摘要
目的测算分析中国中老年人群14种主要慢性病经济负担。方法本研究为横断面研究, 基于中国健康与养老追踪调查2011-2020年五期调查数据, 纳入≥45岁且仅患目标慢性病的患者。14种慢性病包括:高血压病、血脂异常、糖尿病或血糖升高、恶性肿瘤、慢性肺部疾病、肝脏疾病、心脏病、卒中、肾脏疾病、消化系统疾病、情感及精神疾病、记忆相关疾病、关节炎或风湿病、哮喘。疾病经济负担测算涵盖直接和间接经济负担, 其中直接经济负担包括直接医疗和直接非医疗负担, 间接经济负担采用人力资本法进行测算, 并利用当年的医疗保健类居民消费价格指数对其贴现至2024年。采用广义线性混合效应模型比较经济负担的城乡差异, 模型中设置省份和州市为随机效应, 居住地(城市或农村)为固定效应, 性别、年龄、教育程度为协变量, 以控制数据中地域层次结构及混杂因素的影响, 并通过比较增加协变量前后城乡因素的显著性差异以判断模型稳健性。结果中国中老年人14种慢性病年均经济负担中位数范围在7 565~17 174元, 其中直接经济负担为6 909~16 565元, 间接经济负担为284~1 276元。各类疾病的直接经济负担以直接医疗负担为主(占83.67%~95.01%), 其中门诊医疗自付比例为50.00%~100.00%, 住院医疗自付比例为36.30%~61.29%。总体上城乡之间各慢性病经济负担差异无统计学意义, 但城市人群关节炎或风湿病的住院医疗负担(5 338比3 898元;LR=6.04, P=0.014), 高血压病的自我治疗负担(324比238元;LR=8.30, P=0.004)均高于农村, 糖尿病或血糖升高(59比149元;LR=5.99, P=0.014)、卒中(0比307元;LR=4.55, P=0.033)和消化系统疾病(45比107元;LR=9.58, P=0.002)的门诊非医疗负担均低于农村。结论中国城市和农村中老年人慢性病经济负担均较为沉重, 直接经济负担为主要来源, 且门诊医疗自付比例高于住院医疗。
ObjectiveTo estimate the economic burden of 14 chronic diseases among middle-aged and elderly people in China.MethodsThis cross-sectional study was based on longitudinal data from five waves(2011 to 2020)of the China Health and Retirement Longitudinal Study(CHARLS).Participants aged 45 and over who had been diagnosed with exactly one target chronic disease were included in the study.The 14 chronic diseases included:hypertension,dyslipidemia,diabetes or elevated blood glucose,malignant tumors,chronic pulmonary diseases,liver diseases,heart diseases,stroke,kidney diseases,digestive system diseases,emotional and mental diseases,memory-related diseases,arthritis or rheumatic diseases,and asthma.The economic burden of disease was measured in terms of both direct and indirect economic burden,with the results adjusted using a healthcare-specific Consumer Price Index(CPI).The direct economic burden included direct medical and non-medical burden.The human capital method was employed to calculate the indirect economic burden.A generalized linear mixed model(GLMM)was conducted to compare the differences in the economic burden between urban and rural areas,with provinces and prefecture-level cities set as random effects and residence(urban or rural areas)as fixed effects to control for the effects of geographic hierarchical structure.Gender,age and educational attainment were also included as covariates to control for confounding factors.The model′s robustness was assessed by comparing the significance of urban-rural differences before and after adding the covariates.ResultsThe median annual economic burden of the 14 chronic diseases among the middle-aged and elderly population in China ranged from 7565 to 17174 CNY,of which the direct economic burden ranged from 6909 to 16565 CNY,and the indirect burden ranged from 284 to 1276 CNY.The direct economic burden was primarily driven by direct medical burden(83.67%to 95.01%of direct economic burden).Out-of-pocket expenses for outpatient medical burden ranged from 50%to 100%,while those for inpatient ranged from 36.30%to 61.29%.GLMM analysis revealed no statistically significant difference in the overall economic burden between urban and rural areas across diseases.However,the burden of inpatient medical burden for arthritis or rheumatism was higher in urban areas than in rural areas(5338 vs.3898 CNY;LR=6.04,P=0.014).Similarly,the burden of self-treatment for hypertension was also higher in urban areas than in rural areas(324 vs.238 CNY;LR=8.30,P=0.004).The outpatient non-medical burden for diabetes or elevated blood glucose(59 vs.149 CNY;LR=5.99,P=0.014),stroke(0 vs.307 CNY;LR=4.55,P=0.033),and digestive system diseases(45 vs.107 CNY;LR=9.58,P=0.002)was lower in urban areas than rural.ConclusionsChronic diseases cause heavy economic burden on middle-aged and elderly people in both urban and rural areas of China,with direct economic burden accounting for the majority of expenditure.The outpatient medical burden accounts for a higher proportion of out-of-pocket expenses than the inpatient.
作者
张珺
王一单
王辛平
张亚访
李雨洁
严朝芳
邓睿
黄源
Zhang Jun;Wang Yidan;Wang Xinping;Zhang Yafang;Li Yujie;Yan Chaofang;Deng Rui;Huang Yuan(School of Public Health,Kunming Medical University,Yunnan Provincial Key Laboratory of Public Health and Biosafety,Yunnan Provincial Key Laboratory of Cross-Border Infectious Disease Prevention and New Drug Development,Kunming 650500,China)
出处
《中华健康管理学杂志》
北大核心
2025年第12期994-1001,共8页
Chinese Journal of Health Management
基金
云南省基础研究计划(202401AT070178)
云南省高层次人才引进计划(YNQR-QNRC-2018-140)
云南省哲学社会科学创新团队建设项目(2024CX08)
昆明医科大学一流学科团队(2024XKTDTS16)。
关键词
慢性病
经济负担
中老年人
健康调查
中国
Chronic diseases
Economic burden
Middle-aged and elderly people
Health surveys
China
