肺结核病人社会经济情况调查.ppt

2000年全国结核病流行病学抽样调查肺结核病人社会经济情况调查,Sociological&EconomicalStudyonPulmonaryTuberculosisNationwideRandomSurveyfortheEpidemiologyofTuberculosisin2000,内容Content,患病率结果ResultsofPrevalence社会经济情况调查结果ResultsofSociological&EconomicalStudy一般情况GeneralSituation就诊及诊治情况ClinicalConsultation,DiagnosisandTreatment,三次流调患病率结果Prevalenceresultsof3surveys,不同地区的患病率Prevalenceindifferentarea,登记率与患病率的比较Comparisionbetweencaseratesandprevalence,卫V项目与非项目地区涂阳患病率的变化Smearpositiveprevalenceinprojectareaandnon-projectarea,1990年2000年下降%项目地区1429336.1Projectarea非项目地区1301263.1Non-projectarea全国Nationwide13411017.9,一般情况GeneralSituation,性别、年龄分布AgeandGender经济收入能力及文化程度Withorwithoutoccupationalincomeandeducationbackground家庭经济情况FamilyEconomicalSituation医疗保障状况MedicalInsuranceSituation,一般情况GeneralSituation,表1性别、年龄分布Tab1.AgeandGenderDistribution年龄男Male女Femal合计TotalAgeNo.%No.%No.%0-222.5143.4362.810-414.7317.5725.620-657.54911.91148.930-9310.65713.815011.740-11510.75814.017313.550-14416.65914.320315.960-19923.07017.026921.070-16318.85914.322217.480-242.7153.6393.1小计866100.0412100.01278100.0男性病人多：为女性的2倍青壮年病人多：20-59岁病人占50%老年病人多：60岁以上病人占41%,经济收入能力及文化程度Occupationalincome&Educationbackground,表2有经济收入能力的病人所占比例Tab2.Proportionofpatientswhohaveoccupationalincome病人总数有经济收入WithincomeNo.ofPTB病人数No.%男Male86663072.7女Female41219747.8合计Total127882764.7女性病人有经济收入能力的比例仅为47.8%，明显低于男性。有经济收入能力的病人中，77.1%为农林牧渔从业者。(Countrysidefieldworkers,CFW),1.Illiteracy2.Primaryschool3.Juniormiddleschool4.Seniormiddleschool,家庭经济情况FamilyEconomicalSituation,表3病人家庭年人均收入及占当地年均收入的比例分布Tab3.FamilyaverageincomeperpersonperyearofPTBpatientsandthelevelinlocalareas家庭年*当地年均收入平均水平*无当地*人均收入以下Lower以上Higher资料合计（元Yuan）No%No%可参考Total所有病人AllPTB130797678.027622.0261278其中：农林牧渔CFW94150280.012620.010638*FamilyAverageIncomeperpersonperYear*Comparewiththatinthelocalareas*Nodataforreferenceinthelocalarea,医疗保障状况MedicalInsuranceSituation,1278例病人中，1175人无医疗保障，占92%。TheproportionofallPTBpatientswhohavenomedicalinsuranceis92%.638例农林牧渔病人中，625人无医疗保障，占98%。TheproportionofCFWPTBpatientswhohavenomedicalinsuranceis98%.,就诊及诊治情况ClinicalConsultation,DiagnosisandTreatment,卫生宣教HealthEducation症状Symptoms就诊ClinicalConsultation诊断Diagnosis转诊、登记及治疗Transferring,RegistryandTreatment治疗状态TreatmentSituation经济负担EconomicBurden,图2病人在发病前接受TB宣教的情况HealtheducationaboutTBreceivedbeforeillness,图3症状分布Distributionofsymptomatic,有症状就诊ClinicalConsultationAmongSymptomatic,表4有症状就诊情况曾就诊未就诊合计ConsultationmadeNotmadeTotalNo%No%No%2000年62752.746942.81096100.01990年124034.1239365.93633100.0,图4初诊单位Typeofhealthclinicsforfirstclinicalconsultation,表5未就诊原因分析Causesfordelayofclinicalconsultation原因1.自己2.工作忙3.经济4.交通5.就诊6.服务态其他合计Causes不在乎没时间困难不便点太远度不好OtherNo.25915175610134692000年%2.8100.0No.36636169未统计372426521990年%56.25.56.4100.01.Notmind2.Hadnotime3.Financialproblem4.Trafficproblem5.Thehealthunitistoofar6.Badservice,诊断Diagnosis,627例就诊者，就诊期间接受过痰及X线检查的只有161人，占26.2%。Among627patientswhopresentconsultation,161patientshadreceivedsputumandX-rayexaminationatthesametime(26.2%).流调前，有378人已被确诊为肺结核，占60%。378patients(60%)hadbeenconfirmedasPTBbeforethesurvey.,转诊、登记及治疗Transferring,RegistryandTreatment表6转诊、登记及治疗确诊病人数转诊登记治疗No.ofConfirmedPTBTrans-RegistryTreatmentNo%No%No%结防机构TBDispensary454395.245100.0非结防机构Otherhealthunit3334413.25015.032998.8合计Total3789023.837497.9,治疗状态Situationofregulartreatment表8治疗状态1.规则治疗2.中断、间断治疗合计No%No%TotalA结防机构3661.02339.0592000年B非结防机构6621.624979.0315合计Total10227.327272.7374A结防机构25555.520444.14591990年B非结防机构29613.4190686.62202合计Total55120.7211079.326611.Regularlytreated2.IntermittentandInterruptedTreatmentA.TBdispensaryB.Otherhealthunit,1278肺结核病人1096有症状（86%）182无症状（14%）627就诊（57%）469未就诊（43%）378确诊（60%）249未确诊（40%）333在非结防45在结防机构确诊（88%）机构确诊（12%）283未登记50432未登记（4%）（85%）登记93病人发现率CaseDetectionRate(%)1.93/1278=7%2.378/1278=30%,933781278,表9间断或中断治疗原因Tab.9Causesofintermittentorinterruptionoftreatment症状改善*药物反应经济困难其他合计自行停药SideeffectFinancialproblemOtherTotalNo.%No.%No.%No.%涂阳病人4238.532.85954.154.6109S+PTB涂阴病人7445.4106.16238.01710.4163S-PTB合计Total11642.6134.812144.5228.1272*Self-stoppingtakingdrugsaftersymptomsdisappeared,经济负担EconomicBurden,诊疗Clinicalconsultationandtreatment627例有症状就诊的病人，人均诊疗费为1165元，占病人家庭年人均收入的89%。Theaverageclinicalconsultationandtreatmentcostforsymptomaticwhopresentedclinicalconsultationwas1165Yuan.Itoccupied89%ofthefamilyaverageincomeperperson.误工Losingworking721例有经济收入、有症状的病人中，有260人因病误工，人均误工125天，人均经济收入损失为890元。260patientslostworkingtimeamong721patientswhohadregularincomeandsymptoms.Theaveragelosingdayswas125days.Theaveragereducingincomeduetolostworkingdayswas890Yuan.Itoccupied68%ofthefamilyaverageincomeperperson.,结论Conclusion一、肺结核病人的特点CharacteristicsofPTBpatients,1、男性多于女性MalePTBpatientsweremorethanfemalePTBpatients.2、青壮年及老年病人多Mostofthepatientswereadultsandelder.3、有经济收入能力的病人中，多为农林牧渔从业劳动者MostofpatientswereFFSFamongpatientswhohaveearningability.4、有经济收入能力的病人中，文化水平低，女性尤为明显Educationbackgroundwaslowerforthepatientswhohaveearningability.Itismorelowerforfemalepatients.5、家庭经济水平大多低于当地水平Mostofpatientsfamilyeconomiclevelwaslowerthanthelocallevel.6、绝多数无医疗保障Almostallpatientshadnomedicalinsuranceassured.7.经济负担过重Highereconomicburden,二、病人发现与治疗管理的总体评价Evaluationoncasedetectionandcasemanagement,病人发现水平较低Lowercasedetectionlevel规则治疗率低Lowerregulartreatmentrate,病人发现水平低的主要原因Causesoflowercasedetection,半数以上的病人未接受过卫生宣教MorethanhalfofpatientshadnotreceivedhealtheducationconcerningTBbeforesufferingTB.有症状后，因警觉性低及经济困难未就诊LowerawarenessonTBandfinancialproblemwerethemaincauseswhysymptomatichadnotpresentclinicalconsultation.综合医院及乡镇卫生院是病人的首选就诊单位。这些医疗机构主要依据X线检查确诊，确诊比例低；确诊后的病人报告、登记比例低。Generalhospitalsandtownshiphospitalswerethepriorityhealthunitsforthefirstconsultation.ThosehealthunitsmadediagnosismainlybasedonX-rayexamination.Theproportionofconfirmationdiagnosiswaslower.TheproportionofreportedandregisteredinTBdispensariesofconfirmedTBpatientswerelower,规则治疗率低的原因Causesoflowerregulartreatmentrate,88%的病人是在结防机构以外的医疗单位接受治