Poovorawan Kittiyod, Treeprasertsuk Sombat, Thepsuthammarat Kaewjai, Wilairatana Polrat, Kitsahawong Bubpha, Phaosawasdi Kamthorn
Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Ann Hepatol. 2015 Nov-Dec;14(6):862-8. doi: 10.5604/16652681.1171773.
Cirrhosis is responsible for significant health-care costs and morbidity. This study aims to evaluate the burden of illness associated with cirrhosis, its impact on the universal coverage public health care system in Thailand.
We used data from the 2010 Nationwide Hospital Admission Data, the National Health Security Office (NHSO), Thailand. Their baseline characteristics, hospital costs, and outcomes were analyzed according to national health insurance categories including medical welfare scheme (MWFS), social security scheme (SSS) and civil servant medical benefit scheme (CSMBS).
92,301 admissions were eligible for analysis. The mean age was 55 ± 12.8 years, and 63.3% of patients were above 50 years old. The majority of patients (79%) belonged to the MWFS group. The MWFS group incurred the lowest medical expense and had the shortest hospital stay compared to the SSS and CSMBS groups. Overall in-hospital mortality was 10.7%. Cirrhosis complications include bleeding esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and hepatocellular carcinoma. These complications significantly increased mortality rates compared to patients without complications (26 vs. 8.9%, p < 0.001). In-hospital mortality of patients with cirrhosis complications did not differ among the three national health insurance groups. Respiratory failure and septicemia were associated with the highest risk of death (HR 5.4; 95% CI: 4.8-5.9 and HR 5.2; 95% CI: 4.9-5.6 respectively; P < 0.001).
Illness associated with cirrhosis is a significant public health problem in Thailand. Outcomes of cirrhosis complications did not differ between universal public health care coverage systems in Thailand.
肝硬化导致了高昂的医疗费用和发病率。本研究旨在评估与肝硬化相关的疾病负担，及其对泰国全民覆盖公共卫生保健系统的影响。
我们使用了泰国国家健康保险办公室（NHSO）2010年全国医院入院数据。根据国家健康保险类别，包括医疗福利计划（MWFS）、社会保障计划（SSS）和公务员医疗福利计划（CSMBS），分析了患者的基线特征、住院费用和结局。
92301例入院患者符合分析条件。平均年龄为55±12.8岁，63.3%的患者年龄在50岁以上。大多数患者（79%）属于MWFS组。与SSS组和CSMBS组相比，MWFS组的医疗费用最低，住院时间最短。总体住院死亡率为10.7%。肝硬化并发症包括食管静脉曲张破裂出血、自发性细菌性腹膜炎、肝性脑病、肝肾综合征和肝细胞癌。与无并发症患者相比，这些并发症显著提高了死亡率（26%对8.9%，p<0.001）。肝硬化并发症患者的住院死亡率在三个国家健康保险组之间没有差异。呼吸衰竭和败血症与最高死亡风险相关（风险比分别为5.4；95%置信区间：4.8 - 5.9和风险比5.2；95%置信区间：4.9 - 5.6；P<0.001）。
与肝硬化相关的疾病是泰国一个重大的公共卫生问题。泰国全民公共卫生保健覆盖系统中肝硬化并发症的结局没有差异。
