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目的分析农村老年结核病患者疾病经济负担和可能的影响因素。方法采用多阶段随机抽样方法,筛选出其中309例农村老年结核病患者,于2012年6—9月对筛选出的老年结核病患者进行面对面问卷调查。计量资料符合正态分布的采用t检验,不符合正态分布的采用Mann-Whitney秩和检验;应用Spearman相关分析就诊次数与疾病经济负担的关系;多因素分析采用Poisson回归模型,P<0.05为差异有统计学意义。结果不同首次诊断机构、确诊机构、初次诊断结果的农村老年肺结核患者的疾病经济负担不同,差异均有统计学意义(H=17.214、57.452、42.133,均P<0.05)。农村老年肺结核患者就诊次数与疾病经济负担间存在显著相关性(r=0.132,P<0.05)。与村级卫生室相比,在民营医疗机构治疗农村老年结核病患者的疾病经济负担明显增加(OR=1.279,95%CI为1.132~1.358),而在乡镇卫生院、县级结核病防治机构(结防机构)、县级医疗机构治疗的患者疾病经济负担明显降低(OR=0.933,95%CI为0.911~0.963;OR=0.917,95%CI为0.901~0.954;OR=0.969,95%CI为0.933~0.989)。与县级结防机构比较,在市级结防机构和县级医院确诊的患者疾病经济负担会明显增加(OR=1.484,95%CI为1.361~1.579;OR=1.394,95%CI为1.276~1.513)。相比初次诊断为肺结核患者,诊断为普通感冒、支气管炎、肺炎和胸膜炎的患者疾病经济负担明显增加(OR=1.227,95%CI为1.123~1.411;OR=1.371,95%CI为1.211~1.604;OR=1.275,95%CI为1.173~1.563;OR=1.242,95%CI为1.063~1.472)。就诊次数能够显著影响农村老年肺结核患者的疾病经济负担(OR=1.139,95%CI为1.015~1.224)。结论加大在农村地区肺结核知识的宣传教育,大力发展基层医疗服务,增强农村肺结核患者的医疗保障力度,可以有效引导农村肺结核患者合理就诊,减轻农村老年肺结核患者的疾病经济负担。
Objective To analyze the economic burden and possible influencing factors of elderly patients with tuberculosis in the elderly. Methods A total of 309 elderly patients with tuberculosis in rural areas were screened out by multi-stage random sampling method. From June to September 2012, face-to-face questionnaires were collected from elderly TB patients. Mann-Whitney rank sum test was used to fit the normal distribution of the measurement data, and the relationship between the number of visits and the economic burden of the disease was analyzed by Spearman correlation analysis. The Multivariate analysis was performed using the Poisson regression model with P <0.05 The difference was statistically significant. Results The economic burden of different elderly patients with pulmonary tuberculosis from the first diagnosis institution, the confirmed institution and the first diagnosis result was statistically different (all P <0.05). The difference was statistically significant (H = 17.214,57.452,42.133, all P <0.05). There was a significant correlation between the number of elderly patients with tuberculosis in rural areas and the economic burden of disease (r = 0.132, P <0.05). Compared with village health clinics, the economic burden of treating elderly patients with tuberculosis in rural areas was significantly increased (OR = 1.279, 95% CI = 1.132-1.358) in private medical institutions, while in township hospitals, county-level TB prevention and treatment agencies (OR = 0.933, 95% CI: 0.911-0.963; OR = 0.917, 95% CI: 0.901-0.954; OR = 0.969, 95% CI: 0.933) ~ 0.989). Compared with the county-based prevention and control agencies, patients diagnosed at municipal-level prevention and treatment institutions and county-level hospitals will have significantly increased economic burden of illness (OR = 1.484, 95% CI 1.361-1.579; OR = 1.394, 95% CI 1.276 ~ 1.513). Patients diagnosed with common cold, bronchitis, pneumonia and pleurisy had a significantly higher financial burden of illness than those who had initially diagnosed pulmonary tuberculosis (OR = 1.227; 95% CI 1.123-1.411; OR = 1.371; 95% CI 1.211-1.604 ; OR = 1.275, 95% CI 1.173-1.563; OR = 1.242, 95% CI 1.063-1.472). The number of visits can significantly affect the economic burden of disease in rural elderly patients with pulmonary tuberculosis (OR = 1.139, 95% CI 1.015 to 1.224). Conclusions Increasing publicity and education on tuberculosis knowledge in rural areas, vigorously developing grassroots medical services and strengthening rural medical care for tuberculosis patients can effectively guide rural tuberculosis patients to seek reasonable treatment and alleviate the economic burden of disease in rural elderly tuberculosis patients.