2014—2018年青海省人民医院恶性肿瘤住院病例疾病构成及转归影响因素分析

Analysis of Disease Constitution and Influencing Factors of Malignant Tumor Outcomes Among Inpatients in Qinghai Provincial People’s Hospital from 2014 to 2018

[目的]分析2014—2018年青海省人民医院恶性肿瘤住院病例疾病构成及转归影响因素。[方法]整理该院2014年1月至2018年12月全部恶性肿瘤患者住院病例资料,根据国际疾病分类法(ICD-10)进行分类,采用帕累托图法分析疾病构成,采用非条件多项Logistic回归模型分析转归影响因素。[结果]2014—2018年共报告恶性肿瘤住院病例14416例(男9028例,女5388例),平均(59.22±14.01)岁,手术治疗率45.40%(6545/14416),病死率3.41%(491/14416);5年间手术治疗率逐渐上升(χ趋势2=15.29,P<0.001),病死率逐渐下降(χ趋势2=30.87,P<0.001)。疾病构成前10位病种为胃癌(20.48%,2953/14416)、肝癌(14.75%,2126/11416)、肺癌(9.30%,1341/11416)、髓样白血病(5.19%,748/11416)、食管癌(4.40%,635/11416)、直肠癌(3.91%,563/11416)、胰腺癌(3.66%,528/11416)、结肠癌(3.57%,515/11416)、浆细胞骨髓瘤(2.99%,431/11416)和宫颈癌(2.69%,388/11416),共占70.95%;前3位死因病种为肺癌(20.98%,103/491)、肝癌(15.89%,78/491)和胃癌(14.05%,69/491),共占50.92%;前3位致死性病种为非霍奇金淋巴瘤(8.22%,12/146)、肺癌(7.68%,103/1341)和胰腺癌(5.11%,27/528)。不同年龄、性别、民族之间主要病种排序存在差异。老年人群病例数占比最高,达52.09%(7510/14416),中年女性人群妇科恶性肿瘤高发,少数民族女性宫颈癌高发。不同性别、年龄、婚姻、职业、民族、入院病情、住院科室、诊断编码、抢救与否、手术与否、医疗费用支付方式,恶性肿瘤转归结果不同(P<0.05)。[结论]青海地区恶性肿瘤疾病构成和国内其他省市存在较大差异,多种因素影响该地区恶性肿瘤患者病情转归。应结合重要因素采取有针对性的防控策略,同时着重加强主要病种和高致死性病种的筛查与健康教育工作。

[Purpose]To analyze the disease constitution and prognostic factors of malignant tumors among patients hospitalized in Qinghai Provincial People’s Hospital from 2014 to 2018.[Methods]According to the International Classification of Diseases(ICD-10),the data of all malignant tumor inpatients in Qinghai Provincial People’s Hospital from Jan.2014 to Dec.2018 were collected.The disease constitution was analyzed by Pareto diagram method,and the prognostic factors were analyzed by unconditional multinomial Logistic regression model.[Results]A total of 14416 hospitalized malignant tumor cases(9028 males and 5388 females)were admitted in Qinghai Provincial People’s Hospital from 2014 to 2018 with an average age of(59.22±14.01)years.The surgical treatment rate was 45.40%(6545/14416),and the case fatality rate was 3.41%(491/14416).During the study period the surgical treatment rate increased gradually(χtrend2=15.29,P<0.001),and the case fatality rate decreased gradually(χtrend2=30.87,P<0.001).The top 10 diseases were gastric cancer(20.48%,2953/14416),liver cancer(14.75%,2126/14416),lung cancer(9.30%,1341/14416),myeloid leukemia(5.19%,748/14416),esophageal cancer(4.40%,635/14416),rectal cancer(3.91%,563/14416),pancreas cancer(3.66%,528/14416),colon cancer(3.57%,515/14416),plasma cell myeloma(2.99%,431/14416)and cervical cancer(2.69%,388/14416),accounted for70.95%of all cancer cases.The top 3 causes of death were lung cancer(20.98%,103/491),liver cancer(15.89%,78/491)and stomach cancer(14.05%,69/491),accounting for 50.92%of all cancer deaths;while non-Hodgkin lymphoma(8.22%,12/146),lung cancer(7.68%,103/1341)and pancreatic cancer(5.11%,27/528)had the highest fatality rates.The elderly group accounted for the highest proportion of patients(52.09%,7510/14416);the proportion of gynecologic malignant tumors was the highest among middle-aged group,while ethnic minorities had higher proportion of cervical cancer.The outcomes of malignant tumors are related to gender,age,occupation,ethnicity,condition at admission,departments,ICD code,emergency management,surgical treatment,insurance status(P<0.05).[Conclusion]The constitution of malignant diseases in Qinghai region may have some differences from other regions in China.There were multiple influencing factors of the outcomes of malignant tumors.