Investigation on catastrophic cost of pulmonary tuberculosis in three counties, Yunnan Province

doi:10.19983/j.issn.2096-8493.20220154

Abstract

Abstract:

Objective: To investigate the catastrophic costs of pulmonary tuberculosis (PTB) and the influencing factors, in order to provide reference for formulating and improving social security measures for PTB patients in Yunnan Province. Methods: A retrospective investigation was conducted in 233 PTB patients who completed the course of treatment from Mojiang, Lancang and Simao County, Yunnan Province by the way of face-to-face questionnaire and hospital information system query since 2017. The catastrophic costs of PTB patients (account for over 20% of annual income) influencing factors were investigated. Results: A total of 233 patients were included in this survey. The total cost (M(Q₁,Q₃)) was RMB 7820 (5269, 12754) yuan with the total self paid cost of 4623 (3251, 7637) yuan, which accounted for 60.81% of the total cost. The direct medical cost was RMB 2705 (1727, 4559) yuan, which accounted for 62.89% of the total self paid cost. The indirect medical cost was 1760 (822, 3192) yuan, which accounted for 37.11% of the total self paid cost. Overall, the proportion of patients with catastrophic cost was 69.53% (162/233). The results of binary logistic regression analysis showed that patients with high annual family income (≥RMB 4000 yuan) had low risk of catastrophic expenditure (OR=0.062, 95%CI: 0.025-0.156), and the risk of catastrophic expenditure was high in patients with more than once hospitalization experiences or multi-hospital experiences (OR=37.610, 95%CI: 7.615-185.742; OR=4.196, 95%CI: 1.457-12.079). Conclusion: The situation of PTB patients experienced catastrophic cost is severe in Yunnan Province, thus, it is necessary to strengthen the formulation and improvement of social security measures for patients with low annual family income per capita, more than once hospitalization experiences or multi-hospital experiences.

Key words: Tuberculosis, pulmonary, Medical indigency, Small-area analysis

CLC Number:

R521

Liu Liangli, Zhao Yujie, Yang Yunbin, Chen Jin’ou, Xu Lin. Investigation on catastrophic cost of pulmonary tuberculosis in three counties, Yunnan Province[J]. Journal of Tuberculosis and Lung Disease , 2022, 3(6): 469-476. doi: 10.19983/j.issn.2096-8493.20220154

Figures/Tables 4

变量		β值		s $x ˉ$ 值		Wald χ²值		P值		OR(95%CI)值
职业
农民										1.000
其他职业^b		0.267		0.631		0.179		0.673		1.306(0379~4.498)
文化程度
小学及以下										1.000
初中		0.388		0.486		0.637		0.425		1.474(0.568~3.824)
中专/高中		-1.074		0.776		1.916		0.166		0.342(0.075~1.563)
大专/大学		-5.23		0.955		0.300		0.584		0.593(0.091~3.855)
住址类型
农村										1.000
城镇		0.353		0.423		0.697		0.404		0.702(0.307~1.610)
参保类型
新农合										1.000
其他医保^c		-0.836		0.713		1.378		0.240		0.433(0.107~1.751)
家庭人均年收入(元)
<4000										1.000
≥4000		-2.774		0.466		35.454		0.000		0.062(0.025~0.156)
变量	β值		s $x ˉ$ 值		Wald χ²值		P值		OR(95%CI)值
初次就诊到确诊时间(d)
0									1.000
1~4	-0.121		0.718		0.028		0.866		0.886(0.217~3.619)
≥5	-0.290		0.619		0.219		0.640		0.748(0.222~2.518)
住院治疗次数
0									1.000
1	1.940		0.699		7.717		0.005		6.962(1.771~27.371)
≥2	3.627		0.815		19.815		0.000		37.610(7.615~185.742)
就诊路径
仅结核病定点医院									1.000
多院就诊	1.434		0.540		7.065		0.008		4.196(1.457~12.079)

References 27

[1]	吴树才, 章志华, 邸红芹. 重视结核分枝杆菌分子生物学诊断. 结核与肺部疾病杂志, 2021, 2(1): 3-7. doi:10.3969/j.issn.2096-8493.2021.01.002. doi: 10.3969/j.issn.2096-8493.2021.01.002 URL
[2]	Saunders MJ, Evans CA. COVID-19, tuberculosis and poverty: preventing a perfect storm. Eur Respir J, 2020, 56(1):2001348. doi:10.1183/13993003.01348-2020. doi: 10.1183/13993003.01348-2020 URL
[3]	Duan W, Zhang W, Wu C, et al. Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study. BMJ Open, 2019, 9(4):e026638. doi:10.1136/bmjopen-2018-026638. doi: 10.1136/bmjopen-2018-026638 URL
[4]	Prasad BM, Tripathy JP, Muraleedharan VR, et al. Rising Catastrophic Expenditure on Households Due to Tuberculosis: Is India Moving Away From the END-TB Goal? Front Public Health, 2021, 9:614466. doi:10.3389/fpubh.2021.614466. doi: 10.3389/fpubh.2021.614466 URL
[5]	World Health Organization. Global tuberculosis report 2022, Geneva: World Health Organization, 2022.
[6]	赵津, 李仁忠. 结核病定点医院肺结核诊断治疗管理现况分析. 中国健康教育, 2011, 27(1):13-17. doi:10.16168/j.cnki.issn.1002-9982.2011.01.020. doi: 10.16168/j.cnki.issn.1002-9982.2011.01.020 URL
[7]	郁娟, 韩芸倩, 潘佳雪, 等. 兰州市肺结核患者住院费用及影响因素分析. 中国初级卫生保健, 2017, 31(1):17-20. doi:10.3969/j.issn.1001-568X.2017.01.0007. doi: 10.3969/j.issn.1001-568X.2017.01.0007 URL
[8]	王姬, 应世栋, 张文伟. 肺结核患者疾病经济负担及其影响因素分析. 实用预防医学, 2015, 22(11):1352-1354. doi:10.3969/j.issn.1006-3110.2015.011.023. doi: 10.3969/j.issn.1006-3110.2015.011.023 URL
[9]	王迎雪, 刘东波, 李卫彬, 等. 河南省开封市肺结核住院患者疾病经济负担及医疗保障现状调查. 医学与社会, 2014, 27(2):28-30. doi:10.3870/YXYSH.2014.02.009. doi: 10.3870/YXYSH.2014.02.009 URL
[10]	Aung ST, Thu A, Aung HL, et al. Measuring Catastrophic Costs Due to Tuberculosis in Myanmar. Trop Med Infect Dis, 2021, 6(3):130. doi:10.3390/tropicalmed6030130. doi: 10.3390/tropicalmed6030130 URL
[11]	Ruan YZ, Li RZ, Wang XX, et al. The affordability for patients of a new universal MDR-TB coverage model in China. Int J Tuberc Lung Dis, 2016, 20(5):638-644. doi:10.5588/ijtld.15.0413. doi: 10.5588/ijtld.15.0413 URL pmid: 27084818
[12]	吴波, 刘英, 廖文平, 等. 重庆市四区县肺结核患者经济负担分析. 中国防痨杂志, 2022, 44(4):390-396. doi:10.19982/j.issn.1000-6621.20210633. doi: 10.19982/j.issn.1000-6621.20210633 URL
[13]	刘广天, 丁晓燕, 雷娟, 等. 2016年和2019年银川市三区肺结核患者医疗费用及筹资模式评价. 中国防痨杂志, 2021, 43(8):766-771. doi:10.3969/j.issn.1000-6621.2021.08.003. doi: 10.3969/j.issn.1000-6621.2021.08.003 URL
[14]	徐春华, 刘清, 王紫纯, 等. 上海市奉贤区肺结核患者经济负担及其影响因素分析. 中国防痨杂志, 2019, 41(9):974-984. doi:10.3969/j.issn.1000-6621.2019.09.012. doi: 10.3969/j.issn.1000-6621.2019.09.012 URL
[15]	Pedroso MRO, Guidoni LM, Zandonade E, et al. Catastrophic costs and social sequels due to tuberculosis diagnosis and treatment in Brazil. Epidemiol Serv Saude, 2021, 30(3): e2021007. doi:10.1590/S1679-49742021000300012. doi: 10.1590/S1679-49742021000300012 URL
[16]	Stracker N, Hanrahan C, Mmolawa L, et al. Risk factors for catastrophic costs associated with tuberculosis in rural South Africa. Int J Tuberc Lung Dis, 2019, 23(6): 756-763. doi:10.5588/ijtld.18.0519. doi: 10.5588/ijtld.18.0519 URL pmid: 31315710
[17]	Viney K, Itogo N, Yamanaka T, et al. Economic evaluation of patient costs associated with tuberculosis diagnosis and care in Solomon Islands. BMC Public Health, 2021, 21(1):1928. doi:10.1186/s12889-021-11938-8. doi: 10.1186/s12889-021-11938-8 URL
[18]	Muniyandi M, Thomas BE, Karikalan N, et al. Association of Tuberculosis With Household Catastrophic Expenditure in South India. JAMA Netw Open, 2020, 3(2):e1920973. doi:10.1001/jamanetworkopen.2019.20973. doi: 10.1001/jamanetworkopen.2019.20973 URL
[19]	Jiang WX, Long Q, Lucas H, et al. Impact of an innovative financing and payment model on tuberculosis patients’ financial burden: is tuberculosis care more affordable for the poor? Infect Dis Poverty, 2019, 8(1):21. doi:10.1186/s40249-019-0532-x. doi: 10.1186/s40249-019-0532-x URL
[20]	Kirubi B, Ong’ang’o J, Nguhiu P, et al. Determinants of household catastrophic costs for drug sensitive tuberculosis patients in Kenya. Infect Dis Poverty, 2021, 10(1):95. doi:10.1186/s40249-021-00879-4. doi: 10.1186/s40249-021-00879-4 URL pmid: 34225790
[21]	Yang T, Chen T, Che Y, et al. Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China. BMC Public Health, 2020, 20(1):1009. doi:10.1186/s12889-020-09136-z. doi: 10.1186/s12889-020-09136-z URL pmid: 32586305
[22]	Hu H, Chen J, Sato KD, et al. Factors that associated with TB patient admission rate and TB inpatient service cost: a cross-sectional study in China. Infect Dis Poverty, 2016, 5:4. doi:10.1186/s40249-016-0097-x. doi: 10.1186/s40249-016-0097-x URL pmid: 26786599
[23]	Vo LNQ, Forse RJ, Codlin AJ, et al. Socio-protective effects of active case finding on catastrophic costs from tuberculosis in Ho Chi Minh City, Viet Nam: a longitudinal patient cost survey. BMC Health Serv Res, 2021, 21(1):1051. doi:10.1186/s12913-021-06984-2. doi: 10.1186/s12913-021-06984-2 URL pmid: 34610841
[24]	Liu Y, Pang Y, Du J, et al. An Overview of Tuberculosis-Designated Hospitals in China, 2009—2015: A Longitudinal Analysis of National Survey Data. Biomed Res Int, 2019, 2019:9310917. doi:10.1155/2019/9310917. doi: 10.1155/2019/9310917 URL
[25]	Viney K, Amaral S, Marques EB, et al. Four of five tuberculosis patients experience catastrophic costs related to TB diagnosis and care in Timor-Leste. Int J Tuberc Lung Dis, 2019, 23(11):1191-1197. doi:10.5588/ijtld.18.0765. doi: 10.5588/ijtld.18.0765 URL pmid: 31718755
[26]	Samuels THA, Shete PB, Ojok C, et al. Where will it end? Pathways to care and catastrophic costs following negative TB evaluation in Uganda. PLoS One, 2021, 16(7):e0253927. doi:10.1371/journal.pone.0253927. doi: 10.1371/journal.pone.0253927 URL
[27]	Muttamba W, Tumwebaze R, Mugenyi L, et al. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. BMC Public Health, 2020, 20(1):1409. doi:10.1186/s12889-020-09524-5. doi: 10.1186/s12889-020-09524-5 URL pmid: 32938411

特征	例数	构成比(%)	特征	例数	构成比(%)
性别			职业
男性	150	64.38	农民	189	81.12
女性	83	35.62	其他职业^b	44	18.88
年龄组(岁)			住址类型
0~19	15	6.44	农村	149	63.95
20~39	59	25.32	城镇	84	36.05
40~59	94	40.34	婚姻状况
60~85	65	27.90	已婚	173	74.25
民族			其他^c	60	25.75
汉族	68	29.18	参保类型
少数民族	165	70.82	新农合	209	89.70
文化程度			其他医保^d	24	10.30
小学及以下	150	64.38	家庭人均年收入(元)
初中	56	24.03	<4000	133	57.08
中专/高中	18	7.72	≥4000	100	42.92
大专/大学	9	3.87

因素		发生灾难性支出				未发生灾难性支出				χ²值		P值
因素		例数		构成比(%)		例数		构成比(%)		χ²值		P值
性别										0.147		0.701
男性		103		68.7		47		31.3
女性		59		71.1		24		28.9
年龄组(岁)										4.362		0.225
0~19		10		66.7		5		33.3
20~39		35		59.3		24		40.7
40~59		68		72.3		26		27.7
60~85		49		75.4		16		24.6
民族										1.795		0.180
汉族		43		63.2		25		36.8
少数民族		119		72.1		46		27.9
职业										5.747		0.017
农民		138		73.0		51		27.0
其他^b		24		54.5		20		45.5
文化程度										12.137		0.007
小学及以下		109		72.7		41		27.3
初中		42		75.0		14		25.0
中专/高中		7		38.9		11		61.1
大专/大学		4		44.4		5		55.6
住址类型										15.786		<0.001
农村		117		78.5		32		21.5
城镇		45		53.6		39		46.4
参保类型										7.090		0.008
新农合		151		72.2		58		27.8
其他^c		11		45.8		13		54.2
家庭人均年收入(元)										49.747		<0.001
<4000		16		12.0		117		88.0
≥4000		55		55.0		45		45.0
出现症状到首次就诊间隔时间(d)										4.383		0.223
0		13		56.5		10		43.5
1~6		34		64.2		19		35.8
7~13		24		80.0		6		20.0
≥14		91		71.7		36		28.3
确诊前就诊次数										4.485		0.106
0		105		65.6		55		34.4
1		35		74.5		12		25.5
≥2		22		84.6		4		15.4
初次就诊到确诊时间(d)										6.781		0.034
0		103		66.9		51		33.1
1~4		15		57.7		11		42.3
≥5		44		83.0		9		17.0
因素	发生灾难性支出				未发生灾难性支出				χ²值		P值
因素	例数		构成比(%)		例数		构成比(%)		χ²值		P值
住院治疗次数									27.917		<0.001
0	5		31.2		11		68.8
1	80		62.0		49		38.0
≥2	77		87.5		11		12.5
门诊治疗次数									0.231		0.891
1~3	30		68.2		14		31.8
4~6	98		69.0		44		31.0
≥7	34		72.3		13		27.7
就诊路径									13.787		<0.001
仅定点医院	69		58.5		49		41.5
多院就诊	93		80.9		22		19.1

因素	赋值情况	因素	赋值情况
灾难性支出发生(Y)	0=否;1=是	参保类型(X₄)	1=新农合;2=其他医保
职业(X₁)	1=农民;2=其他职业	家庭人均年收入(X₅)	1=<4000元;2=≥4000元
文化程度(X₂)	1=小学及以下;2=初中;3=中专/高中;4=大专/大学	初次就诊到确诊天数(X₆)	1=0d;2=1~4d;3=≥5d
文化程度(X₂)	1=小学及以下;2=初中;3=中专/高中;4=大专/大学	住院治疗次数(X₇)	1=0次;2=1次;3=≥2次
住址类型(X₃)	1=农村;2=城镇	就诊路径(X₈)	1=仅结核病定点医院;2=多院就诊