先天性心脏病的疾病经济负担研究

目的对先天性心脏病（简称先心病）的经济负担进行测算，以便对先心病的预防和控制策略进行规划。方法课题组于2004年对上海、石家庄和西安三地的先心病病人的家属进行卫生服务调查。经济负担调查包括直接医疗费用、直接非医疗费用和间接费用（如劳动收入损失）的调查。采用发病率法，对2003年我国每一新发先心病病例生命周期的经济负担进行测算。结果课题组共调查了303位先心病病人家属。从社会学角度看，每一新发先心病病例生命周期的经济负担平均是9．7万元，其中病人早亡经济损失所占比重为64％，直接卫生保健费用占32％。生存率和人均GDP等因素对疾病的经济负担有影响。结论先心病病人使家庭和社会承受了沉重的经济负担。因此，亟需对先心病病人及家庭提供社会支持，以降低其经济负担。     

Hospital-based study of the economic burden associated with rotavirus diarrhea in eastern China

Rotavirus infection is one of the most common causes of severe diarrhea in China. To evaluate the economic burden associated with rotavirus infection of children in China, we combined data on the disease burden of rotavirus-associated costs for samples comprising 832 outpatients and 604 inpatients from five seaside cities. The average social costs and direct medical costs for rotavirus-associated admissions were calculated to be US $61.64 and US $40.73 for outpatients, and US $684.15 and US $559.48 for inpatients, respectively, from October 1, 2006 to December 1, 2007. On average, the private cost ranged from US $54.64 for outpatients to US $454.24 for inpatients when children suffered from rotavirus infection. Accordingly, this cost accounted for 35.19-293% of the monthly income of an unskilled or service worker. We estimated that the annual number of children with rotavirus diarrhea was 12.10 million. Consequently, the total annual direct cost, total annual social cost, and total annual private cost were US $271.4 million, US $365.0 million, and US $290.0 million, respectively. Furthermore, rotavirus diarrhea affected children's behavior and emotions, which had a great influence on the caretakers’ quality of life. These data indicate the potential requirement for a safe and effective rotavirus vaccine to reduce the economic burden associated with rotavirus disease.     

我国糖尿病的发病变化及其经济负担研究

目的：揭示我国糖尿病的流行现状、变化趋势及经济负担情况。方法：利用流行病学、工生统计学及卫生经济学方法。结果：糖尿病患病率增加明显，90年代与80年代相比不同地区增加约2～4倍。城市和农村糖尿病死亡率的年均增长率分别为785％和7．25％，住院病例数的年增长率分别高达21％和19％。1990年我国糖尿病所致的残疾调整生命年损失为76．6万人年，由此造成的间接社会经济损失高达42.57亿元。1993年全国治疗糖尿病共支出22．16亿元，其中门诊总费用为19．30亿元，住院总费用为2．86亿元。结论：应加强对糖尿病防治工作的投资，制定攻关计划，降低糖尿病的危害。     

肥胖疾病负担的研究现状

随着世界上许多国家工业化和城市化进程的加快,肥胖的发病率和死亡率显著增高。过去肥胖在发达国家人数较多,而现在,肥胖人数在发展中国家亦明显地快速增长。全球目前有超过10亿的超重人口,其中至少3亿是肥胖,如不采取措施加以控制,到2015年将有15亿肥胖人口。发展中国家将要面对肥胖带来的无法估量的慢性病负担。1．肥胖疾病负担研究的重要意义：疾病负担是指疾病造成的健康、经济、资源的损失与产生的生物、心理和对社会的危害,以及对疾病结局如死亡、失能和康复等所带来的后果     

小儿脑性瘫痪的病例对照研究

目的　确定脑瘫的危险因素。方法　１９９７ 年５ ～６ 月在江苏南部进行了以人群为基础的１∶２ 病例对照研究。结果　将脑瘫的危险因素分为４ 类：胎儿发育迟缓、早产和低出生体重;出生窒息、颅内出血、缺血缺氧性脑病及高胆红素脑病;胎头吸引和脑外伤;其他（ 主要是产前因素） 。结论前２ 类因素与脑瘫的关联程度强并且重复性好。应加强产前保健,预防低出生体重等因素的发生;对出生窒息应积极治疗、密切观察;对于第３ 类因素应以产科实践和教育家长为关键措施;对第４ 类因素的认识程度还比较匮乏,可能与第１ 和第２ 类因素密切关联。     

慢性乙型病毒性肝炎及其相关疾病直接经济负担研究

目的研究慢性乙型病毒性肝炎(慢性乙肝)相关疾病患者经济负担,探讨影响经济负担的相关因素。方法对宁波市630例慢性乙肝相关疾病住院患者进行问卷调查,出院后查阅病历,摘录住院费用并计算过去一年的直接费用。分别以直接医疗费用、直接非医疗费用和直接费用为应变量建立逐步多元线性回归,筛选影响费用的因素。结果宁波市平均1例慢性乙肝相关疾病患者年直接医疗费用、直接非医疗费用和直接费用分别为61 606.78、3 532.73和65 139.51元。直接费用原发性肝癌最高,为123 571.78元,其余依次为慢性重型乙肝93 278.65元,肝硬化82 467.99元,慢性乙肝21 824.31元。直接医疗费用和直接非医疗费用平均比值为17.44,原发性肝癌、肝硬化、慢性重型乙肝和慢性乙肝依次为19.17、15.52、21.62和17.02。患者年均直接费用是患者个人年收入的1.75倍,家庭收入的1.02倍。患者职业、合并其他疾病、出院诊断分类和个人年收入等因素均分别是直接费用(包括直接医疗费用和直接非医疗费用)的相关因素。结论宁波市乙肝相关疾病患者经济负担沉重。直接医疗费用大于直接非医疗费用;随着疾病的加重,直接医疗费用增加。     

中国老年人口疾病经济负担变化趋势与应对策略

目的：揭示中国60岁以上老年人口疾病经济负担变化趋势与特点,为制定老年人卫生服务、老年人医疗与护理保障制度提供参考。方法：利用1993、1998、2003、2008年国家卫生服务调查和2011年卫生部医改监测专题调查的纵向可比资料,对老年人因病就诊、自我医疗、住院、失能照护所致经济负担进行时间趋势与增长率变化分析。结果：1993—2011年,老年人疾病经济负担从775亿元增加至4283亿元（当年价格）,占GDP的比例从2.1%增加至3.3%,经价格指数调整,疾病经济负担年均增长12.9%,其中治疗相关费用年均增长12.3%、残障照顾人工费用年均增长14.1%。结论：中国老年人口的疾病经济负担增长迅速,明显快于城乡居民收入和GDP的增长速度,必须尽快建立相关制度,以确保中国社会经济的可持续发展。     

我国伤害所致死亡损失生命年和经济负担分析

目的 分析我国伤害所致疾病负担,为政府确定卫生工作的重点提供依据。方法 人口来源于《中国人口和就业统计年鉴 2013》,伤害死亡数据来源于《中国卫生统计年鉴 2013》,人均国内生产总值来源于《中国统计年鉴 2013》,门诊费用和住院费用来源于国家卫生服务调查。采用全球疾病负担的方法,计算死亡损失生命年（years of life lost, YLLs）、直接和间接经济负担。结果 2012年我国伤害所致疾病负担强度为8.38 YLLs/1 000。疾病负担顺位的前5位为：机动车辆交通事故、自杀、意外跌落、机动车以外的运输事故和淹死。各类伤害所致疾病负担均存在农村高于城市、男性高于女性的特征。交通事故所致疾病负担主要集中在20～60岁年龄段,自杀疾病负担强度存在随年龄增加的趋势,意外跌落多见于老年人（60岁及以上）,淹死所致疾病负担主要集中在1～15岁年龄段。伤害所致总经济负担高达3 792.31亿元。结论 伤害给我国居民健康和社会经济造成了巨大损失,应加强对各类伤害尤其是交通事故、自杀、意外跌落和淹死的预防和干预。     

浙江省小儿脑性瘫痪患病情况调查

目的　了解本省儿童脑瘫的患病情况。方法　 1998年 10～ 11月调查了 15个市县 66个乡 (镇、街道 ) 1～ 6岁儿童中脑瘫患病情况。先统一培训调查人员 ,后按筛查标准列出体检对象 ;然后进一步明确诊断。结果　调查地区共登记 1～ 6岁儿童 62 949人 ,诊断脑瘫 92例 ,患病率为 1 46‰ ,性别与年龄间无显著性差异 (P <0 0 5 )。城市与农村间也无显著性差异。结论　本次调查的患病率低于西方一些发达国家 ,也低于国内江苏等的报道[1 ,2 ] 。     

The methodological quality of economic evaluations of measles outbreaks: A systematic review of cost-of-illness studies

ObjectivesTo identify the main cost components included in the economic evaluations of measles outbreaks, their items and cost drivers, and evaluate the quality of costing methodology, analyzing the key features that may affect the validity of these studies in countries with different income levels. Methods: We systematically searched multiple databases EMBASE, MEDLINE (via PubMed), Biblioteca Virtual em Saúde do Ministério da Saúde (BVS MS), NHS Economic Evaluation Database (NHS EED) and NHS Health Technology Assessment (NHS HTA) (via The Centre for Reviews and Dissemination Library – CRD), and EconLit, SCOPUS, and Web of Science, selecting cost analysis and cost of illness studies (COI) of measles outbreaks. Two independent reviewers screened articles for relevance and extracted the data. The quality of costing methods was assessed using a guide to critical evaluation of COI studies. We performed a qualitative narrative synthesis. Results: Twenty-two studies were reviewed. Most studies evaluated outbreaks that occurred from 2011 to 2013 and 2017 to 2019. Total costs varied from $40,147 to $39.3 million. Per case cost varied from $168 to $49,439. The main drivers of measles outbreak costs were outbreak response, personnel, and productivity losses. Most studies (20/22) did not report the costing methodology adopted, the degree of disaggregation used in the identification and measurement of resource and costs components and the method for the valuation of resource and cost components. Conclusions: The quality of the costing methodology, its transparency and accuracy are essential to the validity of these studies results and their potential use to allocate public health resources in the most efficient manner and to inform measles outbreak control strategies, with rapid and effective response.     

Pain and its relationship with postural asymmetry in adults with cerebral palsy: A preliminary exploratory study

BackgroundPain in adults with cerebral palsy (CP) is commonly reported, with muscular and skeletal dysfunction resulting in postural asymmetry as potential contributors to multifactorial causes of pain. The relationship between pain and postural asymmetry of the thoracic cage, pelvis and hips in non-ambulatory adults with CP however is unknown, particularly in those with cognitive and communication limitations.ObjectiveThe primary aim of this study was to describe and quantify day and night pain in non-ambulatory adults with CP. Secondary aims were to investigate any relationship between pain and postural asymmetry and to describe current pain management strategies utilised.MethodsPain was measured using the Non Communicating Adult Pain Checklist (NCAPC). Posture was measured using the Goldsmith Indices of Body Symmetry (GIofBS) and radiographs. Correlations between pain scores and posture (GIofBS and radiographs) were assessed using non-parametric analysis. Information regarding pain management strategies was gained from medical records and carer interviews.ResultsSeventeen non-ambulatory adults with CP were recruited. High levels of day pain were experienced by ≥ 50% of participants with a high incidence of prescribed medications targeting pain. Strong positive correlations between day and night NCAPC scores, chest right left ratio and night pain, Cobb angle and day pain and between Cobb angle and night pain were evident.ConclusionThe incidence and severity of pain in non-ambulatory adults with CP is high with postural asymmetry a potential contributor. Pain remains difficult to assess and manage in adults with significant cognitive and communication impairments and warrants further investigation.     

中国1993－2008年脑血管病直接经济负担研究

目的 评价1993－2008年中国脑血管病直接经济负担状况及其变化趋势。方法 利用1993、1998、2003和2008年4次国家卫生服务调查数据,采用二步模型法推算中国1993－2008年≥30岁人群脑血管病直接经济负担及其变化情况,包括脑血管病直接门诊费用和直接住院费用。结果 1993－2008年中国≥30岁人群脑血管病直接经济负担明显上升,从1993年的84.73亿元上升至2008年的1 031.25亿元,去除物价影响后,实际增长了5.3倍,年均增速为13.1%,高于同期卫生总费用和GDP的增长速度,其中2003－2008年直接经济负担的增长速度最快,年均增速为19.8%。结论 中国≥30岁人群脑血管病疾病负担给个人和社会造成的影响已相当严峻,应加强对脑血管病相关领域的理论和实践研究。     

Illuminating cases: understanding the economic burden of illness through case study household research

Understanding the economic burden of illness for households can inform pro-poor health and social protection policy, yet research is in its infancy and appropriate methods require further debate. Quantitative studies are powerful when applied to the right health policy questions, including the measurement of illness cost burden indicators. However, this paper argues that not all dimensions of economic burden can be measured easily, some dimensions relevant to policy, such as social actors' responses to illness and their strategies to cope with illness costs, cannot be reduced to quantitative indicators at all, and large-scale surveys may overlook context-specific processes operating at household level that influence people's paths in and out of poverty as a result of illness. This leaves scope for longitudinal case-study household research to enhance understanding of economic burden and provide additional policy insights on how to better protect households from cost burdens and improve resilience. Drawing on the experience of research in urban Sri Lanka, the paper sets out several comparative advantages of case study research in this area. First, it complemented household survey data by revealing the complex and dynamic nature of illness costs and how these cost patterns (for example, sudden cost peaks) influenced household ability to manage costs. Secondly, it improved understanding of vulnerability or resilience to illness costs by capturing the diverse resources, within and outside the household, used by people to cope with illness costs, and the social institutions and decision-making processes that influenced access to them. Thirdly, the cases enabled the research to develop a picture of the inter-connected factors mediating the impact of illness on livelihood outcomes.     

我国结核病定点医院肺结核患者家庭经济负担现况调查

目的 了解我国结核病定点医院就诊的肺结核患者从症状开始至治疗结束全程自付费用及其对家庭造成的经济负担现状,探讨结核病对家庭经济负担的影响因素。方法 以我国东、西部结核病定点医院为抽样框,采用分层整群抽样,在我国东部和西部各抽取5家结核病定点医院,连续招募2017年4－6月期间在上述10家医院就诊的肺结核患者535例,采用问卷调查方式收集患者的社会人口学特征、诊断及治疗相关费用。结果 我国结核病定点医院肺结核患者诊疗全程的人均自付总费用为12 635.5元,其中直接医疗费用占65.3%。不同阶段费用分析显示,近50%的费用发生在定点医院治疗前;文化程度低、初治、初始痰涂片阴性患者发生在定点医院之前的费用所占的比例显著高于其他人群。结核病患者自付总费用占患病前家庭年总收入比（费用收入比）的中位数为22%（10%～57%）。以肺结核患者费用收入比四分位为因变量进行有序logistic回归分析发现,文化程度低、家庭年收入低以及住院、伴有其他慢性病肺结核患者自付总费用占家庭年收入比例高。结论 定点医院就诊患者全程自付费用仍然较高。建议加强结核病非定点医疗机构发现并及时转诊患者的能力建设;结合不同类型患者的实际情况,进一步优化减免政策。     

某农村地区恶性肿瘤构成及经济损失分析

目的了解我国农村贫困地区肿瘤高发区的恶性肿瘤构成情况和恶性肿瘤患者经济负担。方法对河南省某县11个乡（镇）39个村的肿瘤现患病人和近3年来因恶性肿瘤死亡者家属或知情者进行入户问卷调查。结果78例恶性肿瘤现患病人中,占前两位的是消化系统肿瘤和生殖系统肿瘤,分别为40例和17例,分别占51.28%和21.79%;直接医疗费用算术平均值为37 154.92元,直接非医疗费用为4 323.95元,间接经济损失算术平均值为8 749.09元。因恶性肿瘤死亡者15人,直接经济损失和间接经济损失分别为34 716.57元和7 603.57元。结论消化道肿瘤和生殖系统肿瘤是研究地区主要的恶性肿瘤,恶性肿瘤的发生给农民带来了沉重的经济负担。     

北京市房山区手足口病经济负担及影响因素研究

目的 了解北京市房山区手足口病造成的经济负担,判断其影响因素,寻找减轻经济负担的方法。方法 采取问卷调查及实验室检测,对研究对象开展调查,收集患者一般情况及因疾病造成的经济损失情况,估算手足口病造成的经济负担,并根据调查结果及实验室检测结果分析影响因素。结果 共调查手足口病患者43例,总经济负担78 010.52元,其中直接经济负担33 681.52元,间接经济负担14 879.00元,无形经济负担29 450.00元。经多因素Logistic回归分析,手足口病经济负担的影响因素为就诊次数。结论 对北京市房山区手足口病造成的经济负担的测算是低估的。提高医院诊疗水平,控制和降低手足口病发病率将有效减轻手足口病造成的经济损失。     

汉中市2003年农村脑卒中患者经济负担的分析

目的分析汉中市2003年农村人口脑卒中所致直接和间接经济负担。方法直接经济负担的分析中,采用自行设计的调查表,入户进行问卷调查;间接经济负担的分析采用DALYs与人力资本法结合的方法。结果汉中市农村人口脑卒中患者直接经济负担为3100元,男性和女性间差异无统计学意义(P>0.05),各年龄组间差异也无统计学意义(P>0.05)。首发患者的直接经济负担为5500元,既往患者的直接经济负担为1700元,首发患者的直接经济负担明显高于既往患者(P<0.05)。脑卒中间接经济负担为1993977.8元,患者人均间接经济负担为12158.4元。结论脑卒中给汉中农村人口和社会造成了沉重的经济负担,应制定相应策略以降低其所引起的经济负担。     

我国手足口病经济负担研究概况

自2010年,手足口病报告病例数一直处于我国法定传染病首位。手足口病给众多家庭及社会带来了经济损失。本文主要聚焦近年来我国关于手足口病经济负担相关的研究,系统地阐述我国手足口病经济负担的研究方法、主要结果及研究中存在的问题,以期为准确估算手足口病经济负担提供参考。诸多研究显示手足口病,尤其是手足口病重症及死亡病例对社会造成了严重的经济负担。应着重减低手足口病重症及死亡的风险,同时减低轻症病例的发病水平,以降低手足口病对家庭和社会的经济负担。     

云南省农村居民四种主要慢性病的疾病经济负担研究

目的 分析云南省农村居民高血压、糖尿病、冠心病和脑卒中的疾病经济负担。方法 采用分层随机抽样方法于2015年1月～9月对云南省农村抽取的4 979名≥35岁居民进行问卷调查和体格检查,采用人力资本法结合伤残调整生命年（disability adjusted life years,DALY）估算四种慢性病的疾病经济负担。结果 云南省农村居民高血压、糖尿病、冠心病和脑卒中的患病率分别为35.3%、9.9%、3.8%和1.7%;DALY值分别为2.4/千人年、5.2/千人年、23.5/千人年和21.1/千人年,其中以冠心病的每千人口DALY值最高。四种慢性病的人均疾病经济负担分别为6 667.4元、9 126.1元、9 270.0元和16 187.2元,其中男性分别为7 093.8元、9 510.4元、12 060.9元和19 262.4元,女性分别为6 250.7元、8 554.9元、4 849.4元和9 030.6元;男性四种慢性病的人均疾病经济负担均高于女性（均有P<0.05）。四种慢性病的总疾病经济负担分别为108 185.2百万元、41 529.5百万元、16 192.0百万元和12 649.0百万元。结论 高血压、糖尿病、冠心病和脑卒中对云南省农村居民造成了沉重的经济负担,应采取相应措施降低其导致的疾病经济负担。