四省份HIV/AIDS患者因病所致的家庭经济负担及其影响因素研究

Household Economic Burden of HIV/AIDS and Associated Factors in Four Regions,China

背景随着抗反转录病毒治疗的推广,HIV/AIDS患者的期望寿命延长,与年龄相关的疾病愈发常见。且患者易发机会性感染、共感染等情况,健康状况不佳,医疗费用较高,经济负担较重。然而,目前有关HIV/AIDS患者家庭经济负担的研究较少。目的了解我国四省份(北京市、河南省、贵州省、安徽省)HIV/AIDS患者因病所致的家庭经济负担现状,并探究其影响因素。方法于2020年12月至2021年5月,采用典型抽样法在北京市、贵州省、安徽省各选择1家医疗机构、在河南省选择1家疾病预防与控制中心作为调查地点,采用方便抽样法在各调查地点选取2020年获取过医疗卫生服务的HIV/AIDS患者作为调查对象。采用课题组自行设计的问卷,收集患者的社会人口学及经济学特征、疾病状况及就医情况指标。根据患者2020年的自付医疗费用和家庭年收入计算费用收入比,以费用收入比>25%为出现了家庭经济负担,否则为未出现家庭经济负担。结果共纳入1446例患者,患者费用收入比以≤1%(400例,27.7%)和>1%~5%(418例,28.9%)为主,出现家庭经济负担的患者为237例(16.4%)。不同地区、性别、年龄、婚姻状况、文化水平、职业、户口性质、流动情况、医疗保险类型、家庭年收入水平、感染途径、CD_(4)^(+)T细胞计数、就医形式的患者出现因病所致家庭经济负担者占比比较,差异有统计学意义(P<0.001)。多因素Logistic逐步回归分析结果显示:女性出现家庭经济负担的风险高于男性〔OR(95%CI)=1.729(1.050,2.853)〕,≥65岁者出现家庭经济负担的风险高于18~24岁者〔OR(95%CI)=3.445(1.188,10.227)〕,离异者出现家庭经济负担的风险高于未婚者〔OR(95%CI)=2.241(1.073,4.678)〕,事业单位人员出现家庭经济负担的风险低于家务/待业/无业者〔OR(95%CI)=0.287(0.081,0.898)〕,家庭年收入水平为中低收入、低收入者出现家庭经济负担的风险高于高收入者〔OR(95%CI)分别为3.556(1.471,9.428)和29.614(12.348,79.211)〕,经异性性行为感染者出现家庭经济负担的风险较经同性性行为感染者低〔OR(95%CI)=0.356(0.186,0.670)〕,从未接受过抗艾滋病病毒治疗(ART)患者出现家庭经济负担的风险低于接受过ART者〔OR(95%CI)=0.241(0.055,0.835)〕,CD_(4)^(+)T细胞计数为201~350、≤200个/μl者出现家庭经济负担的风险高于>500个/μl者〔OR(95%CI)分别为2.347(1.237,4.515)和2.365(1.200,4.702)〕,仅住院者、门诊+住院者出现家庭经济负担的风险高于仅门诊者〔OR(95%CI)分别为12.492(5.592,27.818)和23.690(14.519,39.933)〕。结论HIV/AIDS患者费用收入比较低,部分患者出现了家庭经济负担。性别、年龄、婚姻状况、职业、家庭年收入水平等社会人口学和经济相关特征,感染途径、ART、CD_(4)^(+)T细胞计数水平、就医形式等疾病和就医相关特征是影响HIV/AIDS患者家庭经济负担的因素。未来应重点关注女性、老年、重症及家庭年收入较低的HIV/AIDS患者,继续完善和落实相关医疗保障政策,切实、有效地降低HIV/AIDS患者的家庭经济负担。

Background The promotion of use of antiretroviral therapy(ART)prolongs the life expectancy of people living with HIV.But age-related diseases are increasingly common,and the risks of opportunistic infections,coinfections and poor health condition are also increased significantly in this group,resulting in high medical costs and heavy economic burden.However,there are few studies on the household economic burden of HIV/AIDS patients.Objective To investigate the household economic burden in HIV/AIDS patients and associated factors in four regions(Beijing,Henan,Guizhou and Anhui)of China.Methods From December 2020 to May 2021,by use of typical sampling,three medical institutions(one in Beijing,another in Guizhou and another in Anhui),and a center for disease control and prevention(located in Henan)were selected,where HIV/AIDS patients who received health services in 2020 were chosen by convenient sampling.A questionnaire developed by our research team was used to collect information on the patients'sociodemographic and economic features,disease-related conditions,and treatment.Household economic burden was defined as ratio of out-of-pocket medical expenses to annual household income(OME/AHI)in 2020 exceeded 25%.Results A total of 1446 patients were included.The patients were classified into two major groups by the OME/AHI ratio:≤1%group(n=400,27.7%),and>1%-5%group(n=418,28.9%).Two hundred and thirty-seven cases(16.4%)had household economic burden.The prevalence of household economic burden differed significantly by region,sex,age,marital status,education level,occupation,urban or rural hukou,floating or permanent population,type of medical insurance,annual household income level,route of infection,CD_(4)^(+)T cell count level,and type of medical treatment(P<0.001).Stepwise multinomial Logistic regression analysis revealed the following:women had higher risk of household economic burden than men〔OR(95%CI)=1.729(1.050,2.853)〕;Sixty-five-year-olds and above had higher risk of household economic burden than 18-24-year-olds〔OR(95%CI)=3.445(1.188,10.227)〕;The divorced had higher risk of household economic burden than those unmarried〔OR(95%CI)=2.241(1.073,4.678)〕;Public institution employees had lower risk of household economic burden than housekeepers,jobseekers,or those unemployed〔OR(95%CI)=0.287(0.081,0.898)〕;Individuals with low〔OR(95%CI)=29.614(12.348,79.211)〕or low-to-middle annual household income〔OR(95%CI)=3.556(1.471,9.428)〕had higher risk of household economic burden compared with those with high annual household income;Heterosexual individuals had lower risk of household economic burden than homosexual individuals〔OR(95%CI)=0.356(0.186,0.670)〕;ART non-recipients had lower risk of household economic burden than ART recipients〔OR(95%CI)=0.241(0.055,0.835)〕;Individuals with CD_(4)^(+)T cell count 201-350 cells/μl〔OR(95%CI)=2.347(1.237,4.515)〕or≤200 cells/μl〔OR(95%CI)=2.365(1.200,4.702)〕had higher risk of household economic burden compared with those with CD_(4)^(+)T cell count>500 cells/μl;Inpatient service recipients〔OR(95%CI)=12.492(5.592,27.818)〕,and both outpatient and inpatient services recipients〔OR(95%CI)=23.69(14.519,39.933)〕had higher risk of household economic burden compared with outpatient service recipients.Conclusion HIV/AIDS patients had relatively low OME/AHI ratio generally,but some of them had household economic burden.Factors associated with household economic burden may include sociodemographic and economic factors such as sex,age,marital status,occupation,annual household income,and features related to HIV/AIDS and treatment such as route of infection,use of ART treatment,CD_(4)^(+)T cell count level,and type of medical treatment.To tangibly reduce the household economic burden of in this group,more attention should be paid to women,the elderly,those with very poor condition or low annual household income.Besides,it is essential to continue to implement and improve relevant medical insurance policies.