【作者】 王芳；

【导师】 梁渊；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2016， 硕士

【摘要】 目的:面对慢性病的漫长病程及其长期医疗所致的疾病负担的挑战,行为的改变(包括锻炼)被认为是一个优先的战略。本研究分析了冠心病病人的锻炼强度与锻炼年限对其住院服务利用和费用的影响,以期为降低其疾病负担提供依据和建议。方法:本研究数据来自东风-同济队列2013年第一次随访数据。选择于2013年因冠心病住院的病人,排除相关变量信息缺失的病例后,纳入分析的病例为1,454例。研究内容包括病人的社会人口学特征、锻炼强度(0、≤18.0 MET-h/week、18.01-36.0 MET-h/week、≥36.01 MET-h/week)和锻炼年限(0、1-4年、5-9年、≥10年),及其2013年住院次数、住院天数、住院费用和总医疗费用(住院+门诊费用)。统计分析采用SPSS17.0,分析方法包括:描述性分析、方差分析、非参数秩和检验、卡方检验、Logistic回归分析和广义线性回归分析。结果:研究对象中不锻炼、低强度、中强度和高强度锻炼的比例分别为:13.14%、29.37%、30.19%、27.30%;锻炼年限为0年、1-4年、5-9年及≥10年的比例分别为:13.14%、11.97%、14.51%和60.39%。研究对象锻炼强度由低到高对应的住院次数≥2次的比例分别为30.37%、23.42%、25.51%和17.88%;住院天数分别为18.91±18.03、15.61±13.95、15.62±12.65和14.50±12.77(天);住院和门诊的总医疗费用中位数分别为11.88、9.61、9.79、9.34(千元);研究对象锻炼年限在0年、1-4年、5-9年及≥10年对应的住院次数≥2次的分别为30.37%、19.54%、17.54%、24.15%;住院天数分别为18.91±18.03、14.41±12.47、13.82±11.70和15.78±13.57(天);住院和门诊的总医疗费用中位数分别为11.88、9.39、9.00、9.79(千元)。多因素分析结果显示,在校正了其他因素后,与不锻炼者相比,不同锻炼强度者的住院次数、住院天数、住院费用和总费用均有所降低,尤其是高强度的锻炼(OR=0.52,95%CI=0.34~0.79;β=-3.07,95%CI:=-5.45~-0.69;βlog=-0.081,95%CI=-0.147~-0.015;βlog=-0.096,95%CI:-0.162~-0.031)。总体上,除住院次数外,锻炼年限对调查对象的住院天数、住院费用和总费用的影响与锻炼强度的结果比较相似。结论:本研究从实证角度验证了锻炼强度、年限与冠心病病人卫生服务利用的关系,且研究结果提示:为应对冠心病的漫长病程及其长期医疗所致的疾病负担的挑战,在病人生理状态许可的前提下,坚持锻炼,特别是较高强度的锻炼应该被倡导,这将可能有利于病人的身体健康以及相关的卫生决策。更多还原

【Abstract】 Objectives: Faced with the challenges from the high incidence, long duration and medical costs of chronic diseases, the intervention of behavior is considered to be a strategic priority. The aim of this study is to analyze the correlation between different levels of physical activity(PA) and annual hospital service use and expenditure for inpatient with coronary heart disease(CHD) in China, and to provide evidence and recommendations for reducing the disease burden.Methods: The data was derived from the first follow-up(2013) survey of Dongfeng-Tongji cohort study; hospital service use and expenditure information in2013 came from the DMC affiliated medical insurance system. 1,454 eligible CHD patients were included, excluded the missing data of independent variables. The research contents included demographic characteristics, intensity of PA levels(0,≤18.0 MET-h/week, 18.01-36.0 MET-h/week, ≥36.01MET-h/week), years of physical activity(0 year, 1-4 years, 5-9 years, ≥10 years), and the number of inpatient visits,number of hospital days, inpatient costs and outpatient costs. All analyses were performed using SPSS 17.0. The analysis methods include descriptive analysis,analysis of variance, nonparametric test, Chi squared test, logistic regression analysis and generalized linear regression.Results: Of the CHD patients, the rates of PA intensity(0, ≤18.0 MET-h/week,18.01-36.0 MET-h/week, ≥36.01MET-h/week) were 13.14%, 29.37%, 30.19%,27.30%, respectively; and those of years of PA(0 year, 1-4 years, 5-9 years, ≥10years) were 13.14%, 11.97%, 14.51% and 60.39%, respectively.The rates for more than once inpatient visits were 30.37%, 23.42%, 25.51% and17.88% by PA intensity from no activity, light, moderate and vigorous of CHD patients; the hospital days were 18.91±18.03, 15.61±13.95, 15.62±12.65 and14.50±12.77 days; the median of total medical costs in 4 levels of PA intensity were11.88, 9.61, 9.79, 9.34(thousand RMB), respectively. The rates for more than once inpatient visits were 30.37%, 19.54%, 17.54% and 24.15% by PA years from 0 year,1-4 years, 5-9 years, ≥10 years of CHD patients; the hospital days were 18.91±18.03,14.41±12.47, 13.82±11.70, 15.78±13.57 days; the median of total medical costs in 4levels of PA intensity were 11.88, 9.39, 9.00, 9.79(thousand RMB), respectively.After adjustment for potential confounders, multivariable analysis showed that,the number of inpatient visits, hospital days, inpatient costs and total costs were declined with different level of PA intensity, compared to no activity patients;especially for the vigorous PA intensity(OR=0.52, 95%CI=0.34~0.79; β=-3.07, 95%CI=-5.45~-0.69; βlog =-0.081, 95% CI=-0.147~-0.015; βlog =-0.096, 95% CI=-0.162~-0.031; respectively). Inpatient costs and total medical costs by levels of the intensity of PA are very similar to those of levels of PA years.Conclusions: This study verified the effects of the intensity and years of PA on hospital service use and expenditure of CHD from the perspective of empirical. In particular, to cope with the long course of coronary heart disease and the challenges of the burden of disease caused by long-term care, keep exercising, especially the vigorous PA, should be advocated, which would contribute to the health of patients and the related health decision making.更多还原