河南省耐多药和非耐多药结核病患者经济状况及相关费用的比较

中国防痨杂志 ›› 2012, Vol. 34 ›› Issue (12): 773-779.

河南省耐多药和非耐多药结核病患者经济状况及相关费用的比较

孙燕妮王国杰甄新安刘占峰 Harley David Hall Gillian Vally Hassan Sleigh Adrian

2601 堪培拉，澳大利亚国立大学澳大利亚国家流行病和人口健康中心 (孙燕妮、Harley David、Hall Gillian、Sleigh Adrian)；河南省疾病预防控制中心结核病防治所预防控制室(王国杰、甄新安、刘占峰)；墨尔本澳大利亚La Trobe大学公共卫生和人类生物科学院（Vally Hassan）

收稿日期:2012-08-23 出版日期:2012-12-10 发布日期:2013-03-09
通信作者: 孙燕妮 E-mail:Yanni.sun@anu.edu.au

The economic status and treatment cost of MDR-TB patients compared to nonMDR-TB patients in Henan province

SUN Yan-ni, WANG Guo-jie, ZHEN Xin-an, LIU Zhan-feng, Harley David, Hall Gillian, Vally Hassan, Sleigh Adrian.

National Centre for Epidemiology and Population Health, the Australian National University, Canberra 2601, Australia

Received:2012-08-23 Online:2012-12-10 Published:2013-03-09
Contact: SUN Yan-ni E-mail:Yanni.sun@anu.edu.au

摘要/Abstract

摘要： 目的调查研究并比较河南省耐多药结核病(multidrug-resistant tuberculosis，MDR-TB)和非耐多药结核病(非MDR-TB)患者社会经济情况及相关治疗花费。方法利用2001年河南省参加世界卫生组织结核病耐药监测调查患者数据库, 采用Excel生成随机数字表方法随机抽取入选病例。使用问卷访谈形式于2010年对MDR-TB患者和非MDR-TB患者的社会经济状况及结核病相关治疗花费进行访谈性调查研究；共调查访谈234例患者。按照对异烟肼和利福平的耐药状态分为暴露组（MDR-TB 患者组）86例和对照组（非MDR-TB患者组）148例。对收集的数据进行t检验和卡方检验。结果暴露组MDR-TB患者家庭年收入低于5000元的比例（55.3%，47/85）明显高于对照组非MDR-TB患者（38.1%，56/147)，两组间差异有统计学意义（χ²=6.9，P=0.031）。与同社区其他居民家庭经济情况进行比较：暴露组患者家庭经济情况位于同社区家庭经济水平下1/3等的比例为47.1% (40/85)，明显高于对照组32.9%（48/146），两组间差异有统计学意义（χ²=4.6，P=0.032）。与对照组比较，暴露组家庭≤3间的可住房间数的比例明显偏高，分别为37.8%(31/82)和17.9%(26/145)，两组间差异有统计学意义（χ²=11.0，P=0.004）。更高比例的暴露组家庭因结核病治疗借款，占19.0% (15/79), 对照组占4.5%(6/134), 且不能按时偿还（χ²=13.4，P=0.001）。与非MDR-TB患者相比，更高比例的MDR-TB患者在结核病相关治疗花费上支付10 000元以上分别30.2%(26/86)和9.5%(14/148)，两组间差异有统计学意义（χ²=19.7,P=0.001）。结论结核病对MDR-TB患者和非MDR-TB患者的社会经济情况有不同程度影响。相比非MDR-TB患者，MDR-TB患者家庭更加贫穷，同时在治疗花费上支出较大。

关键词: 结核/经济学, 社会经济因素, 费用, 医疗, 河南省

Abstract: Objective To investigate the socioeconomic status and treatment cost of MDR-TB patients compared to non-MDR-TB in Henan province in 2010 to provide evidence for comprehensive TB control strategies. Methods Participants were randomly selected by using Excel generated random digits table from an anti-TB drug resistance surveillance survey dataset collected by the Institute for Tuberculosis Control and Prevention, Henan Centre for Disease Control and Prevention in 2001, supported by the World Health Organization. Interviews were carried out using a questionnaire to collect information on the socioeconomic status including wealth and impacts and treatment costs between MDR-TB and non-MDR-TB patients. Bivariate analysis was performed for data analysis. Altogether 234 TB cases were interviewed. Among the interviewed cases, 86 were MDR-TB cases and 148 were non-MDR-TB cases based on their anti-TB drug resistance status. In order to compare, t-test was applied in continuous variables and Chi square test was used for categorical variables. Results Compared to non-MDR-TB household, the proportion of annual household income less than 5000 Yuan for MDR-TB patient’s household was much higher. The difference between the two groups was statistically significant (55.3%,47/85 vs 38.1%,56/147, χ²=6.9，P=0.031). 47.1%(40/85)of MDR-TB patients’ households were in lower 1/3 in term of economic status compared to other households in the community, while 32.9% (48/146)non-MDR-TB patients’ household ranked in lower 1/3(χ²=4.6, P=0.032). Compared to households with non-MDR-TB patients, higher proportion of MDR-TB patients’households had bedrooms less than 3 (37.8%,31/82 vs 17.9%,26/145). The difference between the two study groups was statistically significant(χ²=11.0，P=0.004). More proportion of households with MDR-TB patients reported loan for TB treatment and can not pay back in time(19.0%,15/79 vs 4.5%,6/134χ²=13.4，P=0.001). Much higher MDR-TB households paid treatment costs more than 10000 Yuan compared to non-MDR-TB households (30.2%, 26/86 vs 9.5%,14/148). The difference between two groups was statistically significant(χ²=19.7, P=0.001). Conclusion Economic burden on TB patients, especially on MDR-TB patients is serious. Compared to households with non-MDR-TB patients, the MDR-TB patients’ households is poorer. MDR-TB patients’ households tend to pay more on TB treatment costs as well.

Key words: Tuberculosis/economics, Socioeconomic factors, Fees,medical, Henan province

孙燕妮王国杰甄新安刘占峰 Harley David Hall Gillian Vally Hassan Sleigh Adrian. 河南省耐多药和非耐多药结核病患者经济状况及相关费用的比较[J]. 中国防痨杂志, 2012, 34(12): 773-779.

SUN Yan-ni, WANG Guo-jie, ZHEN Xin-an, LIU Zhan-feng, Harley David, Hall Gillian, Vally Hassan, Sleigh Adrian.. The economic status and treatment cost of MDR-TB patients compared to nonMDR-TB patients in Henan province[J]. Chinese Journal of Antituberculosis, 2012, 34(12): 773-779.

参考文献

［1］Jackson S, Sleigh AC, Wang GJ, et al. Poverty and the economic effects of TB in rural China. Int J Tuberc Lung Dis, 2006, 10（10）:1104-1110.

［2］Xu B, Dong HJ, Zhao Q, et al. DOTS in China-removing barriers or moving barriers? Health Policy Plan, 2006，21（5）:365-372.

［3］Spence DP, Hotchkiss J, Williams CS, et al. Tuberculosis and poverty. BMJ, 1993, 307:759-761.

［4］赵大海，徐飚.结核病与贫穷. 中国防痨杂志，2004，26 (3)：177-179.

［5］王宇. 全国第五次结核病流行病学抽样调查资料汇编.北京：军事医学科学出版社，2012：52-60.

［6］World Health Organization. Guidelines for the programmatic management of drugresistant tuberculosis. Geneva： World Health Organization， 2008.

［7］杜长梅，王国斌，徐吉英，等.河南省第二轮结核病耐药监测及耐药趋势的研究.中国防痨杂志，2006，4（2）：95-99.

［8］Rajbhandary SS, Marks SM，Bock NN. Costs of patients hospitalized for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis, 2004, 8 (8):1012-1016.

［9］王黎霞.中国耐多药结核病的控制亟待加强. 中华结核和呼吸杂志, 2009, 32 (8)：561-563.

［10］申振元，陈伟, 马桂芳，等. 河南省2009年肺结核疫情特征流行病学分析.现代预防医学, 2012，39（4）：993-994.

［11］Wilson LG. The historical decline of tuberculosis in Europe and America: its causes and significance. J Hist Med Allied Sci，1990，45(3):366-396.

［12］Schoeman J, Westaway M， Neethling A. The relationship between socioeconomic factors and pulmonary tuberculosis. Int J Epidemiol，1991，20(2):435-440.

［13］邓斌，何庆伟, 余锦香，等. 初治肺结核治愈后复发危险因素 COX 比例风险模型研究. 国际医药卫生导报, 2005，(17): 28-30.

［14］王纪祥.安徽省结核病控制项目1997年病人化疗情况调查. 疾病控制杂志, 1999, 3（3）:189-191.

［15］陈兆辉. 世行贷款方案治疗肺结核失败227 例原因分析. 临床肺科杂志, 2001, 6（4）:16-18.

［16］World Health Organization.Global tuberculosis control: WHO report 2010. Geneva：World Health Organization，2011.

［17］Benatar SR，Upshur R.Tuberculosis and poverty: what could (and should) be done. Int J Tuberc Lung Dis，2010，14(10):1215-1221.

[1]	王前, 周林, 刘二勇, 赵雁林, 李涛, 陈明亭, 杨丽佳, 王嘉. 我国县级结核病定点医疗机构结核病诊断能力现况调查研究[J]. 中国防痨杂志, 2020, 42(9): 926-930.
[2]	陈娟, 毛毅, 陈洪德. 30例危重症肺结核孕产妇的临床特征及预后分析[J]. 中国防痨杂志, 2020, 42(6): 638-640.
[3]	李志明,俞珊,王涛. 柴竹石膏汤对29例反复发热结核病并发其他感染患者的疗效分析[J]. 中国防痨杂志, 2020, 42(2): 121-125.
[4]	刘彬彬,龚道方,陈振华,郭婧玮,余艳艳,刘丰平,欧阳辉,谭云洪. 三种实验室诊断技术对结核分枝杆菌复合群检出率及检测费用的比较研究[J]. 中国防痨杂志, 2020, 42(2): 143-148.
[5]	申丽君,王艺曈,李雪,刘昭,张帆,赵琨,刘跃华. 基于疗程费用测算耐药结核病患者药物负担[J]. 中国防痨杂志, 2019, 41(9): 962-967.
[6]	汪娟,许缃,蔡晓峰,杨美霞. 对糖尿病患者进行肺结核筛查的效果与成本效益分析[J]. 中国防痨杂志, 2019, 41(9): 968-973.
[7]	徐春华,刘清,王紫纯,邬勇. 上海市奉贤区肺结核患者经济负担及其影响因素分析[J]. 中国防痨杂志, 2019, 41(9): 974-984.
[8]	徐飚. 规范结核病诊疗服务实现零家庭灾难性卫生支出[J]. 中国防痨杂志, 2019, 41(5): 485-487.
[9]	杨林,宁柱,陈诚,胡屹,赵琦,张慧,郑旭彬,张正东,徐飚. 涂阳肺结核患者在定点医疗机构门诊的直接医疗费用及支付方式——一项基于江苏和四川部分地区的肺结核患者队列研究[J]. 中国防痨杂志, 2019, 41(5): 556-563.
[10]	王秀军,商雪辉,付雅峰,吴恩东. 气道管理方案在肺结核并发呼吸衰竭患者中的实施效果评价[J]. 中国防痨杂志, 2019, 41(5): 575-578.
[11]	杨天池,陈琴,陈同,于梅,林相. 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[J]. 中国防痨杂志, 2019, 41(11): 1191-1196.
[12]	李郁如,朱毓萍,周景雯,高颖,王琳. 多学科协助团队在肺结核大咯血救治中的临床价值[J]. 中国防痨杂志, 2019, 41(10): 1118-1123.
[13]	杜世昌,徐彩红,王丽,张慧,陈伟. 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[J]. 中国防痨杂志, 2018, 40(6): 609-615.
[14]	刘颖,戚玉,毕娇. 结核性脓胸患者术后肢体功能锻炼采用多元化健康教育模式的效果分析[J]. 中国防痨杂志, 2018, 40(6): 652-655.
[15]	王晓宁,何天伦,耿梦杰,宋渝丹,赵飞,何广学. 我国12省结核病门诊和实验室感染控制管理措施实施现状的抽样调查及其主成分分析[J]. 中国防痨杂志, 2018, 40(5): 519-524.