新疆维吾尔自治区2017-2019年布鲁氏菌病患者医疗费用分析

目的 分析新疆维吾尔自治区（新疆）布鲁氏菌病（布病）患者的医疗费用及影响因素。方法 收集2017年1月1日至2019年12月31日期间首要诊断为布病患者的人口学信息、就诊信息和费用信息。通过非参数检验分析不同性别、年龄组、临床分期、并发症对患者医疗资源利用及医疗费用的影响。使用中位数描述布病患者的门诊和住院费用。结果 共13 532例纳入分析，其中门诊8 113例，住院5 419例，男性占67.8%（9 176/13 532），年龄（42.7±15.4）岁，以18~44岁（46.6%，6 304/13 532）和45~59岁（34.2%，4 622/13 532）年龄组为主。住院患者年龄（43.3±15.7）岁，高于门诊患者年龄（42.3±15.1）岁（Z=-3.85，P < 0.001）。住院患者就诊时，全身症状以发热（36.9%，1 997/5 419）和乏力（36.6%，1 983/5 419）常见，局部症状以关节/肌肉疼痛（68.9%，3 735/5 419）常见；急性期患者占79.1%（4 289/5 419），慢性期患者占20.9%（1 130/5 419）；患者有并发症占46.5%（2 519/5 419），主要为骨骼系统并发症。门诊患者人均门诊次数（1.6±1.4）次。住院患者次均住院天数为（11.3±4.2）d，慢性期和有并发症患者住院天数较长（P < 0.05）。住院患者同年也有门诊记录占89.3%（4 840/5 419），人均门诊次数（3.6±2.6）次。门诊患者医疗费用以化验费和药物费为主（75.1%），住院患者以药物费、化验费和其他费用为主（74.4%）。2017-2019年门诊患者医疗费用M（Q₁，Q₃）分别为61（52，497）、61（51，346）和58（46，318）元，住院患者医疗费用M（Q₁，Q₃）分别为8 214（6 355，10 721）、9 095（7 018，12 155）和9 492（7 530，12 351）元。患者年龄、临床分期、并发症和关节/肌肉疼痛症状为住院患者医疗费用的影响因素（P < 0.001）。结论 2017-2019年新疆布病住院患者经济负担较重，特别是高年龄组、慢性期、合并骨骼和神经系统并发症的患者。提高患者早期就诊和规范治疗意识，减少慢性化和并发症发生，可降低布病诊治所导致的经济负担。

Medical costs of brucellosis patients in Xinjiang Uygur Autonomous Region, 2017-2019

Objective To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Xinjiang Uygur Autonomous Region (Xinjiang).Methods Information on demographics, medical visits, and costs of patients diagnosed with Brucellosis were collected between January 1, 2017 and December 31, 2019. The effects of different genders, age groups, clinical stages, and comorbidities on patients'' health care utilization and medical costs were analyzed by nonparametric tests. The median was used to describe the outpatient and inpatient costs of patients with Brucellosis.Results A total of 13 532 patients (8 113 outpatient and 5 419 inpatient cases) were included in the analysis. A total of 67.8% (9 176/13 532) were male, with an average age of (42.7±15.4) years; age between 18-44 years (46.6%, 6 304/13 532) and 45-59 years (34.2%, 4 622/13 532) were the dominant groups. The mean age of inpatients(43.3±15.7) years] was higher than that of outpatients(42.3±15.1) years, Z=-3.85, P < 0.001]. When hospitalized patients are treated, systemic symptoms were common with fever (36.9%, 1 997/5 419) and fatigue (36.6%, 1 983/5 419), and with joint/muscle pain (68.9%, 3 735/5 419) being the highest proportion of local symptoms. A total of 79.1% (4 289/5 419) of inpatients were diagnosed with acute Brucellosis. A total of 46.5% (2 519/5 419) of inpatients had complications; skeletal system complications ranked the highest. The average number of outpatient visits per outpatient was (1.6±1.4) times. The duration of hospitalization was (11.3±4.2) days, with longer days for patients in the chronic phase and with complications (P < 0.05). A total of 89.3% (4 840/5 419) of inpatients had outpatient records in the same year, and the average number of outpatient visits per patient was (3.6±2.6) times. Outpatient medical costs were dominated by laboratory and drug costs (75.1%), and inpatient costs were dominated by drug, laboratory, and other costs (74.4%). Outpatient medical expenses M(Q₁, Q₃) were 61(52, 497) Yuan, 61 (51, 346) Yuan and 58 (46, 318) Yuan, respectively. Inpatients'' medical expenses M (Q₁, Q₃) were 8 214 (6 355, 10 721) Yuan, 9 095 (7 018, 12 155) Yuan and 9 492 (7 530, 12 351) Yuan, respectively. For patients, age, clinical stages, complications, and joint/muscle pain symptoms were influential factors for hospitalization costs (P < 0.001).Conclusions The economic burden was higher for inpatients, especially those in the high age group, with chronic phases and skeletal and neurological complications. Improving patients'' awareness of early treatment, standardized treatment, and reducing chronicity and complications are the main points in reducing the economic burden caused by Brucellosis diagnosis and treatment.