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目的分析甘肃省某三级甲等医院就诊患者的疾病构成和疾病负担情况,为了解疾病的流行趋势及临床医学研究提供依据。方法分析2013年1月1日—2014年12月31日期间甘肃省某三级甲等医院114 159例住院患者的疾病谱和住院费用,数据来自甘肃省卫生系统疾病预防控制机构进医院信息平台,疾病按国际疾病标准编码(ICD-10)进行分类。结果 114 159例患者中男性56 394例、占49.40%,女性57 765例、占50.60%;前11位疾病系统中影响健康状态和保健机构接触的因素(χ~2=12.46)、呼吸系统疾病(χ~2=7.90)、妊娠、分娩和产褥期(χ~2=47.28)、肿瘤(χ~2=4.12)、泌尿生殖系统疾病(χ~2=5.72)、神经系统疾病(χ~2=16.99)以及肌肉骨骼系统和结缔组织疾病(χ~2=4.65),两年发病率差异有统计学意义(均P<0.05);前10种疾病分别占当年疾病总数的15.60%和14.28%,高血压Ⅲ期(χ~2=1.65)、不稳定性心绞痛(χ~2=0.034)、慢性阻塞性肺病伴急性加重(χ~2=2.89),两年发病率差异无统计学意义(均P>0.05);男性前2位疾病是2型糖尿病和急性脑动脉供血不足,女性前2位疾病是急症剖宫产和单胎顺产;2013年前10位疾病中高血压(χ~2=3.64)、高血压Ⅲ期(χ~2=0.417)、下肢静脉功能不全(χ~2=0.13)男女患病率差异无统计学意义(均P>0.05);2014年患急性脑动脉供血不足(χ~2=26.88)和胆囊结石伴急性胆囊炎(χ~2=36.31)的女性高于男性,差异有统计学意义(均P<0.05);而阻塞性睡眠呼吸暂停综合征(χ~2=255.09)、不稳定性心绞痛(χ~2=51.86)、慢性阻塞性肺病伴急性加重(χ~2=67.69)、腔隙性脑梗塞(χ~2=41.31)、2型糖尿病(χ~2=59.21)的患病率则是男性高于女性,差异亦有统计学意义(均P<0.05)。结论甘肃省某三级甲等医院就诊疾病的前10位疾病排序与兰州市疾病谱有所不同,疾病负担高于全省和全国住院患者的人均负担。
Objective To analyze the disease constitution and disease burden of patients in a tertiary level Hospitals in Gansu Province in order to provide evidences for understanding the prevalence of diseases and clinical research. Methods The data of disease spectrum and hospitalization of 114 159 hospitalized patients in a Grade A hospital in Gansu from January 1, 2013 to December 31, 2014 were analyzed. The data were collected from the Information System of Disease Prevention and Control of Health System of Gansu Province , The disease was classified according to the International Standard Disease Code (ICD-10). Results A total of 114 399 patients (56 394 males, 49.40% females, 57 765 females, accounting for 50.60%) were found in 114 159 patients. Factors affecting the health status and the contact with health care institutions in the first 11 disease systems (χ ~ 2 = 12.46) (χ ~ 2 = 7.90), pregnancy, childbirth and puerperium (χ ~ 2 = 47.28), tumor (χ ~ 2 = 4.12), genitourinary system (χ ~ 2 = 16.99), and musculoskeletal and connective tissue diseases (χ ~ 2 = 4.65). There was significant difference in the two years incidence rates (all P <0.05). The first ten diseases accounted for 15.60% and 14.28% There were no significant differences in the incidence of hypertension between the two groups (χ ~ 2 = 1.65), unstable angina (χ ~ 2 = 0.034) and acute obstructive pulmonary disease (χ ~ 2 = 2.89) P> 0.05). The first two diseases in men were type 2 diabetes and acute cerebral artery insufficiency. The top two female diseases were cesarean section and single birth with emergency. In the first ten diseases in 2013, hypertension (χ ~ 2 = 3.64 (Χ ~ 2 = 0.417), lower extremity venous insufficiency (χ ~ 2 = 0.13), there was no significant difference between the male and female prevalence (all P> 0.05). In 2014, patients with acute cerebral arterial insufficiency χ ~ 2 = 26.88) and gallbladder The difference was statistically significant (P <0.05), while obstructive sleep apnea syndrome (χ ~ 2 = 255.09), unstable angina pectoris (χ ~ 2 = 51.86), the prevalence of chronic obstructive pulmonary disease (χ ~ 2 = 67.69), lacunar infarction (χ ~ 2 = 41.31) and type 2 diabetes (χ ~ 2 = 59.21) Male is higher than female, the difference is also statistically significant (both P <0.05). Conclusion The rankings of the top 10 diseases in some Grade A hospitals in Gansu Province are different from those in Lanzhou City. The burden of disease is higher than that of inpatients in the whole province and the whole country.