河南睢县秋冬季5岁以下儿童急性胃肠炎疾病负担研究

发布时间：2018-03-23 23:04

本文选题：急性胃肠炎　切入点：秋冬季　出处：《中国疾病预防控制中心》2017年硕士论文

【摘要】：目的:1.了解当地秋冬季节儿童急性胃肠炎流行现状、病因特点、影响因素和诊疗行为。2.评价当地秋冬季儿童急性胃肠炎的DALYs和经济负担,并分析不同年龄组和不同症状类型病例的流行现状、发病情况、就诊情况和疾病负担差异。方法:1.通过文献、统计年鉴、政府报告、官方统计等,收集当地5岁以下儿童总人数、5岁以下儿童各年龄段人数分布、当地人均GDP等基础信息。通过询问医生,填写医疗机构调查表,了解当地医疗机构及相关诊室儿童腹泻病例基本资料和治疗方式。随机抽取的20个社区的所有5岁以下、常住儿童纳为研究对象。2.于2016年12月在河南睢县开展现场调查,采用统一调查表入户调查。主要内容包括家庭和个人基础资料,3个月内最近一次急性胃肠炎发病资料(发病症状、持续时间等),就诊情况(就诊率、住院率、就诊医院、住院天数等),行为习惯、应对方式、治疗措施,医疗费用、非医疗费用和误工天数,急性胃肠炎影响因素(其他疾病、卫生习惯、人文因素、信息途径等)。3.使用EpiData3.1建立数据库,资料复核并逻辑检查。使用Excel2013和SPSS20.0进行数据整理及分析,对调查人群基本特征、急性胃肠炎流行特征、就诊行为与特点、经济负担等进行描述性分析,对相关影响因素进行卡方检验、方差分析、秩和检验等,检验水准为0.05。采用两周罹患率、伤残调整寿命年(DALY)、直接经济负担、间接经济负担等指标反映急性胃肠炎疾病负担。结果:1.本次调查有效调查对象1582名,疾病负担资料是260名对象的,3个月内最近一次急性胃肠炎发病和就诊情况。两周内急性胃肠炎新发102例,两周罹患率6.4%。为真实地反映睢县5岁以下儿童秋冬季急性胃肠炎发病水平,根据睢县各年龄组实际人数及比例,对两周罹患率进行校正,校正后急性胃肠炎两周罹患率为10.4%。不同年龄组罹患率随年龄增长呈下降趋势,2岁及以上男童、女童的两周罹患率较接近,2岁以下年龄组男孩两周罹患率大于女孩。2.本次调查近3个月急性胃肠炎病例260例,出现腹泻症状221例(占85%),出现呕吐症状103例(占39.6%),出现发热症状64例(占24.6%);其中,仅腹泻的病例157例(占60.4%),仅呕吐的病例39例(占15.0%),腹泻和呕吐症状均发生的有64例(占24.6%)。发热症状在仅腹泻、仅呕吐、腹泻且呕吐的病例中分布不一致,不同类型病例在不同年龄组中分布不一致。3.5岁以下儿童急性胃肠炎病程平均为2.92天,0～1岁儿童病程平均持续3.94天,2～4岁儿童病程平均持续2.19天。4.急性胃肠炎病例腹泻症状平均持续3.19天,呕吐平均持续1.70天,腹泻症状通常比呕吐持续时间更长;0～1岁儿童病程平均比2～4岁儿童多持续一天半,腹泻和呕吐24h最多发作次数均比2～4岁多,间接反映病情更为严重。5.调查的260例急性肠胃炎病例中,就诊者194例,就诊率74.6%,其中,住院6例,住院率2.3%,就诊率无性别差异,低年龄组就诊率高于高年龄组。由于基层卫生机构看病较为便捷、便宜,就诊者中有145例(占74.8%)首诊选择村卫生室或个体诊所,所调查的急性胃肠炎病例在就诊过程中,医疗机构采取的治疗措施以吃药为主(占70.1%)。6.本次调查无死亡病例,损失寿命年(YLLs)为0,所以本次调查的DALYs=YLDs。河南睢县72507名5岁以下儿童的秋冬季急性胃肠炎年化疾病负担为219.92DALYs,80.3%的DALY损失集中于0～1岁组。河南睢县的各年龄组DALYs呈现随年龄增长而下降趋势;不同年龄组DALYs差别较大。其中,0岁组最高,其DALY损失占5岁以下儿童的43.9%;1岁组DALY损失仅次于0岁组,占36.4%;2岁、3岁、4岁组DALY损失相对较少,三个年龄组合计43.40DALYs(占19.7%)。7.5岁以下儿童秋冬季急性胃肠炎病例的样本例均经济负担261.72元,经济负担与年龄呈负相关,住院病例经济负担均显著高于其他人群,是门诊病例的10倍以上,是未就诊病例的50倍以上。不同症状病例类型的例均经济负担,腹泻且呕吐病例明显较仅呕吐和仅腹泻病例高,但仅呕吐病例和仅腹泻病例的经济负担无差异。8.经睢县实际人数和发病率校正后的5岁以下儿童例均经济负担为304.71元,校正后两岁以下儿童(0～1岁组)例均经济负担达363.65元。估计河南睢县5岁以下儿童一个季度(3个月)急性胃肠炎发病48540人次,5岁以下儿童急性胃肠炎一个季度(3个月)给河南睢县带来的经济负担总额达1479.06万元,占睢县季度国民生产总值的4.35‰;经济负担主要集中于0～1岁组,仅2岁以下儿童急性胃肠炎经济负担就占睢县季度国民生产总值的3.72‰。结论:该县5岁以下儿童秋冬季急性胃肠炎疾病负担较重,其发病率较高,且随年龄增长而下降;DALYs同样呈现随年龄增长而下降的趋势,绝大部分DALYs集中于2岁以下儿童;年龄与经济负担呈负相关,经济负担主要集中0-1岁年龄组。
[Abstract]:Objective: to understand the epidemic situation of 1., the local autumn season for acute gastroenteritis in children etiology characteristics, influencing factors and treatment behavior evaluation of local.2. in autumn and winter for acute gastroenteritis in children DALYs and economic burden, and to analyze the epidemic situation of different age groups and different types of symptoms were the incidence, treatment and disease burden differences. Methods: 1. through literature statistical yearbook, government reports, official statistics, the collection of local children under the age of 5 the total number of children under the age of 5, the number of age distribution, local per capita GDP and other basic information. By asking the doctor to fill in the questionnaire to understand the local medical institutions, medical institutions and related cases of diarrhea children consulting room basic information and treatment. All 20 a random sample of community resident children under the age of 5, as the research object of nano.2. in December 2016 in Henan Suixian to carry out field investigation, using a unified questionnaire into The household survey. The main contents include family and personal basic information, within 3 months of the last time the incidence data of acute gastroenteritis (symptoms, duration), treatment (treatment rate, hospitalization rate, hospital stay, etc.), behavior, coping style, treatment measures, medical expenses, medical the cost and working time, influence factors of acute gastroenteritis (pathway information of other diseases, health habits, cultural factors, etc.) using.3. EpiData3.1 to establish a database, data review and logical examination. Using Excel2013 and SPSS20.0 data collection and analysis, the basic characteristics of the survey population, the epidemic characteristics of acute gastroenteritis, treatment behavior and characteristics, economic burden such as descriptive analysis, the relevant factors are chi square test, ANOVA, rank sum test, the test level of 0.05. by two weeks of their prevalence, disability adjusted life years (DALY), direct economic The burden and indirect economic burden indicators reflect the disease burden of acute gastroenteritis. Results: 1. of the survey respondents 1582 effective, burden of disease data in 260 subjects, 3 months in a recent onset of acute gastroenteritis and medical treatment. Within two weeks, 102 new cases of acute gastroenteritis, two week prevalence rate is 6.4%. reflect the Suixian children under the age of 5 in autumn and winter incidence rate of acute gastroenteritis in all age groups, according to the Suixian actual number and proportion of incidence of two weeks corrected after correction of acute gastroenteritis in two week prevalence rate of 10.4%. in different age group prevalence rate decreased with age, and over 2 years old boy, two weeks the girls attack rate is close to that of 2 age groups of two week prevalence rate is greater than the boy girl.2. the survey of nearly 3 months of acute gastroenteritis in 260 cases, 221 cases of diarrhea symptoms (85%), vomiting (103 cases accounted for 39.6 %), fever symptoms in 64 cases (24.6%); among them, only 157 cases of diarrhea (60.4%), only 39 cases of vomiting (15%), diarrhea and vomiting were occurred in 64 cases (24.6%). The symptoms of fever in only only diarrhea, vomiting, diarrhea disease and the distribution of vomiting is not the same, different types of distribution of cases in different age groups of children under the age of.3.5 is not consistent with acute gastroenteritis disease for an average of 2.92 days, the duration of children aged 0~1 years in average duration of 3.94 days, the course of 2~4 year old children for an average of 2.19 days.4. cases of acute gastroenteritis diarrhea symptoms lasted an average of 3.19 days, the average duration of 1.70 days of vomiting the symptoms of diarrhea, vomiting usually lasts longer than the average duration of 0~1 year old children; children aged 2~4 to last more than a day and a half, diarrhea and vomiting episodes are the most 24h ratio of more than 2~4 years old, indirectly reflects the more severe disease.5. investigation of 260 cases of acute gastroenteritis cases In 194 cases, treatment, treatment rate of 74.6%, among them, 6 cases of hospitalization, hospitalization rate 2.3%, treatment rate of no gender differences, the low age group were higher than the high age group. The rate of primary health institutions to see a doctor is more convenient, cheap, patients in 145 cases (74.8%) attending the first choice of village clinics or individual clinic survey of acute gastroenteritis cases in the treatment process, the medical institutions take treatment measures based on medication (70.1%).6. in this survey, no deaths, years of life lost (YLLs) was 0, so this investigation DALYs=YLDs. Henan Suixian 72507 children under the age of 5 years of acute gastroenteritis in autumn and winter the burden of disease is 219.92DALYs, 80.3% DALY loss concentrated in the 0~1 age group. Each age group DALYs Henan Suixian show downward trend with age; different age groups DALYs different. Among them, the highest 0 years old group, the DALY loss of children under the age of 5 accounted for 43.9%; 1 The age group of DALY loss after 0 years group, accounting for 36.4%; 2 years old, 3 years old, 4 years old group DALY relatively small loss in three age groups of 43.40DALYs (19.7%) sample of children under the age of autumn and winter.7.5 acute gastroenteritis patients economic burden of 261.72 yuan, the economic burden was negatively correlated with age, hospitalization the economic burden of patients were significantly higher than that of the rest of the population, is 10 times more than the case, is 50 times more than the patients. Different types of cases were diarrhea and vomiting patients economic burden, obviously only vomiting and diarrhea were only high, but only vomiting cases and only diarrhea cases of economic burden and no difference in.8. the actual number of Suixian and the incidence of the corrected cases of children under 5 years are the economic burden of 304.71 yuan, after correction for children under two years of age (0~1 years old) were the economic burden of 363.65 yuan. Henan Suixian children under the age of 5 in a quarter (3 months) of acute The incidence of gastroenteritis in children under the age of 5 48540 people, a quarter of acute gastroenteritis (3 months) the total economic burden brought to Henan in Suixian amounted to 14 million 790 thousand and 600 yuan, accounting for a quarter of Suixian GDP of 4.35 per thousand; economic burden is mainly concentrated in the age group of 0~1, only 2 children under the age of acute gastroenteritis accounted for a quarter of Suixian economic burden 3.72 of the gross national product%. Conclusion: children under the age of 5 in the county of autumn and winter disease acute gastroenteritis burden is heavy, the disease incidence rate is high, and decreased with age; DALYs also decreases with age increasing, most of the DALYs focus on children under 2 years of age; age was negatively correlated with economic burden the economic burden, mainly at the age of 0-1.

【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1;R181.3

【参考文献】