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目的对天津市不同监测模式下确诊的百日咳病例开展经济负担调查,评价免疫规划时期百日咳疾病的危害程度。方法连续3年在所选3家社区医院开展全人群百日咳症状监测,在2家三级医院开展百日咳被动监测,对确诊病例于21天开展入户调查,调查内容包括病例基本信息、就诊信息、因病支出的直接经济负担和间接经济损失。结果 233例百日咳病例的直接经济负担中位数为3364元,其中门诊病例850元,住院病例7282元。间接经济损失中位数为641.29元,误工天数的中位数为12 d。社区症状监测直接经济负担中位数为2800元,显著低于医院被动监测的4200元(P=0.035)。119例门诊病例平均治疗费用1450元;114例住院病例人均费用7105元,平均住院天数10.5 d,日均住院费用为676.67元。<1岁组病例平均费用为7250元,显著高于其他年龄组(P<0.001)。结论在免疫规划时期百日咳疾病负担依旧严重,<1岁患儿疾病负担最重,青少年及成年人病例增加的趋势不容忽视。社区医院百日咳症状主动监测将有效降低患者的直接经济负担。
Objective To investigate the economic burden of whooping cough cases diagnosed in different monitoring modes in Tianjin and evaluate the harm degree of pertussis diseases during immunization planning. Methods The whole-family pertussis syndrome was monitored in 3 selected community hospitals for 3 consecutive years. Passive monitoring of whooping cough was conducted in 2 tertiary hospitals. The survey of 21 cases of confirmed cases was carried out. The survey included basic information of case, The direct economic burden and indirect economic loss due to illness. Results The median direct financial burden of 233 cases of whooping cough was 3364 yuan, of which outpatient 850 yuan, inpatient 7282 yuan. The median indirect economic loss was 641.29 yuan, the median number of lost days was 12 days. The median direct economic burden of community symptom monitoring was 2,800 yuan, significantly lower than the passive monitoring of the hospital 4200 yuan (P = 0.035). The average treatment cost of 119 outpatients was 1,450 yuan. The per capita cost of 114 cases was 7105 yuan, the average hospitalization days was 10.5 days, and the average daily hospitalization cost was 676.67 yuan. The average cost of patients <1 year old was 7250 yuan, significantly higher than other age groups (P <0.001). Conclusion The burden of pertussis disease is still serious during the immunization program. Children <1 year old have the heaviest burden of disease, and the increasing trend of adolescents and adults can not be ignored. Active monitoring of pertussis symptoms in community hospitals will effectively reduce the direct financial burden on patients.