基于多元逐步回归分析的川、浙、津三地慢性病患者住院费用影响因素研究

目的 探讨川、浙、津三地慢性病患者住院费用状况及影响因素。 方法 于2017年9月-2019年7月采用分层抽样和随机抽样结合的方法，对三地共559名慢性病患者进行了问卷调查。基于SPSS22.0和STATA14.0，利用Kruskal-Wallis H、Mann-Whitney U检验、多元逐步回归模型进行影响因素分析。 结果 慢性病患者平均住院费用为11578.9元。年龄（b=0.024）、婚姻状况（已婚:b=-0.856；丧偶:b=0.919）、一年内是否健康体检（b=-0.350）、慢性病种类（消化系统疾病:b=0.370；脑血管疾病:b=0.462;癌症:b=0.559）、多重慢病(b=0.372)、住院天数(b=0.024)是四川慢性病患者住院费用的影响因素（P<0.05）；月收入水平(3000~4000:b=0.290;>4000:b=0.357)、医疗保险(城镇职工医疗保险:b=-0.429；城镇居民医疗保险:b=0.300)、慢性病种类（糖尿病:b=0.374，癌症:b=1.005）、多重慢病（b=0.364）、住院天数（b=0.018）是浙江慢性病患者住院费用的影响因素（P<0.05）；户口性质（b=0.439）、年龄（b=0.018）、一年内是否健康体检（b=-0.399）、慢性病种类（呼吸系统疾病:b=0.900；癌症:b=1.049）、住院天数（b=0.018）是天津慢性病患者住院费用的影响因素（P<0.05）。结论 为有效降低慢性病患者住院费用，建议三个地区均加强慢性病筛查与预防，鼓励定期体检；重视老年慢性病患者健康教育；按病种制定标准住院日。四川应重视慢性病患者情感支持，提高饮食管理水平。浙江应完善医保补偿机制，提高健康公平性。天津则需加强空气治理，并关注农村弱势群体健康问题。

Influencing factors of hospitalization expenses among patients with chronic diseases based on multiple stepwise regression analysis,Sichuan, Zhejiang and Tianjin

Objective To investigate the status of hospitalization expense and influencing factors of patients with chronic diseases in Sichuan, Zhejiang and Tianjin. WTHZ]Methods WTBZ]From September 2017 to July 2019,559 patients with chronic diseases in Sichuan, Zhejiang and Tianjin were surveyed by using a combination of stratified sampling and random sampling. SPSS22.0 and STATA14.0 were used to analyze the influencing factors with Kruskal-Wallis H test, Mann-Whitney U test and multiple stepwise regression model. WTHZ]Results WTBZ]The average hospitalization cost for patients with chronic diseases was 11,578.9 yuan. Age (b=0.024), marital status (married: b=-0.856; widowed: b= 0.919), physical examination within one year (b=-0.350), chronic disease type (digestive system diseases: b=0.370; Cerebrovascular diseases: b=0.462; Cancer: b=0.559), multiple chronic diseases (b=0.372), and length of stay (b=0.024) were the influencing factors of hospitalization costs for patients with chronic diseases in Sichuan (P<0.05). Monthly income level (3000-4000: b=0.290; >4000: b=0.357), Medical insurance (medical insurance for urban employees: b=-0.429; Medical insurance for urban residents: b=0.300), chronic disease type (diabetes: b=0.374, cancer: b=1.005), multiple chronic diseases (b=0.364), and hospitalization days (b=0.018) were the influencing factors of hospitalization costs of patients with chronic diseases in Zhejiang (P<0.05). Household type (b=0.439), age (b=0.018), physical examination within one year (b=-0.399), type of chronic diseases (respiratory diseases: b=0.900; Cancer: b=1.049) and hospitalization days (b=0.018) were the influencing factors of hospitalization costs of patients with chronic diseases in Tianjin (P<0.05). WTHZ]Conclusion WTBZ]In order to effectively reduce the hospitalization costs of patients with chronic diseases, all three regions should strengthen the screening and prevention of chronic diseases, encourage regular physical examinations, promote health education for elderly patients with chronic diseases, and standard hospitalization days of diseases. Sichuan should attach importance to emotional support for patients with chronic diseases, improve their diet management. Zhejiang should perfect medical insurance compensation mechanism and improve health equity. Tianjin needs to strengthen air pollution management and pay attention to the health of vulnerable rural groups in rural areas.