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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (6): 1074-1081. doi: 10.19723/j.issn.1671-167X.2023.06.019

• 论著 • 上一篇    下一篇

2013—2020年北京市慢性阻塞性肺疾病急性加重女性住院患者的流行病学和住院费用分析

王子恺1,莫佳丽2,张蒙1,廖纪萍1,*()   

  1. 1. 北京大学第一医院呼吸和危重症医学科，北京 100034
    2. 北京大学第一医院儿科，北京 100034
  • 收稿日期:2023-07-11 出版日期:2023-12-18 发布日期:2023-12-11
  • 通讯作者: 廖纪萍 E-mail:jipingliao@hotmail.com
  • 基金资助:
    北京市卫生健康和科技成果适宜技术推广项目(BHTPP202053);首都临床特色诊疗技术研究及转化应用项目(Z221100007422040)

Epidemiology and hospitalization costs analysis of female inpatients with acute exacerbation of chronic obstructive pulmonary disease in Beijing from 2013 to 2020

Zi-kai WANG1,Jia-li MO2,Meng ZHANG1,Ji-ping LIAO1,*()   

  1. 1. Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China
    2. Departmant of Pediatrics, Peking University First Hospital, Beijing, 100034, China
  • Received:2023-07-11 Online:2023-12-18 Published:2023-12-11
  • Contact: Ji-ping LIAO E-mail:jipingliao@hotmail.com
  • Supported by:
    Beijing Health Technologies Promotion Program(BHTPP202053);Beijing Municipal Commission of Science and Technology(Z221100007422040)

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摘要：

目的: 研究北京市慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)女性住院患者的流行病学特征及住院费用。方法: 选择2013—2020年北京市AECOPD女性患者的住院医保数据进行回顾性分析, 记录其年龄分布、合并症情况、住院时间、住院费用以及流行病学特征(时间和空间分布特点)。结果: 纳入166家医院57 911例住院患者, 平均年龄(78.84±8.59)岁, 80~89岁患者(49.06%)最多, 70~79岁(31.08%)次之, 18~50岁(0.41%)最少。合并冠心病、高血压以及心力衰竭的患者占比分别为30.60%、30.52%和26.54%。每日住院人次的中位数为18(IQR: 16), 且2013—2020年8年中总体呈增长趋势, 2015年开始明显增加, 上升趋势持续至2019年, 2020年则有所回落。冬春季住院人次占比(54.09%)高于夏秋季(45.91%)。各市辖区总住院人次占比排在前三位的分别为西城区(14.18%)、朝阳区(14.12%)和丰台区(13.47%); 城市西部、中心城区和东北部住院人次密度较高, 而近郊区住院人次密度则相对较低。AECOPD女性患者的住院时间和住院费用中位数分别为12 d和20 648.37元。城区患者的住院时间和住院费用均高于郊区, 差异有统计学意义(P＜0.001)。西药费用是住院总费用的主要部分(33.32%)。研究时段住院费用总体呈先增长后降低随之趋于稳定的变化特征, 不同合并症患者的住院费用差异明显。结论: 北京市AECOPD女性住院患者以70岁及以上老年患者为主, 常合并心血管疾病, 主要在冬春季节发病且有地域差异, 其住院费用与患者年龄、合并症以及所在地区密切相关。

关键词: 慢性阻塞性肺疾病急性加重, 女性, 住院费用, 流行病学

Abstract:

Objective: To study epidemiological characteristics and hospitalization costs of female inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing. Methods: A retrospective study was conducted to analyze electronic hospitalization summary reports of female inpatients with AECOPD in Beijing from 2013 to 2020. Clinical characteristics (age distribution and comorbidities), epidemiological characteristics (temporal and spatial distribution characteristics), hospi-talization times and costs of patients were described. Results: A total of 57 911 subjects in 166 hospitals were included in this study, with a mean age of (78.84±8.59) years and the highest number of patients aged 80-89 years (49.06%), followed by patients aged 70-79 years (31.08%), and the lowest number of patients under 50 years (0.41%). The proportions of patients with coronary heart disease, hypertension and heart failure were 30.60%, 30.52% and 26.54% respectively. The median number of daily hospitalizations during the study period was 18 (IQR: 16). The number of daily hospitalizations for AECOPD showed an overall growth trend over the eight years from 2013 to 2020, starting to increase significantly in 2015 and continuing to increase until 2019, then followed by a decline in 2020. The proportion of inpatient admissions was higher in winter and spring (54.09%) than that in summer and autumn (45.91%). The top three districts in terms of the proportion of total inpatient admissions were Xicheng district (14.18%), Chaoyang district (14.12%) and Fengtai district (13.47%). The density of inpatients was relatively high in the western regions, central urban areas and northeastern regions of the city, while the density of inpatients was relatively low in the near suburbs. The median number of hospital days for female patients with AECOPD was 12 days, and the median hospital costs was CNY 20 648.37. Patients from urban areas had longer hospitalization times and higher hospitalization costs than those from suburban areas (P < 0.001). Western medicine expenses accounted for the largest proportion of total hospital expenses (33.32%). During the study period, hospitalization costs exhibited an overall pattern of initial growth, followed by subsequent decline, eventually stabilizing. The differences in hospitalization costs among the patients with different comorbidities were significant. Conclusion: Female hospitalized patients with AECOPD in Beijing were older than 70 years, often complicated by cardiovascular disease. AECOPD occurred mainly in winter and spring, with regional differences. The hospitalization costs were closely associated with the patients' age, comorbidities, and the geographicical region.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Female, Hospitalization costs, Epidemiology

中图分类号: 

  • R563.9

表1

2013—2020年北京市AECOPD女性患者总体和每日住院人次的临床特征"

Items n (%) Characteristics of daily hospital admissions
M Min Max IQR
Total 57 911(100.00) 18 1 174 16
Age/years
  18-49 237 (0.41) 1 1 3 0
  50-59 1 786 (3.08) 1 1 8 1
  60-69 5 905 (10.20) 2 1 22 2
  70-79 17 996 (31.08) 6 1 56 5
  80-89 28 413 (49.06) 9 1 75 9
  ≥90 3 574 (6.17) 2 1 12 1
Complications
  Coronary heart disease 17 723 (30.60) 6 1 56 6
  Atrial fibrillation 3 473 (6.00) 1 1 10 1
  Heart failure 15 370 (26.54) 5 1 44 5
  Hypertension 17 675 (30.52) 6 1 47 6
  Diabetes 6 643 (11.47) 2 1 16 3

图1

2013—2020年北京市AECOPD女性患者每日住院人次时间序列图"

表2

2013—2020年北京市AECOPD女性患者总体和每日住院人次的季节分布特征"

Items n (%) Characteristics of daily hospital admissions
M Min Max IQR
Spring 14 312 (24.71) 17 1 56 16
Summer 12 501 (21.59) 16 1 43 13
Autumn 14 083 (24.32) 17 1 58 16
Winter 17 015 (29.38) 22 1 174 20

表3

2013—2020年北京市AECOPD女性患者总体和每日住院人次的空间分布特征"

Items n (%) Characteristics of daily hospital admissions
M Min Max IQR
Urban areas
  Dongcheng 6 643 (11.47) 3 1 14 2
  Xicheng 8 212 (14.18) 3 1 13 3
  Chaoyang 8 175 (14.12) 3 1 14 2
  Haidian 5 705 (9.85) 2 1 12 2
  Fengtai 7 800 (13.47) 3 1 14 2
  Shijingshan 4 560 (7.87) 2 1 12 2
Suburban areas
  Daxing 2 060 (3.56) 1 1 22 1
  Tongzhou 1 092 (1.89) 1 1 5 0
  Shunyi 1 288 (2.22) 1 1 11 1
  Changping 1 800 (3.11) 1 1 8 1
  Mentougou 2 449 (4.23) 1 1 10 1
  Fangshan 4 244 (7.33) 2 1 33 2
  Huairou 735 (1.27) 1 1 7 0
  Pinggu 865 (1.49) 1 1 5 0
  Miyun 1 010 (1.74) 1 1 6 1
  Yanqing 1 273 (2.20) 1 1 15 1

图2

2013—2020年北京市AECOPD女性患者住院人次密度地区分布图(/万人年)"

表4

2013—2020年北京市AECOPD女性患者的住院时间和住院费用"

Items Hospitalization times /d, M (IQR) H/U P value Hospitalization costs /yuan, M (IQR) H/U P value
Total 12 (8) 20 648.37 (17 357.88)
Age/years 459.92 ＜0.001 1 495.66 ＜0.001
  18-49 9 (6) 13 494.52 (9 356.01)
  50-59 11 (6) 15 707.68 (11 404.33)
  60-69 13 (9) 17 048.92 (12 861.81)
  70-79 13 (6) 20 197.73 (16 160.18)
  80-89 14 (8) 22 173.09 (18 848.26)
  ≥90 12 (7) 21 754.29 (18 915.54)
With complications 99.46 ＜0.001 489.08 ＜0.001
  Yes 11 (7) 20 118.93 (15 629.94)
  No 12 (9) 21 457.84 (19 992.87)
Season 27.07 ＜0.001 6.78 0.079
  Spring 12 (8) 20 641.66 (16 961.2)
  Summer 12 (8) 20 903.46 (17 822.19)
  Autumn 12 (8) 20 503.37 (16 828.64)
  Winter 11 (8) 20 631.11 (17 683.63)
Areas 1 590.98 ＜0.001 4 358.15 ＜0.001
  Urban areas 13 (8) 22 843.59 (18 307.91)
  Suburban areas 10 (7) 15 159.72 (11 985.30)

图3

2013—2020年北京市AECOPD女性患者住院费用构成"

图4

2013—2020年北京市不同合并症AECOPD女性患者住院费用的时间分布"

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ISSN 1671-167X
CN 11-4691/R
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