空气污染健康损失的条件价值评估与人力资本评估比较研究

目的 探寻在我国定量评估环境污染健康经济损失的途径.方法 通过实例研究,采用条件价值评估方法和人力资本方法对北京市空气污染健康经济损失进行计算和比较.结果 2005年北京市空气污染降低50%的健康效益评估,人力资本法计算得到健康经济效益为21.83亿元,采用条件价值评估方法得到健康经济效益为108.91亿元,是人力资本法的4.99倍.结论 条件价值评估方法能够更全面地评估健康经济损失,它在我国的应用是可行的,仍需要进一步的实证应用.

Abstract：

Objective To explore the applicable method for the quantitative valuation of health economic loss by environmental pollution.Methods The contingent valuation method(CVM) and human capital method were respectively used to valuate the health economic loss by air pollution in Beijing and the comparison of the results was conducted.Results In 2005,the economic benefit of main air pollutants reductionby 50% in Beijing was 2.183 billion Yuan estimated by human capital method,and it was 10.891 billion Yuan estimated by CV M.The result of CVM is 4.99 times as high as that of human capital method.Conclusion CVM is a well recommended technique which can be used to estimate the total value of health loss by environment pollution,and this empirical study proved that it is feasible to estimated health economic loss in China.Further studies are needed to improve the efficiency of evaluation.     

清原县居民伤害流行病学调查

2000年全球疾病负担（global burden of disease, GBD）研究显示，伤害占全球死亡的9％，占伤残调整寿命年（disability adjusted life years, DALY）的12％，中国是世界上伤害死亡率和DALY最高的国家之一。伤害所致的健康寿命损失年（ years lived with disability, YLD）的计算需要年龄别伤害发生率及每种伤害不同损伤性质的比例，     

Estimating the Economic Effects of the Early Covid-19Emergency Response in Cities Using Intracity Travel Intensity Data

In the early days of the Covid-19 pandemic,China implemented the most stringent and serious emergency response.To understand the effect of such an emergency response strategy on the economic system,this study proposed a simultaneous overall estimation method using intracity travel intensity data.The overall effect is represented by the difference between intracity travel intensity with and without the emergency response.Using historical data and time series analysis,we compared intracity travel intensity post China’s implementation of the emergency response with predicted intracity travel intensity without such a response.The loss rates,defined by the proportion of intracity travel intensity loss,were calculated for 360 cities within 33 provincial-level regions in China based on data availability.We found that 30 days after the emergency response,21% of the cities saw over 80% recovery and 10% of the cities showed more than 90% recovery;45 days after the emergency response,more than 83% of the 360 cities witnessed 80% recovery.The correlation between gross domestic production loss rate and travel intensity loss rate was studied quantitatively to demonstrate the representativeness of the intracity travel intensity loss rate.This indicator was also used to analyze the spatial and temporal patterns of the effects on the economy.The results of this study can help us understand the economic effects caused by the early Covid-19 emergency response and the method can be a reference for fast and real-time economic loss estimation to support emergency response decision making under pandemic conditions.     

世界卫生组织健康调查资料的结构方程模型

Objective Based on the 2002 WHO health survey data, to explore the latent relationship among self-reported health level, the actual level of health, the social demographic characteristics and the risk factors, and to analyze the influence of the various surveillence indicators on self-reported health and the degree that the self-reported health explained the actual level of health.Methods Field tests for various components of the World health survey were conducted in nine countries during 2002, including India, Brazil, Burkina, Hungary, Nepal, Russia, Spain, Tunisia, and Vietnam (29 971 ).The survey questionnaire included a self-assessment component and anchoring vignette component.The self-assessment component data was adjusted and eliminated the affect of "cut-point bias" by using the anchoring vignette component data,and then was used to build the structural equation model on the relationship among selfreported health level, actual health level, social demographic characteristics and the risk factors.Results In the final structural equation model, "the actual level of health" = 0.80 × "the self-reported health level" +( - 0.04) × "the social demographic characteristics" + ( - 0.08 ) × "the risk factors" ( R2 = 0.66 ), and"the self-reported health level" = ( -0.70) × "the social demographic characteristics" +0.10 × "the risk factors" (R2 = 0.55 ).The standardized total effect of self-reported health to the actual level of health was 0.80 ,and that of the social demographic characteristics to the self-reported health and the actual level of health were - 0.70 and - 0.60, respectively.And the 16 items of self-reported health consisted of8 dimensions; and sorted by the power of impact to the actual health level, they were mobility, pain and discomfort, sleep, cognition, feelings, self-care ability, visual capacity and interpersonal activities.Conclusion There were significant linear correlation relationship between the actual level of health and the self-reported health, as well as between the self-reported health and the social demographic characteristics.And the self-reported 16 items used by the 2002 WHO health survey played an important role in the health evaluation of population.     

世界卫生组织健康调查资料的结构方程模型

Objective Based on the 2002 WHO health survey data, to explore the latent relationship among self-reported health level, the actual level of health, the social demographic characteristics and the risk factors, and to analyze the influence of the various surveillence indicators on self-reported health and the degree that the self-reported health explained the actual level of health.Methods Field tests for various components of the World health survey were conducted in nine countries during 2002, including India, Brazil, Burkina, Hungary, Nepal, Russia, Spain, Tunisia, and Vietnam (29 971 ).The survey questionnaire included a self-assessment component and anchoring vignette component.The self-assessment component data was adjusted and eliminated the affect of "cut-point bias" by using the anchoring vignette component data,and then was used to build the structural equation model on the relationship among selfreported health level, actual health level, social demographic characteristics and the risk factors.Results In the final structural equation model, "the actual level of health" = 0.80 × "the self-reported health level" +( - 0.04) × "the social demographic characteristics" + ( - 0.08 ) × "the risk factors" ( R2 = 0.66 ), and"the self-reported health level" = ( -0.70) × "the social demographic characteristics" +0.10 × "the risk factors" (R2 = 0.55 ).The standardized total effect of self-reported health to the actual level of health was 0.80 ,and that of the social demographic characteristics to the self-reported health and the actual level of health were - 0.70 and - 0.60, respectively.And the 16 items of self-reported health consisted of8 dimensions; and sorted by the power of impact to the actual health level, they were mobility, pain and discomfort, sleep, cognition, feelings, self-care ability, visual capacity and interpersonal activities.Conclusion There were significant linear correlation relationship between the actual level of health and the self-reported health, as well as between the self-reported health and the social demographic characteristics.And the self-reported 16 items used by the 2002 WHO health survey played an important role in the health evaluation of population.     

Preface

Reproductive health(RH) is a fundamental right of women, and it is alsothe basis for sustainable social and economic development. RH service shouldbe provided as an important part of the essential health services. In order to im-prove the health status of the rural poor in China the Government initiated a Ba-sic Health Services Project(Health Ⅷ, 1998--08--31--2004--06--30) spon-sored by the Word Bank. The project covers 7l poor rural counties in sevenprovinces and municipality with 32 million populations. The major objectives ofHealth Ⅷ are to strengthen the capacity of basic health care provision, improveservice quality and their utilization by the rural poor.     

Social Expenditure on Health Service and Its Macro Estimation

By social expenditure on health service(SEHS)we refer to the sum total of money paid by thewhole society during a certain period of year for the sake of preventing and treating diseases andof protecting and improving the people's health.It reflects objectively the total level of SEHSduring a certain period;the levels of health service expenditures on the parts of the whole society,enterprises,and individuals;the ratio between SEHS and total social expenditure;and the ratiosof SEHS to gross national product and to national income.The article discussed and analysed     

Health fitness and its influencing factors among urban elderly residents in Lanzhou cityCSCD

Objective To analyze the health fitness and its influencing factors among urban elderly residents in Lanzhou city. Methods A multi-stage sampling method was used to survey urban elderly residents in Lanzhou city with self-designed questionnaire from July 17th to August 3rd, 2020. The questionnaire included general information, life habits and Healthy Fitness Measurement Scale Version 1.0 (HFMS V 1.0), a total of 1 124 questionnaires were distributed and 1 124 were collected, including 1 043 valid questionnaires (92.8%). The HFMS V 1.0 was scored with Likert 5-point scale, positive and negative scoring method. The health fitness status of the subjects was divided into low, medium and high levels according to the norms of HFMS V 1.0 for Chinese urban elderly residents. The influencing factors were analyzed by using the chi-square test and ordinal logistic regression. Results The conversion score of HFMS V 1.0 for the urban elderly residents in Lanzhou city was 61.99±14.20, and the physical fitness score was the lowest (57.84± 16.98); of the 1 043 subjects, 332 (31.83%), 360 (34.52%) and 351 (33.65%) subjects were classified with low, medium, and high health fitness levels, respectively. Chronic diseases and poor dietary habits were the risk factors for the health fitness of urban elderly residents in Lanzhou city (both P<0.05); more adequate sun exposure, physical exercise, sufficient sleep, high self-health concern and high frustration quotient were protective factors for health fitness in those subjects (all P<0.05). Conclusion The overall level of health fitness in urban elderly residents in Lanzhou city is moderate, and chronic disease, dietary habits, sun exposure, physical exercise, length of sleep, self-health concern and frustration quotient are the main influencing factors. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

云南省文山州麻风高流行区新登记患者变化分析

目的 分析比较云南省文山州麻风流行动态及探讨流行原因.方法 依据当地上报1989、1999和2009年上半年3个时点麻风流行数据资料进行分析.结果 1989、1999和2009年上半年各阶段新登记病例数无明显变化,平均发现年龄33～35岁.疾病平均延迟期从1989年的35.2个月缩短到2009年的15.9个月,但在12个月以上者仍约占50%.2级畸残患者占15.2%～17.7%.麻风儿童患者比例从1989年的8 1%上升到2009年的13.1%."门诊发现"仍然是主要的发现方式,1999和2009年主动发现的病例数分别占44.3%和42.6%,均高于1989年的17.7%.结论 云南省文山州麻风流行没有明显好转,持续高流行的原因仍然是传染源未得到有效控制.

Abstract：

Objective To analyze the current situation and prevalence of leprosy in Wenshan district, Yunnan province. Methods To collect various data on leprosy reported by the health workers at the county level. Results The number of newly registered patients did not decrease significantly in 1989, 1999 and 2009, respectively. The mean age of patients at detection was 33-35 years old. Time of delay between the disease onset and being diagnosed was shortened from 35.2 months in 1989 to 15.9 months in 2009. However, the proportion of patients with more than 12 months of delay still accounted for nearly 50%. The proportion of Grade II disability fluctuated between 15.2%-17.7% and the proportion of child cases increased from 8.1% in 1989 to 13.1% in 2009. Clinics for skin diseases were the main locations for case detection. The proportion of new cases detected through 'active case finding' program accounted for 44.3% in 1999 and 42.6% in 2009, both higher than 17.7% in 1989. Conclusion The situation of leprosy in Wenshan district, Yunnan province, was still serious and the reason for the occurrence of new cases was related to the fact that the infectious source of leprosy had not been under full control.     

柳州市道路交通伤害的流行特征和经济负担分析

目的 分析柳州城市道路交通伤害流行特点及经济负担,为节约社会资源、预防控制道路伤害提供科学依据.方法 从广西公安厅交警总队收集柳州市城区2000-2009年道路交通伤害资料,整理分析各年龄段受伤害人员交通事故和交通伤的特点,计算伤害的经济负担并描述其分布.结果 2000-2009柳州市年城区道路交通伤害发生男性多于女性(t=427.88,P＜0.001),道路伤害发生人员职业主要为个体户、运输业人员,分别占26.19％和16.74％.15 ～44岁年龄组的负担最重,共损失伤残调整寿命年(disability adjusted of life years,DALY)68472.81人年,占总损失的78.38％,10年间共造成的经济损失为14.96亿元.结论 柳州城市道路交通伤害形式十分严峻,应加强从事个体和运输等驾驶员的交通安全意识和行为教育,加强高危时段的道路安全疏导和监督检查,加强道路的安全设施建设,合理配置资源,为道路使用者提供一个安全的道路交通环境,从而减轻柳州市经济负担.     

失能调整寿命年与人力资本法结合估计间接经济负担的研究

目的介绍失能调整寿命年（DALY）与人力资本法结合估计间接经济负担的方法。方法按照全球疾病负担研究（GBD）中计算DALY的方法，以年龄组分别计算出DALY，再利用DALY与人力资本法结合的方法中推荐的生产力权重加权求和。结果首先在计算DALY中，固定取值均参照GBD，惟一的主观指标是失能评估，在GBD中，要求8～12名各个国家和地区的不同专业的专家组成团，采用人数交换法和时间交换法评估失能，显然这样的方法在大多数研究中均无法实现。采用稍加修改的日常生活行为能力（ADL）量表，按照GBD中失能的理解重新赋值后计算出失能权重；其次，依据国民生产总值（GNP）及不同年龄组在社会价值的创造中赋予的不同生产力权重，分别计算出不同年龄组的间接经济负担，最后相加求得总人口的间接经济负担。结论DALY与人力资本法结合的方法估算间接经济负担是目前较为合理的方法，但其中DALY的计算较困难。     

桂林市2000-2009年道路交通伤害死亡的疾病负担分析

目的 综合评价桂林市2000-2009年道路交通伤害(road traffic injuries,RTI)死亡造成的健康负担和社会经济负担.方法 从广西公安厅交警总队收集桂林市2000 -2009年的RTI资料,计算RTI死亡造成的潜在寿命损失年(years of potential life lost,YPLL)、潜在工作损失年(working years of potential life lost,WYPLL)及校正潜在价值损失年(correct valued years of potential life lost,CVYPLL),并评价其经济负担.结果 (1)桂林市RTI死亡所致的YPLL和WYPLL损失以2000年最多,而CVYPLL损失均以2001年最多;(2)桂林市2000-2009年RTI死亡所致的YPLL、WYPLL和CVYPLL损失总体呈下降趋势;(3)男性RTI死亡所致的YPLL、WYPLL和CVYPLL损失均占70％以上,男性的平均WYPLL和平均CVYPLL损失均高于女性;(4)21 ～50岁的青壮年YPLL和CVYPLL损失最严重,而WYPLL的损失则以11 ～40岁的人群损失最严重;(5)2008年桂林市RTI总的经济损失最多,其次分别为2007年和2006年,2000-2009年RTI总的经济损失占当年国内生产总值的百分比呈逐年下降趋势;(6)总的经济损失以雁山区最多,其次为象山区.结论 桂林市RTI给个人、家庭及社会带来沉重的健康负担和经济负担,政府有关部门应及时采取有效的措施预防和控制RTI的发生,以减轻其疾病负担.     

威海地区居民伤害的疾病负担研究

目的:评价威海地区居民伤害的疾病负担;方法:采用多阶段分层整群随机抽样方法,从威海地区3市1区中抽取样本人群,进行回顾性问卷调查。使用DALY和经济损失指标从2个方面估计伤害的疾病负担,用SPSS11.0进行统计分析;结果:总的DALY损失为377.24人·年,每千人口平均为18.48人·年,男性高于女性;直接经济损失为194.07万元,间接经济损失为82.96万元。在所有的伤害中,因交通事故造成的DALY损失和经济损失都是最高的;结论:伤害是影响威海地区居民健康的危险因素之一,给社会和家庭带来了沉重的疾病负担。     

重庆市2010-2013年人群疾病负担研究

目的 分析重庆市人群所患疾病的健康损失和经济损失负担,为制定疾病防控策略提供可靠的科学依据。方法 采用伤残调整生命年(DALY)测量重庆市2010-2013年人群疾病的健康损失,以二步模型法计算直接经济负担,将DALY与人力资本法结合测算疾病的间接经济负担。结果 2010-2013年重庆市DALY(/1 000人)损失分别为123.90、127.01、123.30和125.99。其中疾病负担模式以非传染性疾病为主(83%~87%),其次为损伤,最低的为传染性疾病。2010-2013年前五位疾病分类均为呼吸系统疾病、循环系统疾病、恶性肿瘤、意外伤害、精神神经疾病。2013年重庆市疾病总经济负担为1 621.34亿元,其中直接经济负担和间接经济负担分别为794.42亿元和826.92亿元,主要负担在循环系统疾病、呼吸系统疾病、损伤、恶性肿瘤和肌肉骨骼和结缔组织疾病等疾病。结论 呼吸系统疾病、循环系统疾病、恶性肿瘤、损伤给重庆市居民带来了严重的健康和经济损失负担,应重点加强这些疾病的预防和控制。     

应用伤残调整寿命年测量山东省居民疾病负担

目的:应用伤残调整寿命年测量山东省居民疾病负担,提出该地区主要卫生问题,为卫生决策提供科学依据。方法:以山东省2000—2005年19个疾病监测点的死因监测资料为基础,利用世界卫生组织(WHO)提供的方法计算不同疾病在不同性别年龄人群所造成的伤残调整寿命年(DALYs),其中,YLDs根据WHO公布的亚太区2002年疾病负担数据进行估算。结果:2000—2005年山东省疾病监测系统居民因为早死和残疾年平均损失149.74个DALYs/千人,其中,76.6%的DALYs损失因慢性非传染性疾病所致,14.1%由传染性疾病等引起,9.2%因为意外伤害造成;接近1/2(45%)的DALYs损失发生在60岁以上人群;恶性肿瘤为造成男性居民DALYs损失的首位原因,其次为精神行为疾患、意外伤害、脑血管病和心脏病等,女性居民则以精神行为疾患为DALYs首位原因,其次为心脏病、恶性肿瘤、脑血管病和呼吸系统疾病。结论:以循环系统疾病、精神行为疾患和恶性肿瘤为首的慢性非传染性疾病为造成山东省疾病负担DALYs损失的主要原因,对于精神行为疾患的重要性的认识有待于进一步提高,研究的主要局限性在于发病率资料的缺乏。     

应用DALY结合人力资本法研究某三甲专科医院医院获得性重症肺炎的间接经济负担

目的应用伤残调整寿命年(DALY)结合人力资本法初步研究某三甲专科医院医院获得性重症肺炎(SHAP)患者的间接经济负担。方法按照全球疾病负担研究中计算DALY的方法,分别计算出某三甲医院2016年1月1日—2017年12月31日SHAP各年龄组患者DALY,再利用DALY与人力资本法结合估计SHAP患者的间接经济负担,并根据SHAP致病菌是否是多重耐药菌进行分组,比较两组患者间接经济负担。结果 71例SHAP患者,损失DALY 172. 35年,平均疾病负担为2. 43 DALY,平均间接经济负担51 428. 37元。SHAP患者多重耐药菌感染组(46例)、非多重耐药菌感染组(25例)平均疾病负担分别为3. 36、0. 71 DALY,平均间接经济负担分别为77 235.32、3 957. 18元;两组SHAP患者平均间接经济负担比较,差异有统计学意义(P 0. 05)。结论 SHAP患者平均疾病负担及间接经济负担均不低,其中SHAP患者多重耐药菌感染的间接经济负担高于非多重耐药菌感染。     

2006-2007年乳山市居民死亡水平及疾病负担研究

[目的]了解乳山市居民死亡水平及流行现状,应用伤残调整寿命年（DALYs）测量疾病负担,找出严重影响居民健康的主要疾病,为卫生决策提供科学依据。[方法]以2006-2007年乳山市全人口死因监测资料为基础,描述人群死亡概况．利用世界卫生组织（WHO）提供的方法计算不同疾病造成的DALYs,其中,YLDs根据WHO公布的亚太区2002年疾病负担数据进行估算。将DALYs与人力资本法（HCA）相结合。利用人均国内生产总值（GDP）计算各类死因的间接经济负担。[结果]心脑血管疾病、恶性肿瘤、伤害、慢性呼吸道疾病和其他肿瘤居死因谱前5位;恶性肿瘤、伤害和心脑血管疾病为人群期望寿命和工作寿命损失的前3位原因,77．86％的PYLL和78．59％的WPYLL为这3类疾病所致;各种疾病导致的疾病负担为11．74万个健康生命年损失。其中因早死所致的健康生命年损失为6．40万个YLLs,因伤残所致的健康生命年损失为5．34万个YLDs;精神神经系统疾病、心脑血管疾病、恶性肿瘤、伤害和肌肉骨骼疾病为人群前5位疾病负担原因;各种疾病造成的人均间接经济负担为2372．87元,估计导致的间接经济负担为13．61亿元,占2007年国内生产总值（GDP）的5．41％。[结论]2006～2007年乳山市人群总死亡水平低于山东省同期水平,粗死亡率随时间变动呈上升趋势,经标化后则下降趋势明显,提示人口老龄化程度加剧。男性人群死亡水平高于女性,50岁以上年龄组死亡概率和风险增大明显。应用CDR、PYLL和DALY三种指标综合分析显示．无论从哪个角度来衡量,心脑血管疾病、恶性肿瘤、伤害已经成为威胁人群健康的最主要“杀手”,且对人群健康的危害正日益加重。     

江苏省狂犬病疾病负担研究

目的通过对江苏省狂犬病的疾病负担进行统计分析和综合评价,为制定疾病防制策略提供参考依据。方法收集2008—2018年江苏省狂犬病疫情资料,进行流行病学特征分析,同时使用世界卫生组织(WHO)公布的计算工具评估因狂犬病早死导致的伤残调整寿命年(DALYs),并结合人力资本法评估早死间接经济负担。结果2008—2018年江苏省累计报告狂犬病病例565例,男女性别比为1∶0.42,所有病例中农民超过了73%;DALYs总损失为12318.22人年,年均损失1119.84人年;DALY强度为0.014人年/1000人;男性年均损失DALYs783.82人年,显著高于女性(t=2.984,P<0.05);45~59岁年龄组损失的DALYs居首位,约占总损失的35.15%;70~79岁年龄组DALY强度最高,为0.0219人年/1000人;江苏省每年因狂犬病死亡导致的间接经济负担为4929.29万元,其中45~59岁组所占比例最高。结论狂犬病主要负担人群为男性以及45~59岁年龄组人群,此外<15岁青少年儿童的负担也较大,应加强对此部分人群的关注,并制定相应防控对策。     

广州市SARS病例经济负担研究

目的估计2003年广州市SARS确诊病例的疾病经济负担和分析住院费用的影响因素。方法收集2003年广州市1 059例SARS确诊病例住院资料及问卷调查339例SARS确诊病例的流行病学资料,根据其住院费用、医疗相关费用和DALY指标计算直接经济负担和间接经济负担。结果2003年广州市1 283例SARS临床确诊病例的总经济负担为5 174.57万元,其中直接经济负担3 107.66万元,间接经济负担2 066.91万元,人均经济负担4.03万元。直接负担中病例的住院费用占83.66%,药费占住院费用比例最高,为54.19%,病例人均住院费用20 263.21元。间接负担中死亡病例的寿命损失年YLLs值为654.73,折算成经济指标后为1 489.43万元,占间接负担的72.06%;存活病例的误工损失为577.48万元。职业、年龄、入院时间、医院级别和住院天数是住院费用的影响因素(P<0.01)。结论SARS确诊病例的人均经济负担较高,直接经济负担高于间接经济负担,直接经济负担以住院费用为主;制定策略降低住院费用对减轻SARS的经济负担具有重要意义。