Zhou Mingchao, Ye Ruixue, Guo Jie, Zhu Xiaolong, Zha Fubing, Luo Jiao, Huang Meiling, Shan Linlin, Li Dongxia, Wang Yulong
Rehabilitation Department, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No. 3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China.
Rehabilitation Department, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong, China.
BMC Public Health. 2025 Aug 25;25(1):2908. doi: 10.1186/s12889-025-24165-2.
Stroke is a leading cause of death and disability among Chinese residents, imposing a significant economic burden. This study aimed to analyze the current status and influencing factors of inpatient rehabilitation costs for stroke in Shenzhen, providing evidence to help reduce costs for patients with stroke in rehabilitation centers.
This multicenter retrospective study used data primarily collected from patient's medical records. We included patients admitted to the rehabilitation departments of public and private hospitals in Shenzhen from January 1, 2019, to October 31, 2021, who met the diagnostic criteria for stroke. After data cleaning, we collected information on hospital demographics, diagnoses, functional impairments, length of stay, and hospitalization costs. Multiple linear regression analysis was used to create a path analysis model to assess the direct and indirect effects of various factors on total hospitalization and average daily expenditures.
The study included 2638 patients with stroke from 22 hospitals in Shenzhen, with 69.6% males and an average age of 59.2 years. Ischemic and hemorrhagic strokes accounted for 56% and 44% of the cases, respectively. The median total hospitalization costs were 27,306.64 Chinese Yuan (CNY) (4022.79 USD) for ischemic stroke and 32,188.25 CNY (4022.79 USD) for hemorrhagic stroke, while the average daily costs were 848.64 CNY (125.87 USD) and 828.23 CNY (125.87 USD), respectively. The median length of stay (LOS) was 30 days for patients with ischemic stroke and 41 days for patients with hemorrhagic stroke. Rehabilitation accounted for the highest cost category (64% and 68%, respectively). Path analysis revealed that LOS was the primary direct factor influencing total hospitalization costs, while hospital grades, functional impairment levels, disease stage, and age were indirect factors. For average daily costs, the primary direct influencing factor was hospital grades, with functional impairment levels, disease stage, and age as indirect factors.
Patients with stroke in Shenzhen face significant financial burden. The government should continuously promote the construction of a three-tiered rehabilitation system and hierarchical LOS management to provide systematic and sustainable medical services. Daily costs should be stratified based on functional impairment levels, disease stage, and age to guide the reform of precision bed-day medical insurance payments for stroke rehabilitation.
The study protocol was registered in the Chinese Clinical Trial Registry (ChiCTR-2000034067, Registration date: 22 June 2020, http://www.chictr.org.cn/showproj.aspx?proj=54770 ).
中风是中国居民死亡和残疾的主要原因，带来了沉重的经济负担。本研究旨在分析深圳中风住院康复费用的现状及影响因素，为帮助降低中风患者在康复中心的费用提供依据。
这项多中心回顾性研究主要使用从患者病历中收集的数据。我们纳入了2019年1月1日至2021年10月31日期间在深圳公立和私立医院康复科住院且符合中风诊断标准的患者。数据清理后，我们收集了医院人口统计学、诊断、功能障碍、住院时间和住院费用等信息。采用多元线性回归分析建立路径分析模型，以评估各种因素对总住院费用和日均费用的直接和间接影响。
该研究纳入了深圳22家医院的2638例中风患者，男性占69.6%，平均年龄为59.2岁。缺血性和出血性中风分别占病例的56%和44%。缺血性中风的总住院费用中位数为27306.64元人民币（4022.79美元），出血性中风为32188.25元人民币（4022.79美元），而日均费用分别为848.64元人民币（125.87美元）和828.23元人民币（125.87美元）。缺血性中风患者的住院时间中位数为30天，出血性中风患者为41天。康复费用占最高费用类别（分别为64%和68%）。路径分析显示，住院时间是影响总住院费用的主要直接因素，而医院等级、功能障碍水平、疾病阶段和年龄是间接因素。对于日均费用，主要直接影响因素是医院等级，功能障碍水平、疾病阶段和年龄为间接因素。
深圳的中风患者面临着巨大的经济负担。政府应持续推进三级康复体系建设和住院时间分层管理，以提供系统和可持续的医疗服务。应根据功能障碍水平、疾病阶段和年龄对日均费用进行分层，以指导中风康复精准床日医保支付改革。
该研究方案已在中国临床试验注册中心注册（ChiCTR-2000034067，注册日期：2020年6月22日，http://www.chictr.org.cn/showproj.aspx?proj=54770 ）
