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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (11): 1191-1196.doi: 10.3969/j.issn.1000-6621.2019.11.009

• 论著 • 上一篇    下一篇

宁波市利福平耐药肺结核患者家庭灾难性医疗支出及其影响因素分析

杨天池(),陈琴,陈同,于梅,林相   

  1. 315010 浙江省宁波市疾病预防控制中心结核病防制所(杨天池、陈同、于梅、林相);中国科学院大学宁波华美医院医疗保险办公室(陈琴)
  • 收稿日期:2019-07-29 出版日期:2019-11-10 发布日期:2019-12-05
  • 通信作者: 杨天池,林相 E-mail:57237243@qq.com
  • 基金资助:
    浙江省医药卫生科研项目(2018KY733)

Analysis of catastrophic health expenditure and its influencing factors in patients with rifampicin-resistant pulmonary tuberculosis

YANG Tian-chi(),CHEN Qin,CHEN Tong,YU Mei,LIN Xiang   

  1. Tuberculosis Control Center, Ningbo Center for Disease Control and Prevention, Zhejiang Province, Ningbo 315010, China
  • Received:2019-07-29 Online:2019-11-10 Published:2019-12-05
  • Contact: Tian-chi YANG,Xiang LIN E-mail:57237243@qq.com

摘要:

目的 了解利福平耐药肺结核患者家庭灾难性医疗支出发生情况及其影响因素。方法 选取2016—2017年宁波市耐药结核病定点医院登记并治疗满12个月的92例利福平耐药肺结核患者(经结核分枝杆菌痰培养及临床分离株对利福平和异烟肼等药物敏感性试验确诊)进行疾病经济负担问卷调查。共发放问卷92份,回收有效问卷85份,有效率为92.4%。根据世界卫生组织给出的灾难性医疗支出建议,以自付费占家庭可支付费用(家庭年收入扣除食品支出后的部分)的40%作为阈值,计算患者家庭灾难性医疗支出发生率;灾难性医疗支出影响因素分析先进行单因素卡方检验,以α=0.10为检验水准筛选可疑因素,再以可疑因素为自变量、α=0.05为检验水准进行多因素logistic回归分析。结果 71.8%(61/85)的被调查患者家庭因肺结核发生灾难性医疗支出。多因素logistic回归分析显示,与年人均收入低于1.5万元的家庭相比,年人均收入高(“2.5万元~”:OR=0.179,95%CI=0.035~0.906,P=0.038;“≥4.0万元”:OR=0.118,95%CI=0.023~0.605,P=0.010)患者家庭发生灾难性医疗支出的风险较低;因肺结核住院的患者家庭发生灾难性医疗支出的风险较高(OR=5.623,95%CI=1.739~18.178,P=0.004)。结论 利福平耐药肺结核患者家庭灾难性医疗支出发生率高,因肺结核住院是发生灾难性医疗支出的危险因素,家庭年人均收入高是保护因素。

关键词: 利福平, 结核, 抗多种药物性, 结核, 肺, 医疗费用无力承担, 因素分析, 统计学

Abstract:

Objective To understand the incidence of catastrophic health expenditure (CHE) and its influencing factors in patients with rifampicin-resistant tuberculosis (TB).Methods Ninety-two patients (confirmed by sputum culture of Mycobacterium tuberculosis, rifampicin and isoniazid susceptbility test of clinical isolates) who were registered from 2016 to 2017 in the drug-resistant TB designated hospital in Ningbo and treated for at least 12 months were selected to participant in a questionnaire survey on the economic burden of TB, 85 participants completed the survey with an effective rate of 92.4%. According to recommendation given by World Health Organization, CHE was defined as health expenditure exceeding 40% of the family’s capacity to pay, incidence of household CHE were then calculated. Chi-square test was conducted to screen out suspicious factors with α=0.10, then multivariate logistic regression was conducted to identify influencing factors of CHE with the suspicious factors as independent variables and α=0.05.Results 71.8% (61/85) of those families surveyed had CHE due to TB. Multivariate logistic regression analysis showed that families with high annual per capita income (“RMB 25000 yuan-”:OR=0.179, 95%CI=0.035-0.906, P=0.038; “≥RMB 40000 yuan”:OR=0.118, 95%CI=0.023-0.605, P=0.010) had a lower risk of CHE comparing with those with low annual per capita income (“OR=5.623, 95%CI=1.739-18.178, P=0.004) had a higher risk of CHE.Conclusion The incidence of CHE in patients with rifampicin-resistant TB is high. Hospitalization for TB is a risk factor of CHE, high annual per capita income of the family is a protective factor.

Key words: Rifampin, Tuberculosis, multidrug-resistant, Tuberculosis, pulmonary, Medical indigency, Factor analysis, statistical