Tang Xuwei, Xie Xiaoxu, Rao Zhixiang, Zheng Zhenquan, Hu Chanchan, Li Shanshan, Hu Zhijian
Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China.
Institute of Health Research, School of Public Health, Fujian Medical University, Fuzhou, China.
Front Public Health. 2021 Nov 17;9:774342. doi: 10.3389/fpubh.2021.774342. eCollection 2021.
As China embraced an aging society, the burden of age-related diseases had increased dramatically. Knowledge about spatial distribution characteristics of disease burden and the influencing factors of medical expenditure is of great significance to the formulation of health policies. However, related research in rural China is still insufficient. A total of 5,744,717 records of hospitalized rural elderly in southeast China were collected from 2010 to 2016. We described the temporal trends of hospitalization medical expenditure and the prevalence of catastrophic health expenses (CHE) in the rural elderly by common diseases. Then, geographical information tools were used for visualization of geographic distribution patterns of CHE, the ordinary least squares methods (OLS) and geographically weighted regression (GWR) were employed to examine the influencing factors of medical expenditure. The number of CHE hospitalizations and the total number of hospitalizations for the rural elderly people increased by 2.1 times and 2.2 times, respectively, from 2010 to 2016. Counties with a high prevalence of CHE were clustered in the eastern coastal area (Moran's = 0.620, < 0.001, General < 0.001, < 0.001). Unspecified transport accidents, cardiovascular disease, and essential hypertension were the top causes of CHE in the rural elderly. Adequate hospital beds ( < 0.05) and reasonable utilization and distribution of town-level ( < 0.001) and county-level hospitals ( < 0.001) may help reduce medical expenditures. In the context of an aging society, the disease burden for the elderly in rural areas should arouse more attention. These findings highlight the importance of age-related disease prevention and the rational allocation of medical resources in rural areas.
随着中国步入老龄化社会，与年龄相关疾病的负担急剧增加。了解疾病负担的空间分布特征以及医疗支出的影响因素对于制定卫生政策具有重要意义。然而，中国农村地区的相关研究仍然不足。我们收集了2010年至2016年中国东南部5744717例农村老年住院患者的记录。我们描述了农村老年人住院医疗支出的时间趋势以及常见疾病导致的灾难性卫生支出（CHE）的患病率。然后，利用地理信息工具对CHE的地理分布模式进行可视化，采用普通最小二乘法（OLS）和地理加权回归（GWR）来研究医疗支出的影响因素。从2010年到2016年，农村老年人CHE住院次数和住院总次数分别增加了2.1倍和2.2倍。CHE患病率高的县集中在东部沿海地区（莫兰指数 = 0.620，P < 0.001，全局P < 0.001，局部P < 0.001）。未明确的交通事故、心血管疾病和原发性高血压是农村老年人CHE的主要原因。充足的医院床位（P < 0.05）以及乡镇级（P < 0.001）和县县级医院的合理利用与分布（P < 0.001）可能有助于降低医疗支出。在老龄化社会背景下，农村地区老年人的疾病负担应引起更多关注。这些发现凸显了农村地区预防与年龄相关疾病以及合理分配医疗资源的重要性。
