毕节市敏感肺结核患者家庭灾难性支出情况分析

目的 了解毕节市敏感肺结核患者家庭疾病灾难性支出（CTC）及影响因素，为降低患者家庭负担提供政策建议。方法 以2020年5—6月期间毕节市登记并在调查时已成功治疗的敏感患者为调查对象，通过概率比例抽样对其进行问卷访谈。灾难性支出采用率描述，用χ2检验和二分类logistic回归分析其原因。结果 毕节市309例肺结核患者家庭总自付费用 M （ P 25， P 75）为5 169.31（2 098.52，14 778.49）元；直接医疗费用、直接非医疗费用和间接费用 M （ P ? P ?分别为1 688.15（987.31，3 337.50）、720.00（200.00，1 425.00）和1 200.00（0.00，8 390.00），差异具有统计学意义（χ2=63.545， P ＜0.001）。309例患者家庭CTC发生率为52.43%；其中，家庭年收入较低（ OR =25.740，95% CI :9.676～68.473）、住院（ OR =3.515，95% CI :1.782～6.933）、确诊延迟（ OR =2.492，95% CI :1.297～4.789）是导致其发生CTC的危险因素（ P 均＜0.05）。结论 毕节市肺结核患者经济负担以间接费用为主，CTC发生率较为普遍。其中，家庭年收入低、住院和确诊延迟患者是其重要危险因素，可针对性地加强患者健康教育、落实医疗机构诊疗规范以及通过政府和社会给予患者补偿，共同降低其疾病负担减少CTC情况。

Catastrophic total costs of patients with sensitive pulmonary tuberculosis,Bijie City

Objective To understand the family disease CTC and influencing factors of sensitive pulmonary tuberculosis patients in Bijie City to provide policy suggestions for reducing the family burden of patients.]Methods The sensitive patients registered in Bijie City from May 1 st to June 30th, 2020, and successfully treated at the time of investigation were investigated, interviewed by probability proportional sampling. CTC was described by rate and the causes were analyzed by chi-square test and binary logistic regression.]Results The total out-of-pocket expenses of 309 patients with pulmonary tuberculosis in Bijie City were 5 169.31（2 098.52，14 778.49）yuan. The direct medical expenses, direct non-medical expenses, and indirect expenses were 1 688.15 (987.31, 3 337.50), 720.00 (200.00, 1 425.00), and 1 200.00 (0.00, 8 390.00) respectively, the difference was statistically significant（x2=63.545，P＜0.001）. The CTC rate of 309 patients was 52.43%. Among them, low annual family income (OR=25.740，95%CI:9.676-68.473), hospitalization (OR=3.515，95%CI:1.782-6.933), and delayed diagnosis(OR=2.492，95%CI:1.297-4.789) were the risk factors leading (all P<0.05).]Conclusion The economic burden of tuberculosis patients in Bijie City is mainly indirect costs and the CTC rate is more common. Among them, low annual family income, hospitalization, and delayed diagnosis patients are important risk factors. We can jointly reduce the disease burden and reduce CTC by strengthening patient health education, implementing the diagnosis and treatment norms of medical institutions, and compensating patients through the government and society.