山东省农村慢性病家庭灾难性卫生支出及影响因素研究

  目的  分析云南省农村居民高血压、糖尿病、冠心病和脑卒中4种慢性病流行现状及对家庭经济影响。  方法  2015年1 — 9月，采用多阶段分层随机抽样方法抽取云南地区农村3 909户家庭进行调查，采用家庭灾难性卫生支出和因病致贫评价4种慢性病对家庭经济影响。  结果  当地农民4种慢性病导致总的家庭灾难性卫生支出发生率和因病致贫率分别为30.5 %（ 460/1 510）和25.2 %（380/1 510），其中因高血压、糖尿病、冠心病和脑卒中导致的家庭灾难性卫生支出发生率分别为25.4 %（258/1 015）、39.4 %（87/221）、39.8 %（76/191）和47.0 %（39/83）；导致的因病致贫发生率分别为19.8 %（201/1 015）、35.7 %（79/221）、34 %（65/191）和42.2 %（35/83）。患有高血压、糖尿病、冠心病、脑卒中、人均收入和年龄均是家庭灾难性卫生支出和因病致贫的影响因素，多因素logistic回归分析结果显示，患高血压、糖尿病、冠心病和脑卒中的患者家庭发生家庭灾难性卫生支出的风险分别是非患病家庭的3.5、3.1、6.2和9.9倍，患高血压、糖尿病、冠心病和脑卒中的患者家庭发生因病致贫的风险分别是非患病家庭的3.8、2.4、4.8和7.2倍，有老年人的家庭也更易出现家庭灾难性卫生支出和因病致贫，其发生风险分别是没有老年人家庭的1.9和1.5倍。较高的人均收入是家庭灾难性卫生支出和因病致贫的保护性因素。  结论  高血压、糖尿病、冠心病和脑卒中对云南省农村家庭经济的影响巨大。

Measuring the global burden of disease

  Objective  To analyze the prevalence of four chronic diseases (hypertension, diabetes, coronary heart disease and stroke) and the impact of the diseases on family economic condition among rural residents in Yunnan province.  Methods  Multistage stratified random sampling was used to select a representative sample of 3 909 rural families for a questionnaire survey between January and September 2015. Catastrophic health payments and medical impoverishment were used to assess the impact of the four diseases on household economic status.  Results  Among the households surveyed, the overall incidence rate of catastrophic health payments and medical impoverishment was 30.5% and 25.2%; the incidence rate of catastrophic health payments related to hypertension, diabetes, coronary heart disease (CHD), and stroke were 25.4%, 39.4%, 39.8%, and 47.0% and the rate of medical impoverishment were 19.8%, 35.7%, 34.0%, and 42.2%, respectively. Suffering from hypertension, diabetes, CHD, stroke, per capita income, and age were the risk factors of catastrophic health care payments and medical impoverishment. The results of multivariate logistic regression analyses revealed that after adjusting for confounding factors, households with patients of hypertension, diabetes, CHD, and stroke had the 1.7, 3.8, 3.5, and 4.7 times of risk for catastrophic health payments and 2.2,1.9,1.6, and 2.1 times of risk for medical impoverishment compared to the households with no sufferers of the diseases. The households with elderly family members had a 1.9 times of risk for catastrophic health payments and a 1.5 times of risk for medical impoverishment compared to those with no elderly family members. Higher per capita income was a protective factor for catastrophic health payments and medical impoverishment.  Conclusion  Hypertension, diabetes, CHD, and stroke had significant impacts on household economic condition among residents in rural Yunnan province. Effective measures are needed to improve the management of chronic diseases for reducing economic burden of the families with sufferers of the diseases.