Analysis on disease economic risk and influencing factors of chronic obstructive pulmonary disease among Na Xi ethnic minority in Yunnan Province
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摘要:
目的 分析云南省纳西族居民慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的疾病经济风险及影响因素。 方法 采用多阶段分层随机抽样的方法,对云南省玉龙县≥35岁的纳西族居民进行现场问卷调查及肺功能检查。 结果 云南省纳西族COPD的患病率为17.66%,COPD患者的疾病经济风险是观察人群的1.53倍(RR=1.53);COPD患者家庭的灾难性卫生支出和因病致贫发生率分别为13.49%和18.58%。多因素Logistic回归分析模型分析结果显示,COPD患者家庭(OR=2.378,95% CI:1.681~3.363,P<0.001)和人均年收入越低的家庭(OR=0.467,95% CI:0.332~0.656,P<0.001)发生灾难性卫生支出的可能性越高。人均年收入越低(OR=0.028,95% CI:0.016~0.047,P<0.001)和家里无厕所的家庭(OR=0.561,95% CI:0.402~0.784,P<0.001),其因病致贫发生的可能性越高。 结论 云南省纳西族居民COPD患者的疾病经济风险较高,应加强对COPD患者和低收入家庭的经济与医疗支持。 Abstract:Objective The aim of this study was to analyze the disease economic risk and influencing factors of chronic obstructive pulmonary disease (COPD) among Na Xi ethnic minority in Yunnan Province. Methods A multi-stage stratified random sampling method was used to conduct on-site questionnaire survey and lung function tests among Na Xi ethnic minority residence aged ≥ 35 years in Yulong County, Yunnan Province. Results The prevalence of COPD among Na Xi ethnic minority in Yunnan Province was 17.66%. The economic risk of COPD patients was 1.53 times higher than that of the observed population (RR=1.53), and the incidence of catastrophic health care expenditures and poverty due to illness among households with COPD patients was 13.49% and 18.58%, respectively. The results of multivariate logistic regression analysis showed that households with COPD patients (OR=2.378, 95% CI:1.681-3.363, P < 0.001) and households with lower per capita annual income (OR=0.467, 95% CI:0.332-0.656, P < 0.001) were more likely to experience catastrophic health care expenditure. Households with lower per capita annual income (OR=0.028, 95% CI:0.016-0.047, P < 0.001) and households without toilets (OR=0.561, 95% CI:0.402-0.784, P < 0.001) were more likely to experience poverty due to illness. Conclusions The economic risk of COPD is relatively high among Na Xi ethnic minority in Yunnan Province. We should enhance economic and medical support for households with COPD patients and households with low income. -
表 1 云南省纳西族COPD患者人均直接疾病经济负担(元)
Table 1. Mean unit direct economic burden of COPD among Na Xi ethnic minority in Yunnan Province (Yuan)
特征 住院费 交通及住宿费 营养费 门诊费 药费 合计 男性 1 453.85 31.77 73.08 123.85 1 023.08 2 705.63 女性 1 583.33 22.91 145.83 237.29 970.83 2 960.19 合计 1 516.00 27.52 108.00 178.30 998.00 2 827.82 表 2 云南省纳西族COPD患者疾病经济风险
Table 2. The economic risk of COPD patients among Na Xi ethnic minority in Yunnan Province
特征 COPD患者人均医疗费用(元) 相对风险度(RR) 校正相对风险度(ARR) 是否为贫困户 否 6 308.96 1.50 1.39 是 6 440.91 1.77 1.73 家里是否有厕所 无 3 233.33 0.77 0.31 有 6 585.42 1.59 1.63 住房类型 石头土坯 3 264.81 0.82 0.86 砖木砖混 7 949.02 1.89 1.66 医疗服务可及性(min) ≥30 6 295.59 1.38 1.29 <30 6 352.27 1.63 1.49 人均年收入(元) ≤5 000 3 614.52 0.97 0.96 >5 000 8 117.02 1.77 1.95 合计 6 327.56 1.53 1.43 表 3 云南省纳西族COPD患者家庭灾难性卫生支出与因病致贫发生情况
Table 3. The catastrophic health expenditures and poverty due to illness among households with COPD patients in Na Xi ethnic minority in Yunnan Province
项目 COPD患者家庭数(户) 灾难性卫生支出 χ2值) P值 灾难性卫生支出 χ2值) P值 家庭数(户) 发生率(%) 家庭数(户) 发生率(%) 是否为贫困户 0.438 0.508 0.682 0.409 否 305 43 14.10 54 17.70 是 88 10 11.36 19 21.59 家里是否有厕所 0.820 0.365 0.233 0.629 无 44 4 9.09 7 15.91 有 349 49 14.04 66 18.91 住房类型 0.200 0.655 0.056 0.814 石头土坯 114 14 12.28 22 19.30 砖木砖混 279 39 13.98 51 18.28 医疗服务可及性(min) 0.264 0.607 4.558 0.033 ≥30 161 20 12.42 38 23.60a <30 232 33 14.22 35 15.09 人均年收入(元) 9.136 0.003 8.320 0.004 ≤5 000 342 53 15.50a 71 20.76a >5 000 51 0 0.00 2 3.92 合计 393 53 13.49 73 18.58 注:a各组内比较,P<0.05。 表 4 云南省纳西族居民家庭灾难性卫生支出和因病致贫影响因素的Logistic回归分析模型分析
Table 4. Logistic regression model analysis of influential factors of catastrophic health expenditures and poverty due to illness among households with COPD patients in Na Xi ethnic minority in Yunnan Province
变量 灾难性卫生支出 因病致贫 β值 Sx OR(95%CI)值 P值 β值 Sx OR(95%CI)值 P值 是否患有COPD 0.866 0.177 2.378 (1.681~3.363) <0.001 -0.012 0.155 0.988 (0.729~1.339) 0.939 人均年收入 -0.762 0.174 0.467 (0.332~0.656) <0.001 -3.589 0.276 0.028 (0.016~0.047) <0.001 家里是否有厕所 -0.226 0.248 0.798 (0.490~1.298) 0.363 -0.578 0.170 0.561(0.402~0.784) 0.001 -
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