| Background:Epidemic cerebrospinal meningitis (ECM) is a kind of suppurative meningitis caused by Neisseria meningitis (Nm). The major clinical symptom of ECM is meningeal stimulation, such as sudden onset of fever, headache, vomiting, mucocutaneous petechia and ecchymosiss, and stiff neck and so on. Septic shock and meningoencephalitis are the serious clinical manifestations. The Nm group A is the mainly type in our country. In recent years, the Nm group C increases gradually.The state of ECM cases is often serious, and the course of disease progresses rapidly. If the treatment is inappropriate or not in time, the survivor cases often have the sequela of nervous system, or even causes death. However, the rate of mortality and disability, and the sequela are not clear due to the lacking of long-term follow-up materials. Meanwhile, the data of economic burden is also short nationally and internationally. Therefore, we need to urgently carry out the research of disease burden on ECM.In the recent20years, the morbidity of ECM is0.29/100000～1.33/100000population, and the morbidity and mortality were instability in recent years. In addition to the timeliness and drug resistance, some researchers believes that the increase of fulminant meningococcal meningitis (FFM), the increase of cases due to Nm group C, whose virulence is higher than Nm group A, may cause the increase of mortality. In2006, the government releases "the Monitoring Plan of National Epidemic Cerebrospinal Meningitis", and the sampling and testing of Nm on ECM cases are improved gradually.Objectives:To learn the morbidity, mortality and the sequela of ECM. To learn the economic burden of ECM. To descript the mortality, sequela, the economic burden such as the expense of medical service and the expense of ECM sequela due to Nm group A and Nm group respectively.Methods: Based on the following three conditions:(1) The provinces which reported cumulatively relatively more ECM cases in "National Diseases Reporting Information System", from2008to2010;(2) The provinces which laboratory-conformed and classified relatively more ECM cases in "ECM Reporting Information System", from2008to2010;(3) one province selected each in both eastern and western area, through the calculation and argument, we finally chosen Zhejiang province and Guizhou province as the field of investigation. From2008to2010,179cases from the two provinces were chosen as the research objects. We collected information by household questionnaire survey, on the aspects of medical progress, fees and sequela etc.; More detailed and accurate hospital expenses information were collected through consulting hospital records; Through consulting the statistical yearbook and statistical bulletin of the two provinces, we collected population and economic development data. The method of arrangement, classification and summed up were used to analyze qualitative material, the method of descriptive analysis, comparative analysis,x2test, Wilcoxon rank test and were used to analyze the quantitative data.Results:1. The average mortality rate of ECM was21.21%in the two provinces, and the average sequela rate was20.19%. Various kinds of sequela type were collected, and no special advantage sequela type was noticed.2. The age composition, years of life lost (YLLs) and Years of living with disability (YLDs) of ECM show that the children under the age of15are the most vulnerable population group in the two provinces. The total DALY in rural area (380man-years) is more than the total DALY in urban area (63man-years), x2=30.14, P<0.01.3. The Wilcoxon rank test shows that the expenses of medical service on ECM cases in the two provinces are different. The direct economic burden per capita in Zhejiang province (12487.34yuan) is2.64times of Guizhou Province’s (4727.92yuan). The indirect economic burden is790100yuan per capita in Zhejiang province, and is573400yuan per capita in Guizhou province. Total economic burden is802600yuan per capita in Zhejiang province, and is578100yuan in Guizhou province.4. There is no statistical difference between the Nm group A and Nm group C on mortality and sequela rate, because the number of the cases is not enough. The inpatient days and delay days of ECM shows no statistical difference between the Nm group A and the Nm group C. The direct medical expense of ECM is7197.3yuan on Nm group A, and it is8129.22yuan on Nm group C, and there is no statistical difference between the expenses by Wilcoxon rank test. The total direct medical economic burdens are8463.04yuan and9699.92yuan respectively on Nm group A and Nm group C.Conclusion: 1. In recent years, the morbidity of ECM is reduced gradually, but the mortality and sequela rate have not lower. Therefore, the ECM still bring the serious disease burden both on the family and the society.2. There is statistical significant difference between the two provinces on DALY in both urban and rural area respectively, x2=30.14, P<0.01. It corresponds with the differences of urbanization progress and the proportion of urban population between the two provinces. The sum of DALY in the rural area is6.03times than it in urban area. Considering the health conditions are still poor in rural area in China, the rural area is still the key area of ECM prevention and control.3. The average expense of medical service per capita on ECM in Zhejiang province (9854yuan) is as2.52times as in Guizhou province (3912yuan) Z=3.2236, P=0.02<0.05. It corresponds with the differences of economic development level, income level and consumption level between the two provinces.4. The direct medical expenses of ECM are7197.3yuan and8129.22yuan on Nm group A and Nm group C respectively and there is no statistical difference between them. But they are more than the average summation medical expense (6420.64yuan) in the two provinces. It may be because the patients who run Nm classification test in hospital lab are often the more serious ones; therefore, the average direct medical expense of ECM on such cases is higher than it on the total ECM cases. |
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