云南省农村高血压患者疾病经济负担及影响因素分析

Analysis of the disease economic burden and its influencing factors of rural hypertensive patients in Yunnan Province

目的 了解云南省农村高血压患者的疾病经济负担及影响因素,为相关部门合理调整当地高血压防控策略,减轻高血压患者的疾病经济负担提供参考依据。方法 于2020年11月—2021年11月采用多阶段分层随机抽样的方法,在云南省农村地区抽取7 572名≥35岁常住居民为研究对象,进行问卷调查(包括一般人口学特征,高血压患病情况、诊疗情况以及因患高血压产生的费用支出)和体格检查。采用SPSS 24.0软件进行统计学分析,采用二步模型法测算高血压患者的直接疾病经济负担,采用人力资本法测算间接疾病经济负担,并用Amos 24.0构建结构方程模型分析其影响因素。结果 调查人群高血压患病率为41.57%,其中男性44.48%,女性38.74%。高血压患者的人均疾病经济负担为14 479.67元,其中人均直接经济负担为14 164.85元,人均间接经济负担为314.82元。在直接疾病经济负担中,人均住院费、门诊费、药费和交通及住宿费分别为10 736.36、1 473.53、1 606.53和348.43元,以住院费为主(占75.8%)。结构方程模型分析结果显示,高血压患者的人口学特征、住院情况、误工情况、1年内门诊次数对疾病经济负担均有影响,其标准化路径系数分别为0.10、0.69、0.69和0.10。其中,以住院情况和误工情况对高血压疾病经济负担直接影响最大。结论 云南省农村高血压患者患病率较高,疾病经济负担较重,降低患者住院机构的级别和减少患者的住院天数有助于减轻其疾病经济负担。

Objective To understand the disease economic burden and its influencing factors of rural hypertensive patients inYunnan Province,and provide the reference for reasonably adjusting local hypertension prevention and control strategies andreducing the economic burden of hypertension patients in relevant departments. Methods Multi-stage stratified random samplingmethod was used to select 7 572 residents(≥35 years old) in rural areas of Yunnan Province from November 2020 to November2021 as the subjects. The investigation was performed with questionnaire ( including general demographic characteristics ,prevalence of hypertension,medical treatment,and expenses due to hypertension) and physical examination. SPSS 24.0 was usedfor statistical analysis. The two-step model method was used to estimate the direct economic burden of hypertension. The humancapital method was used to calculate the indirect economic burden. The structural equation model was constructed by Amos 24.0 toanalyze its influencing factors. Results The morbidity of hypertension in subjects was 41.57%(males:44.48%;females:38.74%).The hypertension disease economic burden per capita,direct disease economic burden per capita and indirect disease economicburden per capita were 14 479.67 Yuan,14 164.85 Yuan and 314.82 Yuan,respectively.In the direct disease economic burden,the hospitalization fee,outpatient fee,medication fee,transportation and accommodation fee per capita were 10 736.36 Yuan ,1 473.53 Yuan,1 606.53 Yuan,and 348.43 Yuan,respectively;the main proportion of direct disease burden was hospitalizationfee(75.8%). The results of structural equation model analysis showed that the demographic characteristics of hypertensivepatients,conditions of hospitalization,loss of working time,and the number of outpatient visits within one year had the impact onthe disease economic burden,and the standardized path coefficients were 0.10,0.69,0.69 and 0.10,respectively. Hospitalizationand loss of working time had the greatest direct impact on the economic burden of hypertensive diseases. Conclusion Themorbidity of hypertension and the disease economic burden of hypertension patients in rural areas of Yunnan Province are high.Reducing the level of inpatient institutions and duration of hospital stay is helpful to reduce the disease economic burden ofhypertension.