Study On The Treatment Costs Of Respiratory Diseases In Jilin Province Based On Air Environment

With the development of the world economy,the process of industrialization and urbanization has accelerated,resulting in significant changes in air quality and climate,with frequent occurrences of air pollution and extreme weather events.The human respiratory system is directly connected to the outside world and is more susceptible to external environmental influences than other systems in the body.Previous studies have confirmed a positive correlation between changes in the air environment and the number of respiratory disease diagnoses.The high incidence and prevalence of respiratory diseases result in a large consumption of health resources and an increase in the economic burden of disease.Therefore,it is of great significance to analyze the current situation of respiratory disease treatment costs and explore the mechanism of the influence of air environmental factors on the treatment cost of respiratory diseases.Obejctives:Based on the perspective of air environmental,this study systematically analyzes the association between air environmental,including air pollutants and temperature,and the treatment costs of respiratory diseases in Jilin Province,starting from its unique environmental characteristics and temperature features.The study explores the mechanism by which air environmental factors affect the treatment costs of respiratory diseases,provides a basis for improving the understanding and attention of health departments and residents to respiratory diseases,effectively preventing and controlling the occurrence of respiratory diseases,and reasonably regulating the treatment costs of respiratory diseases.Methods:（1）According to the sampling principles of the System of Health Accounts 2011（SHA2011）,a total of 854 sample institutions in 5 sample areas of Jilin Province were obtained through multi-stage stratified sampling,and a total of 3.1475 million respiratory disease patient data were collected.According to the SHA2011 accounting operation process,using existing statistical data and sample data from the province,and following the“top-down”accounting principle,the treatment costs of respiratory diseases in the province from 2017 to 2020 were systematically accounted for,and the scale,population distribution,and seasonal characteristics of treatment costs were grasped.（2）Taking Changchun City,the capital of Jilin Province,as an example,the daily hospitalization costs of respiratory disease patients admitted to the hospital from 2017to 2020 were summarized according to the date of admission,and daily air pollutant and temperature data were collected.The daily hospitalization costs of respiratory diseases and the concentration of air pollutants were decomposed using Seasonal and Trend decomposition using Loess（STL）to understand their trends and seasonal characteristics.The spatiotemporal association effects between changes in air pollutants and temperature and hospitalization costs of different types of respiratory diseases were analyzed using Generalized Addictive Model（GAM）and Distributed Lag non-linear model（DLNM）,respectively.The relationship between environmental exposure and hospitalization costs of respiratory diseases was quantified,and stratified analysis by age and gender was conducted to identify key populations for prevention and control.（3）Based on the research results of the spatiotemporal association effects between environmental exposure and treatment costs of respiratory diseases,the daily air quality in Changchun City from 2017 to 2020 was reassigned based on the principles of maximum cumulative lag days and Tuke fence method to determine the daily air quality characteristics and temperature features.The differences in the number of respiratory disease admissions,individual hospitalization costs,and cost structure under different air quality and temperature conditions were analyzed.The interaction of temperature,air quality,and patient characteristics on hospitalization cost is analyzed based on multi-group structural equation model.From an individual perspective,the impact of environmental factors on hospitalization costs for respiratory diseases in different populations was further explored.Results:（1）The basic information of respiratory disease patients shows that the number of male patients（52.68%）is higher than that of female patients（47.32%）;the number of patients in the 0-14 years old children’s group is the highest（54.48%）.In terms of disease type,acute upper respiratory tract infection（41.93%）,influenza and pneumonia（14.71%）,other acute lower respiratory tract infections（7.04%）,other diseases of the upper respiratory tract（10.14%）,and chronic lower respiratory tract diseases（20.03%）are the types of respiratory diseases with a higher number of patients,with a cumulative proportion of 93.85%for these types of respiratory diseases from 2017 to 2020.（2）The outpatient costs of respiratory disease patients generally show a fluctuating growth trend,while hospitalization costs show a trend of first decreasing and then increasing,with median outpatient and hospitalization costs increasing by 40.87%and-16.29%,respectively,in 2020 compared to 2017.In terms of treatment costs for different characteristic populations,the median outpatient and hospitalization costs for male patients were higher than those for female patients,with statistically significant differences（P<0.05）.For different age groups,the median outpatient and hospitalization costs increased with age,with statistically significant differences（P<0.05）.Other major respiratory diseases affecting the pulmonary interstitium diseases,lung diseases caused by external causes,and purulent and necrotic diseases of the lower respiratory tract were types of respiratory diseases with higher median treatment costs,with statistically significant differences（P<0.05）.（3）The SHA2011 accounting results show that the treatment costs of respiratory diseases accounted for 8.25%of all diseases from 2017 to 2020.Among them,the proportion of treatment costs for males and females was 55.21%and 44.79%,respectively;the proportion of treatment costs for children aged 0-14 years,people aged15-59 years,and elderly people aged 60 years and above was 26.57%,32.44%,and40.99%,respectively.Acute upper respiratory tract infection（24.92%）,influenza and pneumonia（28.35%）,other acute lower respiratory tract infections（6.44%）,other diseases of the upper respiratory tract（7.10%）,and chronic lower respiratory tract diseases（18.68%）were types of respiratory diseases with high treatment costs,consuming a total of 85.49%of all treatment costs for respiratory diseases from 2017to 2020.（4）In terms of the seasonal distribution of treatment costs for respiratory diseases,winter（December to February of the following year）has the highest proportion of treatment costs,with a cumulative proportion of 38.14%over four years;followed by spring（March to May）,with a cumulative proportion of 23.08%over four years;while summer（June to August）has the lowest proportion of treatment costs for respiratory diseases,with a cumulative proportion of 18.56%over four years.（5）The results of the GAM model for the spatiotemporal correlation effect between air quality changes and hospitalization costs for respiratory diseases show that after excluding factors such as time trends,meteorological factors and holidays,increases in the concentrations of particulate matter(PM_2.5/PM₁₀),SO₂and NO₂ are correlated with increases in hospitalization costs for respiratory diseases.Among them,particulate matter(PM_2.5/PM₁₀)has the greatest correlation with hospitalization costs for other acute lower respiratory infections.When the concentration of PM_2.5 or PM₁₀increases by 10μg/m³,the maximum daily increase in hospitalization costs for other acute lower respiratory infections is 2.42%（95%CI:1.65%,3.19%）and 1.35%（95%CI:0.81%,1.90%）,respectively.SO₂ and NO₂ have a relatively large correlation with hospitalization costs for five types of respiratory diseases.When the concentration of SO₂ or NO₂ increases by 10μg/m³,the maximum daily increase in hospitalization costs for acute upper respiratory infections is 13.01%（95%CI:8.23%,17.99%）and 5.80%（95%CI:3.38%,8.28%）,respectively;the maximum daily increase in hospitalization costs for influenza and pneumonia is 3.02%（95%CI:2.03%,4.02%）and 3.10%（95%CI:2.52%,3.69%）,respectively;the maximum daily increase in hospitalization costs for other acute lower respiratory infections is 14.51%（95%CI:10.52%,18.65%）and 6.53%（95%CI:4.48%,8.61%）,respectively;the maximum daily increase in hospitalization costs for other diseases of the upper respiratory tract is 5.04%（95%CI:3.56%,6.54%）and 5.25%（95%CI:4.24%,6.28%）,respectively;and the maximum daily increase in hospitalization costs for chronic lower respiratory diseases is 8.30%（95%CI:6.81%,9.81%）and 5.52%（95%CI:4.66%,6.38%）,respectively.（6）The DLNM model results of the spatiotemporal correlation effect of temperature change and respiratory disease hospitalization costs show that after excluding factors such as time trend,pollutant factors and holidays,compared with the average temperature（7.2°C）,low temperature（<-17.91°C）has a greater correlation with the hospitalization costs of acute upper respiratory tract infection,influenza and pneumonia,other acute lower respiratory tract infections,and other upper respiratory tract diseases.When low temperatures occur,the daily maximum hospitalization costs of these diseases increase by 7.51%（95%CI:-0.36%,15.99%）,6.01%（95%CI:2.02%,10.16%）,6.48%（95%CI:-1.08%,14.62%）and 10.47%（95%CI:3.49%,17.92%）,respectively.High temperature（>26.81°C）has a greater correlation with the hospitalization costs of other acute lower respiratory tract infections and other uppe respiratory tract diseases.When high temperatures occur,the daily maximum hospitalization costs of these diseases increase by 9.91%（95%CI:0.94%,19.66%）and2.68%（95%CI:0.17%,5.25%）,respectively.（7）The results show that the impact of the environment on the number of hospital admissions for different types of respiratory system diseases.The number of admissions for other acute lower respiratory tract infections,other upper respiratory tract diseases,and chronic lower respiratory tract diseases during periods of air pollution is higher than during periods of normal air quality.At the same time,the difference in the number of admissions for other acute lower respiratory tract infections and chronic lower respiratory tract diseases during different air quality periods is statistically significant（P<0.05）,while the difference in the number of admissions for other upper respiratory tract diseases during different air quality periods is not statistically significant（P>0.05）.Acute upper respiratory tract infection shows that the number of admissions during normal air periods is higher than during pollution periods,and the difference is statistically significant（P<0.05）.However,the daily average number of admissions for acute upper respiratory tract disease during air pollution periods for people aged 15-59years and those aged 60 years and over is higher than during normal periods,and the difference is statistically significant（P<0.05）.At the same time,influenza and pneumonia,other acute lower respiratory tract infections and chronic lower respiratory tract diseases have a higher daily average number of admissions during cold seasons than during warm seasons,and the difference is statistically significant（P<0.05）.Acute upper respiratory tract infection shows that the daily average number of admissions during warm seasons is higher than during cold seasons,and the difference is statistically significant（P<0.05）.Other upper respiratory tract diseases also show that the daily average number of admissions during warm seasons is higher than during cold seasons,but the difference is not statistically significant（P>0.05）.（8）The median hospitalization costs for five types of respiratory system diseases during periods of air pollution are higher than during normal periods.Except for chronic lower respiratory tract diseases,where the difference in hospitalization costs between different air quality levels is not statistically significant（P>0.05）,the difference in hospitalization costs for other diseases between different air quality levels is statistically significant（P<0.05）.At the same time,the median hospitalization costs for acute upper respiratory tract infections,other acute lower respiratory tract infections,other upper respiratory tract diseases,and chronic lower respiratory tract diseases are higher during the cold season than during the warm season.However,the difference in hospitalization costs for chronic lower respiratory tract diseases between the cold and warm seasons is not statistically significant（P>0.05）,while the difference in hospitalization costs for other diseases between the cold and warm seasons is statistically significant（P<0.05）.（9）When air quality and cold/warm seasons change,the single cost with the greatest correlation with the hospitalization costs of acute upper respiratory tract infection,influenza and pneumonia,other acute lower respiratory tract infections and chronic lower respiratory tract diseases is drug cost.The single cost with the greatest correlation with the hospitalization costs of other upper respiratory tract diseases is surgical cost.At the same time,drug cost and laboratory test cost have a high contribution rate to the change in hospitalization costs of acute upper respiratory tract infection and other acute lower respiratory tract infections.Treatment cost and laboratory test cost have a high contribution rate to the change in hospitalization costs of influenza and pneumonia.Surgical cost and nursing cost have a high contribution rate to the change in hospitalization costs of other upper respiratory tract diseases.Drug cost and nursing cost have a high contribution rate to the change in hospitalization costs of chronic lower respiratory tract diseases.（10）The results of multi-group structural equation of the treatment cost of respiratory diseases showed that the days of hospitalization had the greatest impact on the hospitalization cost.The more days of hospitalization,the higher the hospitalization cost.The cost of hospitalization is higher for those aged 60 and above;Hospitalization costs are higher for patients with surgery and multiple conditions;Hospital admission costs are higher for general hospital patients.（11）The multi-group structural equation of the impact of air quality and patient characteristics on individual hospitalization costs under different cold and warm seasonal environments shows that during the cold and warm seasons,the difference in the impact of air pollution on hospitalization costs for acute upper respiratory tract infections,other acute lower respiratory tract infections,and other upper respiratory tract diseases is statistically significant（P<0.05）.Among them,during the cold season,hospitalization costs for other acute lower respiratory tract infections and other upper respiratory tract diseases are relatively higher under air pollution conditions,while during the warm season,hospitalization costs for acute upper respiratory tract infections are relatively higher under air pollution conditions.At the same time,during the cold and warm seasons,the difference in the impact of 0-14 years old children on hospitalization costs for influenza and pneumonia,other acute lower respiratory tract infections,and other upper respiratory tract diseases is statistically significant（P<0.05）.Among them,during the cold season,hospitalization costs for influenza and pneumonia and other acute lower respiratory tract infections for 0-14 years old children are relatively higher,while during the warm season,hospitalization costs for other upper respiratory tract diseases for 0-14 years old children are relatively higher.Conclusions:（1）Under the typical regional characteristics and environmental conditions of Jilin Province,the treatment cost of respiratory diseases accounts for 8.25%of all diseases,consuming a large amount of medical and health resources.Males,children aged 0-14years and people aged 60 years and over are key populations for prevention and control.Acute upper respiratory tract infection,influenza and pneumonia,and chronic lower respiratory tract diseases are key types of diseases for prevention and control.（2）The treatment cost of respiratory diseases shows obvious seasonal changes.The proportion of treatment costs in winter（December to February of the following year）is the highest,with a peak.The proportion of treatment costs in summer（June to August）is the lowest,with a trough.（3）Environmental exposure,including changes in temperature and air quality,has a spatiotemporal correlation with changes in hospitalization costs for respiratory diseases.There is also an interaction effect between temperature and air pollutants on individual patient hospitalization costs.This effect is particularly significant for children aged 0-14 years old（4）The changes in the concentrations of particulate matter(PM_2.5/PM₁₀),SO₂ and NO₂ have a significant correlation with the changes in hospitalization costs of respiratory diseases,and there are obvious lag and cumulative effects.At the same time,the correlation between SO2 and NO2 with hospitalization costs is greater than that of particulate matter(PM_2.5/PM₁₀).For temperature,low temperature（<-17.91°C）has a significant correlation with the hospitalization costs of acute upper respiratory tract infection,influenza and pneumonia,other acute lower respiratory tract infections,and other upper respiratory tract diseases.High temperature（>26.81°C）has a significant correlation with the hospitalization costs of other acute lower respiratory tract infections and other upper respiratory tract diseases.（5）When air quality and temperature change,not only does the daily average number of admissions for respiratory diseases change,but also the individual hospitalization costs and cost structure of patients change.During air pollution and low temperature periods,hospitalization costs for respiratory disease patients are higher.Among them,drug cost,laboratory test cost and nursing cost have a higher contribution rate to the change in hospitalization cost structure.