云南省白族居民脑卒中患病对家庭经济影响

Stroke prevalence and its impact on household economic condition among rural Bai ethnic minority in Yunnan province

目的了解云南省白族居民脑卒中患病对家庭经济的影响,为减轻脑卒中患病家庭的经济负担提供科学依据。方法于2018年4—5月采用多阶段分层随机抽样方法在云南省大理州剑川县抽取2501名≥35岁白族居民进行面访调查,并采用灾难性卫生支出和因病致贫的发生率评价脑卒中患病对家庭经济的影响。结果云南省2501名≥35岁白族居民中,患脑卒中者155例,脑卒中患病率为6.2%;其中,男性居民脑卒中患病率(7.8%)高于女性居民(4.9%),贫困户居民脑卒中患病率(10.2%)高于非贫困户居民(5.9%),差异均有统计学意义(均P<0.05)。新型农村合作医疗补偿前,云南省155户白族居民脑卒中患者家庭灾难性卫生支出和因病致贫的发生率分别为25.16%和18.71%,补偿后分别为21.94%和9.67%,分别下降了12.80%和48.32%。多因素非条件logistic回归分析结果显示,贫困户白族居民发生家庭灾难性卫生支出和因病致贫的风险分别为非贫困白族居民的1.676倍(OR=1.676,95%CI=1.079~2.602)和3.278倍(OR=3.278,95%CI=2.311~4.648),患脑卒中白族居民发生家庭灾难性卫生支出和因病致贫的风险分别为未患脑卒中白族居民的4.511倍(OR=4.511,95%CI=3.005~6.770)和1.851倍(OR=1.851,95%CI=1.131~3.029);年人均收入>5700元白族居民发生家庭灾难性卫生支出和因病致贫的风险分别为年人均收入≤5700元白族居民的0.430倍(OR=0.430,95%CI=0.314~0.588)和0.035倍(OR=0.035,95%CI=0.020~0.062)。结论云南省白族居民脑卒中患病对家庭经济的影响较大,应加强对贫困户和低收入家庭的医疗与经济支持。

Objective To examine the impact of stroke on household economic condition among Bai ethnic minority in Yunnan province and to provide evidences for reducing stroke-related family economic burden in the population.Methods Totally 2 700 rural Bai ethnic residents aged 35 years and over were recruited using stratified multistage random sampling in 9 villages of a county in Yunnan province and interviewed face-to-face with a self-designed questionnaire during April–May 2 018. The participants′ information on catastrophic health expenditure(CHE) and disease-induced poverty(DIP) were collected to evaluated the impact of stroke on family economic condition. Results Among 2 501 residents with valid response, 155 stroke patients were identified and the stroke prevalence rate was 6.2%. The stroke prevalence rate was significantly higher among the male than among the female residents(7.8% vs. 4.9%) and higher among the residents with poor familial economic status than among those without familial economic difficulty(10.2% vs. 5.9%)(both P < 0.05).Among the 155 stroke patients, 25.16% and 18.71% reported family CHE and DIP before the compensation of medical expenses from the New Rural Cooperative Medical Scheme(NRCMS);while, the two rates decreased to 21.94% and 9.67%,respectively, after the NRCMS′s compensation of the medical expenses. The results of unconditional multivariate logistic regression analysis demonstrated that compared to the residents without family economic difficulty, the residents with poor family economic condition were more likely to have CHE(odds ratio [OR] = 1.676, 95% confidence interval [95% CI]:1.079–2.602) and DIP(OR = 3.278, 95% CI: 2.311–4.648);the residents with stroke were at a significantly higher risk of CHE(OR = 4.511, 95% CI: 3.005–6.770) and DIP(OR = 1.851, 95% CI: 1.131–3.029) than the non-stroke residents;while, the residents with the average annual family income of > 5 700 Yuan(RMB) per capita were less likely to have CHE(OR = 0.430, 95% CI: 0.314–0.588) and DIP(OR = 0.035, 95% CI: 0.020–0.062) in comparison with those with the income of ≤ 5 700 Yuan. Conclusion Stroke is of significant impact on household economic condition among rural Bai ethnic minority in Yunnan province. The result suggests that medical and financial support should be promoted for stroke patients with low income or poor family economic condition in the population.