Association between hospital visit and self-rated treatment effect among rural stroke patients at high risk of returning to poverty
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摘要:
目的 了解中国农村≥40岁高返贫风险脑卒中患者就诊行为、自评治疗效果情况及二者关联。 方法 利用“健康扶贫动态管理系统”数据，筛选14 614名农村≥40岁高返贫风险脑卒中患者，采用描述性分析和多因素Logistic回归分析模型对其就诊情况与自评治疗效果进行关联性分析。 结果 14 614名脑卒中患者中，自评病情好转率为62.5%；到基层医疗机构、县域内医疗机构进行就诊、住院治疗和5年间因脑卒中就诊次数为1~2次的患者比例较高，患者年医疗花费中位数为4 646.53元。多因素Logistic回归分析模型结果显示，在基层就诊(OR=1.10，95% CI：1.02~1.19)、住院治疗(OR=2.01，95% CI：1.83~2.21)和年医疗花费越高的患者自评治疗效果更好，2016-2020年间就诊3~5次(OR=0.77，95% CI：0.70~0.84)、6次及以上(OR=0.59，95% CI：0.51~0.67)的患者与就诊1~2次的患者相比，自评治疗效果较差。 结论 农村≥40岁高返贫风险脑卒中患者的就诊情况与自评治疗效果紧密相关。 Abstract:Objective To examine the situation of hospital visits and its association with self-rated treatment effect among rural stroke patients aged ≥40 years at high risk of returning to poverty in China. Methods From the database of national system for dynamic management on rural health poverty alleviation, we extracted the information about 14 614 rural stroke patients aged ≥40 years at high risk of returning to poverty. Descriptive analysis and multivariate Logistic regression analysis were conducted to explore the association between hospital visits and self-rated treatment effect among the participants. Results Of the 14 614 stroke patients, self-rated improvement of stroke after medication were reported by 62.5% of the participants. The proportion of patients who visited primary medical institutions and medical institutions in the county for treatment and hospitalization, and only visited hospital once or twice in five years was high. The median annual medical cost of patients was 4 646.53 Yuan. The results of multivariate Logistic regression analysis showed that patients who visited the primary medical institutions (OR=1.10, 95% CI: 1.02-1.19), were hospitalized (OR=2.01, 95% CI: 1.83-2.21), and had higher annual medical expenditure had better self-rated treatment outcomes. Patients with 3-5 visits (OR=0.77, 95% CI: 0.70-0.84), patients with ≥6 visits (OR=0.59, 95% CI: 0.51-0.67) during 2016-2020 had worse self-rated treatment outcomes than patients with 1-2 visits. Conclusion The self-rated treatment effect is closely related to the situation of hospital visits among stroke patients aged ≥40 years in rural areas at high risk of returning to poverty. -
Key words:
- Rural areas /
- High risk of returning to poverty /
- Stroke /
- Self-rated treatment effect
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表 1 农村高返贫风险脑卒中患者的基本人口学特征和医疗服务利用情况
Table 1. Basic demographic characteristics and health service utilization of stroke patients with high risk of returning to poverty in rural areas
变量 例数(n) 百分比(%) 变量 例数(n) 百分比(%) 性别 是否基层就诊 男 8 153 55.8 否 8 256 56.5 女 6 461 44.2 是 6 358 43.5 年龄(岁) 是否县域外就诊 40~＜60 3 060 20.9 否 13 854 94.8 60~＜70 4 214 28.8 是 760 5.2 70~＜80 5 248 35.9 是否住院治疗 80~105 2 092 14.4 否 5 226 35.8 文化程度 是 9 388 64.3 文盲及半文盲a 4 365 29.9 5年间因脑卒中就诊次数(次) 小学 7 149 48.9 1~2 10 180 69.7 初中及以上 3 100 21.2 3~5 2 432 16.6 是否独居 ≥6 2 002 13.7 非独居 12 496 85.5 年医疗花费(元) 独居 2 118 14.5 0~＜1 500 3 489 23.9 患有其他慢性病数量 1 500~＜4 500 3 647 25.0 0 2 882 19.7 4 500~＜10 000 3 949 27.0 1 4 100 28.1 ≥10 000 3 529 24.1 2 3 026 20.7 3 2 023 13.8 ≥4 2 583 17.7 注：a15岁及以上不识字及识字很少的人。 
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表 2 农村高返贫风险脑卒中患者自评治疗效果的单因素分析
Table 2. Single-factor analysis of self-rated treatment effect of stroke patients at high risk of returning to poverty in rural areas
变量 n 自评病情好转 χ2 P值 变量 n 自评病情好转 χ2 P值 人数 病情好转率(%) 人数 病情好转率(%) 性别 0.499 0.480 是否基层就诊 65.648 < 0.001 男 8 153 5 073 62.2 否 8 256 5 393 65.3 女 6 461 4 057 62.8 是 6 358 3 737 58.8 年龄(岁) 9.566 0.023 是否县域外就诊 0.004 0.951 40~＜60 3 060 1 976 64.6 否 13 854 8 656 62.5 60~＜70 4 214 2 640 62.7 是 760 474 62.4 70~＜80 5 248 3 211 61.2 是否住院治疗 716.426 <0.001 80~105 2 092 1 303 62.3 否 5 226 2 514 48.11 文化程度 27.889 <0.001 是 9 388 6 616 70.47 文盲及半文盲 4 365 2 633 60.3 5年间因脑卒中就诊次数(次) 439.144 <0.001 小学 7 149 4 443 62.2 1~2 10 180 6 884 67.6 初中及以上 3 100 2 054 66.3 3~5 2 432 1 356 55.8 是否独居 0.003 0.953 ≥6 2 002 890 44.5 非独居 12 496 7 808 62.5 年医疗花费(元) 266.253 <0.001 独居 2 118 1 322 62.4 0~＜1 500 3 489 1 779 51 患有其他慢性病数量 9.671 0.046 1 500~＜4 500 3 647 2 342 64.2 0 2 882 1 836 63.7 4 500~＜10 000 3 949 2 658 67.3 1 4 100 2 574 62.8 ≥10 000 3 529 2 351 66.6 2 3 026 1 902 62.9 3 2 023 1 271 62.8 ≥4 2 583 1 547 59.9 注：年龄、文化程度、患有其他慢性病数量、5年间因脑卒中就诊次数和年医疗花费(元)采用Kruskal-Wallis秩和检验，其余变量采用单因素χ2检验。
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表 3 农村高返贫风险脑卒中患者自评治疗效果的多因素分析
Table 3. Multivariate analysis of self-rated treatment effect of stroke patients at high risk of returning to poverty in rural areas
变量 OR(95%CI)值 Wald值 P值 变量 OR(95%CI)值 Wald值 P值 性别 是否基层就诊 女 1.00 否 1.00 男 0.94(0.87~1.01) 2.656 0.102 是 1.10(1.02~1.19) 5.476 0.019 年龄(岁) 是否住院治疗 40~＜60 1.00 否 1.00 60~＜70 0.96(0.87~1.06) 0.593 0.44 是 2.01(1.83~2.21) 214.330 < 0.001 70~＜80 0.95(0.86~1.05) 1.000 0.316 5年间因脑卒中就诊次数(次)a 80~105 0.96(0.85~1.09) 0.336 0.562 1~2 1.00 文化程度 3~5 0.77(0.70~0.84) 29.921 < 0.001 文盲及半文盲 1.00 ≥6 0.59(0.51~0.67) 89.114 < 0.001 小学 1.06(0.97~1.15) 1.664 0.196 年医疗花费(元) a 初中及以上 1.27(1.14~1.42) 18.576 <0.001 0~＜1 500 1.00 患有其他慢性病数量 1 500~＜4 500 1.18(1.06~1.32) 9.120 0.003 0 1.00 4 500~＜10 000 1.28(1.14~1.43) 17.556 < 0.001 1 0.97(0.88~1.07) 0.313 0.574 ≥10 000 1.20(1.06~1.36) 8.468 0.004 2 1.01(0.90~1.12) 0.014 0.902 3 1.02(0.90~1.15) 0.090 0.768 ≥4 0.92(0.82~1.04) 1.664 0.196 注：a表示趋势性检验显著(P < 0.05)。多因素Logistic回归分析模型：纳入了性别、年龄、文化程度、患有其他慢性病数量、是否基层就诊、是否住院治疗、5年间因脑卒中就诊次数和年医疗花费(元)。其中，是否独居、是否县域外就诊在单因素检验中差异无统计学意义且尚无明确证据表明其对自评治疗效果在重要影响，故不纳入模型。
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