南山区脑卒中患者住院费用的影响因素分析

Factors affecting hospitalization costs among stroke patients in Nanshan District

目的分析不同亚型脑卒中患者住院费用的影响因素,为减轻患者经济负担提供参考。方法通过深圳市南山区各区属医院医疗信息系统收集2016年1月1日—2021年12月31日出院、主要诊断为出血性脑卒中和缺血性脑卒中的患者资料,分析不同亚型脑卒中患者住院费用;采用结构方程模型分析不同亚型脑卒中患者住院费用的影响因素。结果收集10298例脑卒中患者资料,其中出血性脑卒中2820例,占27.38%,住院时间M(Q_(R))为19.00(18.00)d,住院费用M(Q_(R))为26759.48元(51000.87)元;缺血性脑卒中7478例,占72.62%,住院时间M(Q_(R))为12.00(10.00)d,住院费用M(Q_(R))为12199.87(13290.20)元。结构方程模型分析结果显示,住院科室、出院时情况、离院方式、手术治疗和高血压既可直接影响出血性脑卒中患者住院费用,又可通过住院时间产生间接影响;总效应最大为住院时间(0.684),其次为手术治疗(0.632)。就业情况、入院途径、住院科室、离院方式、付款方式、手术治疗和血脂异常既可直接影响缺血性脑卒中患者住院费用,又可通过住院时间产生间接影响;总效应前三位依次为住院时间(0.746)、手术治疗(0.424)和住院科室(0.151)。结论南山区脑卒中患者住院费用相对较高,住院时间和手术治疗对不同亚型脑卒中患者住院费用影响较大。

Objective To analyze the influencing factors for hospitalization costs among stroke patients with different subtypes,so as to provide the reference for reducing the economic burden of patients.Methods Data of patients with hemorrhagic or ischemic stroke who were discharged from hospitals in Nanshan District,Shenzhen City from January 1,2016 to December 31,2021 were collected through Hospital Information System.Hospitalization costs were analyzed be-tween hemorrhagic and ischemic stroke patients,and factors affecting hospitalization costs among stroke patients with dif-ferent subtypes were identified using a structural equation model.Results A total of 10298 patients with stroke were recruited,including 2820 patients with hemorrhagic stroke(27.38%)and 7478 patients with ischemic stroke(72.62%).The patients with hemorrhagic stroke had a median duration of hospital stay of 19.00(interquartile range,18.00)d,and a median hospitalization cost of 26759.48(interquartile range,51000.87)Yuan.The patients with ischemic stroke had a median duration of hospital stay of 12.00(interquartile range,10.00)d,and a median hospitalization cost of 12199.87(interquartile range,13290.20)Yuan.Structural equation model analysis showed that department of hospital-ization,discharge status,ways of leaving hospital,surgery and hypertension had direct effects on hospitalization costs and indirect effects on hospitalization costs through duration of hospital stay among hemorrhagic stroke patients,and du-ration of hospital stay had the highest total effect(0.684),followed by surgery(0.632).Employment status,admission route,department of hospitalization,ways of leaving hospital,payment mode,surgery and dyslipidemia had direct effects on hospitalization costs and indirect effects on hospitalization costs through duration of hospital stay among ischemic stroke patients,and duration of hospital stay(0.746),surgery(0.424)and department of hospitalization(0.151)ranked the top three in total effects.Conclusion The hospitalization cost is relatively high among stroke patients in Nanshan District,and duration of hospital stay and surgery have great influence on hospitalization costs among stroke patients with different subtypes.