我国西部地区肺结核患者家庭经济负担现况调查

doi:10.19982/j.issn.1000-6621.20230137

摘要/Abstract

摘要：

目的: 了解我国西部地区肺结核患者的经济负担情况,为制定减轻肺结核患者家庭经济负担的政策提供参考依据。方法: 本研究为横断面调查,采用整群抽样的方法选取我国西部12个省份的16家结核病定点医疗机构,2020年10—12月对其中治疗时间大于2周的利福平敏感肺结核患者进行面对面问卷调查,调查内容包括患者的基本信息、费用情况,以及家庭收入等。对患者的社会人口学特征、各类费用情况及灾难性支出发生率进行描述性分析。结果: 本研究共纳入1030例肺结核患者。结核病患者总费用中位数(四分位数)为8703.30(4046.00,15715.59)元,直接医疗费用为5823.85(2341.01,10852.23)元,直接非医疗费用为1589.53(675.14,3163.45)元,间接费用为12.03(0.34,720.27)元。肺结核患者家庭灾难性支出发生率为52.82%(544/1030)。结论: 我国西部地区肺结核患者经济负担较重,结核病患者总费用和直接医疗费用较高,导致家庭灾难性支出发生率较高。

关键词: 结核,肺, 经济负担, 费用, 问卷调查

Abstract:

Objective: To investigate the economic burden of patients with pulmonary tuberculosis (TB) in western China and provide reference for developing policies to reduce the economic burden of TB patients. Methods: This cross-sectional study employed cluster sampling to select 16 TB treatment facilities across 12 western provinces in China from October 2022 to December 2020. Face-to-face questionnaire surveys were conducted on drug-susceptive pulmonary TB patients who had undergone treatment for more than two weeks. These surveys encompassed their demographic characteristics, expenses and household income. Descriptive analysis was used to analyze the demographic characteristics, expenses and catastrophic expenditure of patients. Results: A total of 1030 patients with pulmonary TB were included in the study. The median (IQR) of the total cost for tuberculosis patients was 8703.30 (4046.00, 15715.59) yuan, comprising direct medical costs of 5823.85 (2341.01, 10852.23) yuan, direct non-medical costs of 1589.53 (675.14, 3163.45) yuan, and indirect costs of 12.03 (0.34, 720.27) yuan. A total of 52.82% (544/1030) of patients experienced household catastrophic expenditure for the treatment of pulmonary TB. Conclusion: The economic burden of pulmonary TB patients in western region of China is heavy. The total cost and direct medical cost of pulmonary TB patients are high, contributing to a heightened incidence of household catastrophic expenditure.

Key words: Tuberculosis, pulmonary, Economic burden, Expenditure, Questionnaires survey

中图分类号:

郝冬青, 李涛, 黄飞, 徐彩红. 我国西部地区肺结核患者家庭经济负担现况调查[J]. 中国防痨杂志, 2023, 45(11): 1021-1030. doi: 10.19982/j.issn.1000-6621.20230137

Hao Dongqing, Li Tao, Huang Fei, Xu Caihong. A cross-sectional study on the economic burden of pulmonary tuberculosis patients from western China[J]. Chinese Journal of Antituberculosis, 2023, 45(11): 1021-1030. doi: 10.19982/j.issn.1000-6621.20230137

图/表 4

图1

表1

表2

不同特征患者的各类费用情况

特征	直接医疗费用 [元,M(Q₁,Q₃)]			直接非医疗费用 [元,M(Q₁,Q₃)]	间接费用 [元,M(Q₁,Q₃)]	总费用 [元,M(Q₁,Q₃)]
年龄(岁)
<15	4203.58 (525.27,9723.31)			1640.61 (465.54,3789.26)	86.35 (9.32,3022.50)	6605.08 (981.50,17200.50)
15~44	4727.03 (1474.32,9489.59)			1219.53 (496.22,2534.12)	7.84 (0.27,128.38)	6581.28 (2044.38,12125.19)
45~64	6345.41 (3167.36,12138.11)			1576.08 (765.81,2986.89)	8.04 (0.20,477.70)	8885.01 (4651.43,15657.38)
≥65	6922.03 (3726.22,11332.23)			2347.43 (1307.77,4092.30)	108.99 (7.03,2642.50)	12008.99 (7152.59,18138.50)
χ²值	27.852			54.574	61.739	53.845
P值	<0.001			<0.001	<0.001	<0.001
性别
男性	5630.68 (2572.77,10923.45)			1611.76 (688.99,3145.00)	11.62 (0.27,640.34)	8638.53 (4279.84,15556.85)
女性	6111.15 (1868.99,10773.99)			1540.54 (652.70,3179.66)	16.89 (0.41,800.00)	8759.89 (3267.03,16012.00)
χ²值	0.168			0.000	0.860	0.262
P值	0.682			0.996	0.354	0.609
婚姻状态
未婚	3833.78 (1037.30,7572.43)			1052.97 (418.38,2319.86)	11.55 (0.47,161.08)	5589.64 (1377.43,10497.25)
已婚	6666.28 (3076.01,11870.00)			1729.53 (792.57,3353.45)	12.03 (0.27,1000.00)	9831.29 (4931.00,16570.00)
离婚	5084.46 (3573.78,11283.51)			1231.01 (634.53,3695.74)	4.86 (0.00,31.35)	6913.00 (4566.00,13486.75)
丧偶	7823.72 (3411.76,12408.78)			2603.72 (1229.26,4843.58)	105.81 (7.70,3255.88)	13201.52 (7337.80,20373.73)
χ²值	46.947			39.570	16.776	60.449
P值	<0.001			<0.001	0.001	<0.001
特征	直接医疗费用 [元,M(Q₁,Q₃)]		直接非医疗费用 [元,M(Q₁,Q₃)]		间接费用 [元,M(Q₁,Q₃)]	总费用 [元,M(Q₁,Q₃)]
居住地
城镇	5478.24 (1776.55,10004.26)		1344.80 (573.58,2790.00)		8.24 (0.20,425.95)	7823.08 (2967.55,14151.00)
农村	7424.19 (3566.08,13586.01)		2331.49 (1228.51,4636.42)		47.03 (6.69,2016.08)	11497.00 (5895.00,20500.00)
χ²值	25.100		47.151		40.526	41.026
P值	<0.001		<0.001		<0.001	<0.001
家庭人口数
<4	6868.00 (3518.02,12118.27)		1811.30 (950.00,3504.46)		6.01 (0.01,640.36)	9639.45 (5411.18,17700.71)
≥4	4901.84 (1308.00,9923.00)		1350.00 (520.71,2790.00)		16.88 (0.74,780.64)	7650.00 (2034.74,14121.30)
χ²值	33.065		19.960		14.006	28.481
P值	<0.001		<0.001		<0.001	<0.001
文化程度
文盲	6920.07 (3411.76,11938.92)		2169.66 (1244.26,3622.64)		46.89 (1.55,2380.00)	11353.55 (5920.30,17695.35)
小学	6422.16 (2527.50,11003.65)		1728.38 (713.45,3626.62)		14.46 (0.41,775.14)	9072.00 (4530.52,16645.30)
初中	5478.45 (2109.05,10166.01)		1283.85 (532.97,2786.01)		10.54 (0.47,493.72)	7924.68 (3560.80,14121.00)
高中	4609.59 (1610.00,9018.24)		1163.51 (433.78,2379.59)		8.85 (0.27,153.92)	6218.09 (2220.90,12406.00)
大专及以上	6023.99 (2775.61,12239.80)		1371.69 (714.73,3481.49)		1.89 (0.00,121.89)	8191.76 (4082.00,17800.00)
χ²值	15.362		38.007		21.300	27.877
P值	0.004		<0.001		<0.001	<0.001
家庭主要收入来源者
是	6411.42 (3356.76,12441.55)		1785.54 (936.96,3616.89)		4.26 (0.00,408.09)	9197.73 (5175.02,18881.87)
否	5455.54 (1799.93,10200.00)		1464.46 (580.00,2966.15)		16.89 (0.61,1050.00)	8480.00 (2760.00,14992.80)
χ²值	13.600		12.496		19.565	11.895
P值	<0.001		<0.001		<0.001	0.001
流动人口
是	4244.31 (1830.14,7745.41)		698.45 (434.39,1932.57)		47.50 (0.00,989.93)	6151.25 (2615.19,8577.07)
否	5865.07 (2367.97,10935.74)		1616.35 (688.99,3179.66)		12.03 (0.34,720.27)	8768.89 (4095.00,15797.00)
χ²值	1.077		4.714		0.062	2.270
P值	0.299		0.030		0.804	0.132
特征	直接医疗费用 [元,M(Q₁,Q₃)]		直接非医疗费用 [元,M(Q₁,Q₃)]		间接费用 [元,M(Q₁,Q₃)]	总费用 [元,M(Q₁,Q₃)]
医保情况
未参加	5745.81 (1830.14,8608.99)		675.14 (124.26,1230.47)		8.51 (0.88,37.91)	6367.51 (2615.19,11721.21)
城镇职工	2320.41 (340.54,7522.03)		844.05 (360.00,2703.24)		12.03 (0.68,170.74)	4157.00 (800.41,11164.10)
新农合	7404.32 (4122.84,12155.27)		1892.36 (1128.45,3355.88)		12.03 (0.34,1297.09)	10357.16 (5991.00,17360.00)
其他	2761.28 (1699.53,4260.14)		1595.54 (346.82,2531.76)		501.08 (107.43,925.68)	5328.43 (2700.00,7600.00)
χ²值	142.949		76.845		3.222	118.614
P值	<0.001		<0.001		0.359	<0.001
治疗类型
初治	5642.57 (2261.15,10569.66)		1541.35 (665.07,3684.86)		12.03 (0.41,642.84)	8525.70 (3897.10,15306.10)
复治	8896.49 (3945.61,17644.46)		2528.31 (1225.20,4332.03)		5.27 (0.00,1385.27)	13404.83 (6400.00,23510.00)
χ²值	10.257		9.877		1.309	12.459
P值	0.001		0.002		0.253	<0.001
住院治疗
是	7646.15 (4452.23,12734.26)		1965.00 (1196.62,3739.86)		12.03 (0.14,1500.74)	11062.00 (6876.00,18370.00)
否	630.61 (261.08,2073.72)		434.39 (247.03,715.00)		12.03 (5.61,54.05)	1291.22 (712.23,3106.74)
χ²值	374.046		305.921		0.637	395.705
P值	<0.001		<0.001		0.425	<0.001
HIV状态
阳性	5630.68 (698.85,9435.27)		621.62 (409.26,4868.65)		2.50 (0.41,604.73)	6454.02 (999.93,13246.28)
阴性	6613.65 (3593.11,11825.81)		1786.22 (962.23,3361.15)		10.47 (0.27,1001.15)	9665.41 (5420.78,16671.51)
不清楚	366.28 (138.65,1474.32)		468.65 (281.35,1015.14)		16.89 (8.31,107.43)	857.18 (606.00,3194.76)
χ²值	180.534		96.262		3.170	163.759
P值	<0.001		<0.001		0.205	<0.001
患有其他慢性病^a
否	5949.66 (2775.61,10764.26)		1534.66 (735.54,3034.05)		10.34 (0.27,723.65)	8537.81 (4476.20,15518.69)
是	5505.74 (1651.01,11265.88)		1712.57 (532.97,3282.23)		16.89 (0.74,642.84)	9108.92 (2267.51,16099.67)
χ²值	2.675		0.008		3.201	0.556
P值	0.102		0.929		0.074	0.456
特征	直接医疗费用 [元,M(Q₁,Q₃)]	直接非医疗费用 [元,M(Q₁,Q₃)]			间接费用 [元,M(Q₁,Q₃)]	总费用 [元,M(Q₁,Q₃)]
患病前家庭年收入(元)
≤15000	1805.88 (326.00,8385.93)	842.85 (356.77,2762.75)			16.88 (5.77,154.78)	3194.76 (774.36,13369.00)
>15000~40000	5559.18 (2731.06,10483.80)	1724.77 (843.10,3284.28)			10.63 (0.25,1025.04)	8739.67 (4700.45,16256.40)
>40000~60000	6729.95 (3864.00,11470.00)	1808.52 (1085.00,3458.00)			10.67 (0.08,1053.27)	9240.44 (5799.70,15904.00)
>60000	7445.78 (4019.00,12436.00)	1700.00 (989.66,3034.05)			5.61 (0.25,1288.53)	10364.33 (5877.80,16907.00)
χ²值	99.978	36.864			3.059	80.122
P值	<0.001	<0.001			0.383	<0.001
合计	5823.85 (2341.01,10852.23)	1589.53 (675.14,3163.45)			12.03 (0.34,720.27)	8703.30 (4046.00,15715.59)

表2

表3

参考文献 27

[1]	World Health Organization. Global strategy and targets for tuberculosis prevention, care and control after 2015. Geneva: World Health Organization, 2014.
[2]	Tanimura T, Jaramillo E, Weil D, et al. Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review. Eur Respir J, 2014, 43(6):1763-1775. doi:10.1183/09031936.00193413. pmid: 24525439
[3]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012, 34(8):485-508.
[4]	Hu M, Feng Y, Li T, et al. Unbalanced Risk of Pulmonary Tuberculosis in China at the Subnational Scale: Spatiotemporal Analysis. JMIR Public Health Surveill, 2022, 8(7):e36242. doi:10.2196/36242.
[5]	World Health Organization. Tuberculosis patient cost surveys: a handbook. Geneva: World Health Organization, 2017.
[6]	Xu C, Xia Y, Hu D, et al. Financial Burden of Tuberculosis Patients-China, 2020. China CDC Wkly, 2023, 5(12):266-270. doi:10.46234/ccdcw2023.048.
[7]	Liu Y, Xu CH, Wang XM, et al. Out-of-pocket payments and economic consequences from tuberculosis care in eastern China: income inequality. Infect Dis Poverty, 2020, 9(1):14. doi:10.1186/s40249-020-0623-8. pmid: 32019611
[8]	刘艳, 徐彩红, 王振宇, 等. 我国结核病定点医院肺结核患者家庭经济负担现况调查. 中华流行病学杂志, 2019, 40(5):559-564. doi:10.3760/cma.j.issn.0254-6450.2019.05.013.
[9]	李秋燕, 曹秀玲, 赵广通, 等. 山东省肺结核患者疾病经济负担及影响因素分析. 中国卫生经济, 2010, 29(4):71-73.
[10]	钟节鸣, 黄玉, 王晓萌, 等. 初治肺结核患者在定点医院医疗费用分析. 浙江预防医学, 2014, 26(3):224-228. doi:10.19485/j.cnki.issn1007-0931.2014.03.003.
[11]	王娜, 王黎霞, 李仁忠. 四地市结核病定点医院住院初治涂阳肺结核患者医疗费用及经济负担分析. 中国防痨杂志, 2012, 34(2):79-84.
[12]	成玉萍, 赵黎芳, 宫志敏. 上海市闵行区流动人口肺结核病患者直接费用分析. 中国初级卫生保健, 2014, 28(1):65-67.
[13]	孙晓英, 程俊, 边学峰, 等. 山东省初治肺结核患者直接费用及疾病经济负担分析. 中国热带医学, 2020, 20(2):126-130. doi:10.13604/j.cnki.46-1064/r.2020.02.07.
[14]	吴波, 刘英, 廖文平, 等. 重庆市四区县肺结核患者经济负担分析. 中国防痨杂志, 2022, 44(4):390-396. doi:10.19982/j.issn.1000-6621.20210633.
[15]	Xia L, Gao L, Zhong Y, et al. Assessing the influencing factors of out-of-pocket costs on tuberculosis in Sichuan Province: a cross-sectional study. BMC Public Health, 2023, 23(1):1391. doi:10.1186/s12889-023-16180-y. pmid: 37468877
[16]	刘良丽, 赵誉洁, 杨云斌, 等. 云南省三县区肺结核患者灾难性支出调查研究. 结核与肺部疾病杂志, 2022, 3(6):469-476. doi:10.19983/j.issn.2096-8493.20220154.
[17]	杜世昌, 徐彩红, 王丽, 等. 新疆五县(区)肺结核患者医疗费用及经济负担现况的调查分析. 中国防痨杂志, 2018, 40(6):609-615. doi:10.3969/j.issn.1000-6621.2018.06.012.
[18]	马晓雪, 黄爱菊, 陈慧娟, 等. 毕节市敏感肺结核患者家庭灾难性支出情况分析. 现代预防医学, 2022, 49(3):527-531.
[19]	Yang T, Chen T, Che Y, et al. Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China. BMC Public Health, 2020, 20(1):1009. doi:10.1186/s12889-020-09136-z. pmid: 32586305
[20]	Xu CH, Jeyashree K, Shewade HD, et al. Inequity in catastrophic costs among tuberculosis-affected households in China. Infect Dis Poverty, 2019, 8(1):46. doi:10.1186/s40249-019-0564-2.
[21]	王姬, 应世栋, 张文伟. 肺结核患者疾病经济负担及其影响因素分析. 实用预防医学, 2015, 22(11):1352-1354.
[22]	Kilale AM, Pantoja A, Jani B, et al. Economic burden of tuberculosis in Tanzania: a national survey of costs faced by tuberculosis-affected households. BMC Public Health, 2022, 22(1):600. doi:10.1186/s12889-022-12987-3. pmid: 35351063
[23]	Hu H, Chen J, Sato KD, et al. Factors that associated with TB patient admission rate and TB inpatient service cost: a cross-sectional study in China. Infect Dis Poverty, 2016, 5(1):4. doi:10.1186/s40249-016-0097-x.
[24]	Vo LNQ, Forse RJ, Codlin AJ, et al. Socio-protective effects of active case finding on catastrophic costs from tuberculosis in Ho Chi Minh City, Viet Nam: a longitudinal patient cost survey. BMC Health Serv Res, 2021, 21(1):1051. doi:10.1186/s12913-021-06984-2. pmid: 34610841
[25]	Fuady A, Houweling TaJ, Mansyur M, et al. Catastrophic total costs in tuberculosis-affected households and their determinants since Indonesia’s implementation of universal health coverage. Infect Dis Poverty, 2018, 7(1):3. doi:10.1186/s40249-017-0382-3.
[26]	Florentino JL, Arao RML, Garfin AMC, et al. Expansion of social protection is necessary towards zero catastrophic costs due to TB: The first national TB patient cost survey in the Philippines. PLoS One, 2022, 17(2):e0264689. doi:10.1371/journal.pone.0264689.
[27]	Wondawek TM, Ali MM. Delay in treatment seeking and associated factors among suspected pulmonary tuberculosis patients in public health facilities of Adama town, eastern Ethiopia. BMC Public Health, 2019, 19(1):1527. doi:10.1186/s12889-019-7886-7. pmid: 31727034