratified sampling method and typical survey method, we carried out the questionnaire survey in nine provinces in China including the east, the medium and the western region using a questionnaire on the seeking medical behavior pf pneumoconiosis patients and the influencing factors. The subjects include occupational pneumoconiosis cases and clinically diagnosed cases and the response rate is 94.3 percent. The data was entered twice with epidate3.1 and error detection and statistical analysis was completed with SPSS 20.0. Chi-square test was used for univariate analysis, and multivariate logistic regression was used for multivariate analysis. Results One thousand and thirty-seven subjects were investigated with average age 55.9±11.2 years. Seventy percent of them were silicosis and 21.9 percent were coal worker’s pneumoconiosis with 67.5 percent of them residing permanently in the countryside, and 37.9 percent of their education background were primary school culture and 33.1 percent of them had junior high school culture. Thirty two point six percent of respondents had no personal income with a median monthly income of 1 200 yuan. Four hundred and thirty four of subjects hadn't seek medical treatment since they got the pneumoconiosis accounting for 41.9 percent with three hundred and thirty seven of them hospitalized directly. The reasons of no seeking medical treatment for the respondents mainly include the self-induction symptoms lighter, the high cost of treatment and cannot claiming the payment of the medical expenses, buying drugs in drugstore, thinking that no medicine can cure pneumoconiosis or no effect, complex procedures, too far away from medical institutions, no unaccompanied, needing a long time or no time, communication disorders, etc. accounting for 44.4 percent, 24.6 percent, 10.9 percent, 9.1 percent, 6.9 percent, 4.4percent, 3.2 percent, 2.9 percent, 1.9 percent, 1.5 percent, respectively. The results of multivariate analysis showed the main characteristics of subjects with restrictions to the outpatient health service utilization are as follows: demographic sociological indicators such as registered permanent residence area is western (ORwestern=2.18, 95%CI:1.38-3.43), more than seventy five years old (ORover 75=6.82, 95%CI:2.04-22.9), unemployment, temporary or permanent employment (ORunemployment=1.90, 95%CI:1.17-3.08;ORtemporary employment=3.11, 95%CI:1.57-6.14;ORpermanent employment=2.10, 95%CI:1.18-3.74), self-rated health score of 50 or above (ORself-rated-70=2.04, 95%CI:1.18-3.51;ORself-rated-90=3.00, 95%CI:1.97-5.37;ORself-rated 90=2.95, 95%CI:1.74-8.07);with increase to the outpatient health service utilization are breath with difficulty (OR=0.57, 95%CI:0.41-0.78), emphysema (OR=0.48, 95%CI:0.26-0.90), hospitalized with pneumo-coniosis (OR=0.12, 95%CI:0.07-0.20). Conclusion Pneumoconiosis patients no covered by injury insurance should be orderly included in the basic medical security system, and be given the medical treatment actively;It should be strengthened the health management for the pneumoconiosis patients and correctly guided the utilization of medical services.