云南省纳西族居民慢性阻塞性肺疾病的疾病经济风险及影响因素

刘颖楠; 蔡乐; 王旭明; 崔文龙; 申静蓉; 左春梅; 何连菊

doi:10.16462/j.cnki.zhjbkz.2020.10.007

云南省纳西族居民慢性阻塞性肺疾病的疾病经济风险及影响因素

doi: 10.16462/j.cnki.zhjbkz.2020.10.007

刘颖楠¹,
蔡乐^1, ,,
王旭明^{1, 2},
崔文龙¹,
申静蓉¹,
左春梅¹,
何连菊¹

1.
650500 昆明, 昆明医科大学公共卫生学院
2.
650032 昆明, 昆明医科大学第一附属医院呼吸科

基金项目:

国家自然科学基金资助项目 71663035

云南省科技厅-昆明医科大学联合专项重点项目 [2017FE467(-002)]

云南省高校科技创新团队支持计划 [(2018)134]

云南省创新团队培育计划 [2019(6)]

详细信息

通讯作者:
蔡乐，E-mail：caile002@hotmail.com

中图分类号: R563.9
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- 被引次数: 0
出版历程
- 收稿日期: 2020-02-24
- 修回日期: 2020-06-06
- 刊出日期: 2020-10-10

Analysis on disease economic risk and influencing factors of chronic obstructive pulmonary disease among Na Xi ethnic minority in Yunnan Province

1.
School of Public Health, Kunming Medical University, Kunming 650500, China
2.
Department of Respiratory, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China

Funds:

Grants from the National Natural Science Foundation of China 71663035

The Major Specific Project Fund of the Yunnan Provincial Department of Science and Technology and Kunming Medical University [2017FE467(-002)]

Program for Innovative Research Team (in science and technology) in University of Yunnan Province [(2018)134]

Cultivation Plan for Innovation Team of Yunnan Province [2019(6)]

More Information

Corresponding author: CAI Le，E-mail:caile002@hotmail.com

摘要

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。
- 慢性阻塞性肺疾病 /
- 疾病经济风险 /
- 灾难性卫生支出 /
- 因病致贫 /
- 影响因素 /
- 纳西族
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.
- Chronic obstructive pulmonary disease /
- Disease economic risk /
- Catastrophic health care expenditures /
- Poverty due to illness /
- Influencing factors /
- Na Xi ethnic minority

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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

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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

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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
项目	COPD患者家庭数(户)	家庭数(户)	发生率(%)	χ²值)	P值	家庭数(户)	发生率(%)	χ²值)	P值
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	23.60^a
＜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	15.50^a			71	20.76^a
＞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。

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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
变量	β值	S_x	OR(95%CI)值	P值	β值	S_x	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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