| Objectives:Using on the data of disease monitoring,clinical diagnosis and treatment,and health survey in Nanshan District,the epidemiological burden and economic burden of stroke in Nanshan District were calculated and analyzed,and the factors affecting the economic burden of stroke were further analyzed to provide a basis for the formulation of stroke prevention and control strategies in Nanshan District.Methods:1.The morbidity and mortality data of stroke in Nanshan District from 2016 to 2021 were obtained from the Shenzhen Chronic Disease Prevention and Management System,and the data were collated and analyzed using Excel 2019 software and R software V4.2.0.The epidemiological burden of stroke was analyzed using indicators such as years of life lost due to disability(YLDs),years of life lost due to early death(YLLs),and disability adjusted life years(DALYs).The trend of changes in the epidemiological burden of stroke was analyzed using average annual percentage change(AAPC).2.331 patients with the first onset of stroke in the past three years were selected from the stroke monitoring system in Nanshan District by using a systematic sampling method.Questionnaire surveys were used to collect information on the physical health status of stroke patients,direct expenses such as medical expenses,meal expenses,accommodation expenses,transportation expenses,and indirect expenses such as labor time losses and labor capacity losses incurred by patients and their families within one year.The stepwise model method and the human capital method were used to calculate the direct and indirect economic burden of stroke patients,respectively.The median and quartile intervals were used to describe the current situation of the economic burden of stroke disease.Nonparametric testing was used to conduct a univariate analysis of the economic burden of stroke,and a binary logistic regression model was used to conduct a multivariate regression analysis.The test level was 0.05.3.Based on the inpatient cost data of stroke patients admitted to hospitals in Nanshan District from 2016 to 2021,the median and quartile intervals were used to describe the basic situation of stroke inpatients,the internal structure and change trend of inpatient costs were analyzed using gray correlation degree and structural change degree,and nonparametric tests were used to explore the impact of different demographic characteristics and chronic diseases on inpatient costs,Multiple linear regression was used to analyze the influencing factors of hospitalization expenses for stroke inpatients.Results:1.From 2016 to 2021,a total of 19813 cases of stroke were reported among permanent residents in Nanshan District,including 12716 males and 7097 females;There are 825 deaths from stroke,including 480 males and 345 females.From 2016 to 2021,the incidence rate,mortality,YLD rate,YLL rate and DALY rate of stroke in male residents are higher than those in women;The incidence rate,YLD rate and DALY rate of ischemic stroke are higher than those of hemorrhagic stroke,but the mortality and YLL rate are lower than those of hemorrhagic stroke.From 2016 to 2021,the YLD rate of stroke in Nanshan District increased from 4.66 ‰ to 4.84 ‰,with AAPC=1.78%;The DALY rate decreased from 6.90 ‰ to 5.95 ‰,with AAPC=-2.16%.However,the overall trend of changes in the YLD rate and DALY rate was not statistically significant(P>0.05).From 2016 to 2021,both YLL and YLL/DAY of stroke showed a downward trend(P<0.05),decreasing from 2.24 ‰ and 32.46% to 1.11 ‰ and 18.67%,respectively.2.A total of 331 people participated in the health survey,including 207 males,accounting for 62.54%,and 124 females,accounting for 37.46%;48 patients under 50 years of age(14.50%),122 patients between 50 and 65 years of age(36.86%),and 161 patients over 65 years of age(48.64%);There are 277 married patients,accounting for83.69%.In 2021,the average(median)economic burden of stroke patients with a disease course of less than 3 years in Nanshan District within 1 years of disease was approximately 26200 yuan,of which the direct economic burden was 14100 yuan and the indirect economic burden was 6100 yuan;The average(median)economic burden of patients with a disease course of 1 year is about 49100 yuan,significantly higher than11600 yuan for stroke patients with a disease course of 1 to 2 years and 11900 yuan for stroke patients with a disease course of 2 to 3 years(χ2=42.836,P<0.001).Multivariate analysis showed that the degree of disability(OR>1,P<0.001),course of disease(OR<1,P<0.001),type of registered residence registration(OR>1,P=0.037),hypertension(OR=2.18,P=0.029),coronary heart disease(OR=2.57,P=0.007)were the influencing factors of the direct economic burden of stroke patients;The degree of disability(OR>1,P<0.001),course of disease(OR<1,P<0.001),stroke classification(OR<1,P<0.05),communication disorder(OR>1,P<0.05),diabetes(OR=1.83,P=0.047)were the influencing factors of indirect economic burden of stroke patients.3.From 2016 to 2021,the average(median)hospitalization cost for stroke inpatients in Nanshan District was 14760.11 yuan,including 12199.87 yuan for ischemic stroke and 26759.48 yuan for hemorrhagic stroke.In the composition of hospitalization expenses for different subtypes of stroke,drug expenses accounted for the largest proportion.However,from 2020 to 2021,diagnosis expenses accounted for the highest proportion of hospitalization expenses for ischemic stroke(22.97%,25.24%),and consumables expenses accounted for the highest proportion of hemorrhagic stroke(19.76%,21.10%).The results of gray correlation analysis show that among the individual costs of the total inpatient cases of stroke,ischemic stroke,and hemorrhagic stroke in 2016-2021,the highest correlation between drug costs and stroke inpatient costs was 0.997,0.986,and 0.996,respectively.The results of structural change analysis show that,in 2016-2021,the structural change contribution rate of drug expenses is the largest(45.36%),but in 2020-2021,the structural change contribution rate of diagnosis expenses is the largest for the overall inpatient cases of stroke and inpatient cases of ischemic stroke,respectively,25.45% and 26.20%.The structural change contribution rate of rehabilitation expenses is the largest(25.50%)for inpatient cases of hemorrhagic stroke.The results of multivariate analysis showed that the hospitalization cost of stroke gradually increased with the increase of age and hospitalization days(P<0.001);The hospitalization expenses of inpatients in neurosurgery,rehabilitation medicine,geriatric medicine,and critical medicine departments were higher than those in neurology(P<0.001);The hospitalization cost of patients with diabetes and atrial fibrillation was higher than that of patients without diabetes and atrial fibrillation(P<0.001),but the hospitalization cost of patients with hypertension,dyslipidemia,and hyperhomocysteinemia was lower than that of patients without hypertension,dyslipidemia,and hyperhomocysteinemia(P<0.001).Conclusions:1.From 2016 to 2021,the YLL rate of stroke in Nanshan District showed a downward trend,but the change trend of DALY rate of stroke was not obvious.Improving the health literacy of male residents,reducing the incidence rate of ischemic stroke and the mortality of hemorrhagic stroke were the key points for further comprehensive prevention and control of stroke.2.The average annual economic burden of stroke patients within 3 years of disease duration in Nanshan District is 26200 yuan,and basic diseases such as hypertension,diabetes and coronary heart disease can increase the economic burden of stroke patients by influencing hospitalization expenses or indirect economic burden.Nanshan District should vigorously promote health management services of basic medical institutions,and strengthen the management of basic diseases such as hypertension,diabetes and coronary heart disease of stroke patients in Nanshan District.3.From 2016 to 2021,the average hospitalization cost for stroke inpatients in Nanshan District was 30442.75 yuan,with drug expenses accounting for the largest proportion and consumables expenses showing an increasing trend.However,the proportion of treatment expenses is relatively low.Therefore,Nanshan District still needs to further optimize the structure of stroke hospitalization expenses,improve the procurement and charging system of medical consumables,and avoid increasing the economic burden of stroke patients due to high consumables expenses.4.The inpatient department,length of stay,and whether surgery is an important factor affecting the hospitalization cost of stroke.Further promoting the construction of stroke centers,improving standardized diagnosis and treatment and disease management models for stroke,improving the level of stroke treatment,and standardizing the clinical pathway for stroke,guiding patients to seek medical treatment scientifically are important means to effectively reduce the economic burden of stroke patients. |
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