| Objectives:(1)To grasp the high incidence area and possible accumulation area of hemorrhagic fever with renal syndrome in Yichun City,2010-2017,and provide scientific basis for the prevention and control of HFRS epidemic.(2)To understand the economic burden of hemorrhagic fever with renal syndrome(HFRS)in Yichun city and to grasp the related factors affecting the economic burden of hemorrhagic fever with renal syndrome(HFRS),so as to provide scientific basis for formulating health policy to reduce the economic burden of HFRS disease.Methods:(1)The epidemic situation,demography and geographic information of hemorrhagic fever with renal syndrome(HFRS)in Yichun from 2010 to 2017 were collected.The epidemiological characteristics of hemorrhagic fever with renal syndrome(HFRS)in Yichun in 2010-2017 were analyzed by descriptive epidemiological method.Using the method of space-time scanning,from the two dimensions of time and space,on the basis of case and geographical information data,we take the county as the unit,and take the case and geographical information as the basis.To explore the areas with high incidence of hemorrhagic fever with renal syndrome(HFRS)in Yichun City from 2010 to 2017,and to explore the time of aggregation,so as to provide scientific basis for the prevention and control of HFRS epidemic situation.Adopting SPSS 19.0 and SaTScan9.5 software for data analysis.(2)In that high-incidence area of HFRS in Yichun city,the direct medical expense,direct non-medical expense and indirect cost investigation were carried out in the high-incidence area of HFRS in Yichun city,and the economic burden of HFRS in the region was obtained.The influencing factors of the economic burden of hemorrhagic fever with renal syndrome in Yichun City were selected by multiple linear stepwise regression analysis.The data is sorted and analyzed by using Excel and SPSS19.0 software.Results:(1)In Yichun City from 2010 to 2017,2307 cases of HFRS were reported,with an average annual incidence of 288 cases,and the annual incidence ranged from 3.50/ 100,000 to 6.52/ 100,000.In the time distribution,HFRS in Yichun City,Yichun City,was on a monthly basis,with two peaks each year,one in April-July of each year,and the other in November-February of each year.Population distribution,in the case of HFRS in Yichun City,2010-2017,1562 males and females In 745 cases,the sex ratio of male and female was 2.10:1.The incidence of all age groups was mainly concentrated in the age group of 40 to 65,accounting for 47.12% of the total number of cases(1087/2307),and the proportion of the group was 45~49 years,accounting for 11.01%(254/2307).The proportion of the population was 67.75%(1563/2307),11.75%(271/2307)and 5.46%(126/2307).In the area,there are 10 counties and districts in Yichun City.The incidence of disease and incidence is mainly distributed in the central area of Yichun City,and the incidence of the east of Yichun City(Fengcheng and Zhangshu City)and the western area(Yuanzhou District,Wanli County and Tonggu County)is relatively low.(2)The results of simple spatial scanning showed that there was a major aggregation area,including Shanggao County and Yifeng County,LLR=1101.80,RR=8.17,P < 0.001;Gao’an City was a secondary aggregation area with LLR=53.79,RR=1.71,P < 0.001,and the difference was statistically significant.(3)From November 1,2011 to February 29,2012,the spatial-temporal scanning results showed that there was a main cluster area,which was located in Shanggao County and Yifeng County,the location of which was consistent with that of simple spatial scanning.Jingan County from November 1,2014 to February 28,2015 and Gao’an from November 1,2015 to February 29,2016 were two secondary clusters,respectively.The results of scanning in each cluster area showed significant difference(P < 0.001).(4)The median direct medical cost was 9784.18 yuan,with the highest component ratio of 47.58%.In different hospital grades,the median direct medical cost of HFRS patients transferred to hospital was the highest,which was 27163.45 yuan,and the median direct medical expenses of moderate and severe cases with different HFRS clinical classification was the highest,which was 15118.79 yuan.(5)The median of direct non-medical expenses was 4262.39 yuan,and the proportion of visitors giving away nutrition was the highest(48.06%).In different grade hospitals and clinical classification,the median direct non-medical expenses of HFRS transferred cases and death cases were the highest(5268.95 yuan and 18260.67 yuan,respectively).(6)The median of indirect expenses was 4741.10 yuan,and the proportion of patients’ miswork expenses was the highest(58.79%);In different grade hospitals and clinical classification,the median indirect cost of second A hospital and death cases was the highest,which was 4876.56 yuan and 10579.83 yuan,respectively.(7)The total economic burden of HFRS in this survey is 62.43 million yuan,the median is 20866.03 yuan,and the proportion of direct medical expenses is the highest(53.26%);in different grade hospitals and clinical types,the median economic burden of HFRS cases and severe cases is the highest,RMB 37919.64 and 30839.12 respectively.(8)The results of multiple linear stepwise regression analysis of total economic burden of HFRS investigated cases showed that hospital grade,clinical classification,length of stay in hospital,days of missed work,operation and visiting number were the influencing factors of total economic burden of HFRS cases(P < 0.05).According to the standardized regression coefficient,the order of influence on economic burden was days in hospital,days of missed work,clinical classification,operation,hospital grade and number of visitors.Conclusions:(1)The incidence of HFRS in Yichun City showed obvious seasonality,showing two peak peaks in late spring,early summer peak and early winter peak,mainly in winter and spring peak,the age of onset was concentrated in the age of 40 years old and 65 years old,the sex was male and the occupation was farmer;The cases were mainly concentrated in Shanggao County,Gao’an County and Yifeng County in the central part of Yichun City,which may be related to the distribution of rodent species,the density of rodent and the rate of rodent carrying virus in these areas.(2)The results of spatio-temporal scanning indicate that there is a certain aggregation of HFRS in the high incidence area of Yichun,especially in the peak period of winter and spring,if the epidemic situation occurs and the results of on-the-spot investigation are combined with the results of field investigation,the epidemiological significance of the cluster area can be determined.Study the risk of epidemic situation.(3)The economic burden of the high incidence area of HFRS in Yichun City was serious,and the direct medical expenses had the greatest influence on the economic burden of HFRS cases,and the economic burden of transferred cases and severe and dead cases was heavier.(4)Early diagnosis,early treatment,strengthening prognosis and rehabilitation,reducing the occurrence of critical patients and dead patients,reducing the days of delayed work and shortening the days of hospitalization are of great significance in reducing the economic burden of HFRS disease. |
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