阿尔茨海默病疾病负担研究

发布时间：2018-06-27 09:14

本文选题：阿尔茨海默病 + 疾病负担　；参考：《山西医科大学》2012年硕士论文

【摘要】：阿尔茨海默病即老年痴呆症，是一种进行性发展的致死性神经退行性疾病，临床表现为认知和记忆功能不断恶化，日常生活能力进行性减退，并有各种神经精神症状和行为障碍。由于AD对老年人更是重要的死亡或致残原因，在世界与我国人口老龄化趋势日益加速的情况下，AD对人类所造成的疾病负担还将日渐加重。因此，全面了解AD所造成的疾病负担，具有现实意义。本研究以疾病负担现状与预测两个方面研究为基础，对AD患者的疾病负担进行了较为全面的研究，为促进我国AD疾病负担的研究及今后卫生资源的合理配置提供了参考。本研究对AD患者的疾病负担现状进行了评价，分别从患者群体负担、经济负担、照料者负担以及家庭负担四个方面出发，对AD导致的疾病负担进行了全面的研究。患者群体负担研究采用全国死因监测系统数据；经济负担研究对象为采用整群抽样方法选取的太原市两所医院和三个社区共168名AD患者；照料者负担调查对象为168名AD患者的照料者；家庭负担调查对象为168名AD患者的主要家庭成员。 AD患者群体负担研究伤残调整生命年（DALY）评价AD患者的负担大小。首先利用死亡数据计算YLL，其次利用疾病负担模型拟合数据，产生YLD所需数据，从而计算YLD。结果显示AD患者DALY值大于国内相关研究结果，且以YLD为主。60岁上男性每千人DALYs为6.46，女性每千人DALYs为8.65，总人群每千人DALYs为7.59。YLL方面：男性的每千人YLLs和死亡率均高于女性。不论男性还是女性，基本随着年龄的增长而增长。同一年龄段每千人YLLs比较：60岁以上人群基本上是男性高于女性。YLD方面：女性的每千人YLDs和死亡率均高于男性。不论男性还是女性，YLD均随着年龄的增长而增长。同一年龄段每千人YLDs比较：60岁以上人群基本上是女性高于男性。经济负担采用自编的经济负担问卷，包括直接医疗费用、直接非医疗费用、间接费用。直接医疗费用包括挂号费、诊疗费、化验费、检查费、治疗费、药品费等；直接非医疗费用包括交通费、住宿费、伙食费、营养保健品费用、雇佣照顾者费用、商业医疗保险费用等；间接费用包括患者由于疾病或身体不适导致的不能正常生活以及家属提供无偿照料所导致的损失。结果显示：AD患者直接医疗费用均值为7708元/年，直接非医疗费用为1525元/年，间接费用为6516元/年。医疗总费用为15749元/年。多因素分析结果显示影响经济负担总费用的因素包括患者性别、年龄以及认知功能。照料者负担采用照料者负担问卷（CBI）进行评价照料者的负担严重程度。并利用路径分析构建患者因素，照料者因素对最终负担的影响。结果表明：照料者得分为47.54±17.61，处于中等水平。患者认知水平低、照料时间长加重照料者的负担；社会支持度高、家庭关怀度高、感受越积极，，照料者的负担会越低。照料时间、社会支持及家庭关怀度不仅与患者的认知水平有直接关系，而且均是患者认知水平与照料者负担的中间调节因素。同理，社会支持是患者日常行为能力与照料者负担的中间调节变量；照料时间与积极感受是患者精神行为症状与照料者负担的中间调节变量。 AD家庭负担研究以家庭负担量表(FBS)为测评工具，评价患者家庭负担各方面的严重程度。首先对FBS应用于AD家庭负担的信度和效度进行测试，随后对各维度家庭负担得分进行分析，最后用逐步回归对FBS总分进行多因素分析。结果显示：FBS具有良好的分半信度(分半信度系数为0.930 )和内部一致性信度(各维度Cronbach a系数范围为0.691-0.734 )，内容效度、结构效度以及反应度也较好。FBS得分分析结果表明：AD患者家庭负担各维度均存在不同程度的负担，家庭日常生活和家庭娱乐活动两方面负担相比其它维度则更为显著；多因素分析结果显示影响FBS总得分的因素包括患者性别、认知功能以及日常生活能力。本研究采用预测模型对2010年-2030年中国AD患病数进行预测。基础模型是一个多状态时间离散Markov模型。个体可以从健康状态，进展到疾病早期阶段，然后到疾病晚期阶段。个体在每一个阶段都有一定的死亡危险。结果显示：模型估计2010年大约有6621268人患有AD，男性患者2920486（44.1%），女性患者3700782（55.9%）；疾病的早期阶段3730547（56.3%），晚期阶段2890721（43.7％），并且患病率会随着年龄的增长而增长。以患病数预测为例，到2030年由于人口因素，AD的患病数可能增加为原来的2.42倍，男性患者与女性患者比值约44.2：55.8，早期与晚期的比例稳定（55.9：44.1）；根据方案P（2012年实施预防干预措施导致了疾病的发病延迟2年）2030年增加患病数仅仅1.85倍，男性患者与女性患者比值约44.2：55.8，早期与晚期的比例稳定（56.0：44.0）；方案T（2012年实施治疗干预导致了疾病的进展延缓2年），患病数增长为2.54略高于方案D（基本方案），男性患者与女性患者比值约44.2：55.8；早期：晚期比例为64.1：35.9；方案C（综合干预）很好的表示了以上两个干预措施，总体患病数增长为1.94倍；并且阶段比例发生转变，约为64.2：35.8。男性患者与女性患者比值没有改变，约44.2：55.8。结论：（1）监测区老年人平均伤残调整生命年为7.59/千人，说明AD带来的患者群体负担较严重，影响患者的生存质量。（2）AD患者经济负担较重，相对其他相关研究结果一致。患者医疗费用占48.9%，直接非医疗费用占9.7%，间接费用占41.4%，说明患者带来的医疗费用较高，患者损失的时间以及照料者由于照料患者带来的时间损失所占比重也较大。（3）AD患者照料者研究中，AD患者认知水平、日常行为能力、精神行为症状严重程度与照料者负担呈密切关系，照料者获得的社会支持、家庭关怀度以及自我积极感受也与其自身负担密切相关，关注患者的相关问题，积极促进照料者的人文关怀，有助于减轻照料者的负担。（4）AD患者家庭负担中，相比较其他研究，家庭负担较重，AD患者带给家庭成员日常生活以及娱乐方面很大的影响。（5）预测研究显示：2030年我国将有16032655人患AD。开展积极的预防控制措施将有效降低AD患病数，缓解家庭和社会负担。
[Abstract]:Alzheimer's disease, known as Alzheimer's disease, is a progressive progressive neurodegenerative disease, characterized by worsening cognitive and memory functions, progressive impairment of daily living capacity, and various neuropsychiatric symptoms and behavioral disorders. Because AD is more important for death or disability in the elderly, it is in the world and in China With the increasing trend of population aging, the burden of disease caused by AD will be more and more serious. Therefore, it is of practical significance to fully understand the burden of disease caused by AD. Based on the two aspects of the status and prediction of the disease burden, this study has carried out a more comprehensive study on the disease burden of the patients of AD, in order to promote the disease burden. The study of AD disease burden in China and the rational allocation of health resources in the future provide a reference.
In this study, the status of the disease burden of AD patients was evaluated. From the four aspects of the group burden, the economic burden, the burden of the caregivers and the family burden, the disease burden caused by AD was comprehensively studied. The study of the population burden of the patients adopted the data of the national death cause monitoring system; the object of economic burden study was to adopt the study. A total of 168 AD patients were selected from 2 hospitals in Taiyuan and three communities in a cluster sampling method. The caregivers' burden of investigation was the caregivers of 168 AD patients, and the family burden survey was the main family members of 168 AD patients.
AD patients' population burden study on disability adjusted life year (DALY) to evaluate the burden of AD patients. First, YLL is calculated by using death data, and then data can be obtained by using the disease burden model to generate the data required for YLD, thus the results of YLD. show that the DALY value of AD patients is greater than that of domestic related research results, and YLD is the main male per thousand DALY on.60 years old. S was 6.46, women per 1000 people DALYs was 8.65, and the total population was DALYs per 1000 people 7.59.YLL: male per thousand YLLs and mortality were higher than women. No matter male or female, it increased basically with age. Comparison of each thousand people at the same age group YLLs: men over 60 years older than women.YLD aspect: Female The YLDs and mortality rate of every 1000 people were higher than that of men. Both male and female, YLD increased with age. YLDs compared to each thousand people in the same age group: the population over 60 years old was basically higher than that of the male.
The economic burden adopts the self compiled economic burden questionnaire, including direct medical expenses, direct non medical expenses and indirect costs. Direct medical expenses include registration fee, diagnosis and treatment fee, laboratory fee, inspection fee, treatment fee, drug fee and so on. Direct non medical expenses include transportation, lodging, food, nutrition and health care expenses, and hiring caregivers' expenses. The indirect cost includes the loss of the patient's unnormal life due to disease or physical discomfort and the free care provided by the family members. The result shows that the average cost of direct medical treatment for AD patients is 7708 yuan per year, the direct non medical cost is 1525 yuan per year, the indirect cost is 6516 yuan per year. The total medical cost is 15. 749 yuan / year. Multivariate analysis showed that the factors affecting the total cost of the economic burden included gender, age and cognitive function.
The caregiver burden of caregiver burden questionnaire (CBI) was used to evaluate the burden of the caregivers. The effect of the patient factor and the caregiver factors on the ultimate burden was constructed by means of path analysis. The results showed that the caregivers were 47.54 + 17.61, at the middle level. The patients' cognitive level was low and the care time was longer for the burden of the caregivers. High social support, high family care, more positive feelings, the lower the burden of caregivers. Care time, social support and family care are not only directly related to the cognitive level of the patients, but also the middle adjustment factors of the patient's cognitive level and the burden of the caregivers. The mediating variables of burden are caregiver time and positive feeling.
AD family burden study used family burden scale (FBS) as an assessment tool to evaluate the seriousness of the family burden. First, the reliability and validity of FBS applied to AD family burden were tested, and then the family burden scores of each dimension were analyzed. Finally, the multifactor analysis of the total score of FBS was carried out by stepwise regression. The results showed that: FBS With good semi reliability (half reliability coefficient 0.930) and internal consistency reliability (the range of Cronbach a coefficient of each dimension is 0.691-0.734), content validity, structure validity and response degree also better.FBS score analysis results show that all dimensions of family burden of AD patients have different degrees of burden, family daily life and family entertainment The two aspects of the music activity were more significant than those of other dimensions. The results of multiple factors analysis showed that the factors affecting the total score of FBS included the gender, cognitive function and daily living ability.
The prediction model is used to predict the number of Chinese AD diseases in -2030 2010. The basic model is a multi state time discrete Markov model. The individual can move from healthy state to early stage of the disease and then to the late stage of the disease. The individual has a certain risk of death at each stage. The results show that the model is estimated to be 2010 About 6621268 people in the year were AD, 2920486 (44.1%) for men, 3700782 (55.9%) for women, 3730547 (56.3%) at the early stage of the disease, 2890721 (43.7%) in the late stage, and the prevalence rate increased with age. For example, the number of AD may increase to 2.42 by 2030 due to population factors. The ratio of male and female patients was about 44.2:55.8, and the proportion of early and late period was stable (55.9:44.1). According to program P (2 years of disease delay in 2012), the number of diseases increased by only 1.85 times in 2030, and the ratio between male and female patients was about 44.2:55.8, and the proportion of early and late period was stable (56). 44): (44); program T (2012 implementation treatment intervention led to a delay of 2 years of disease progression), the number of diseases increased by 2.54 slightly higher than that of program D (basic scheme), the ratio of male to female patients was about 44.2:55.8; early stage ratio was 64.1:35.9; program C (comprehensive intervention) was a good indication of the above two interventions and overall illness. The number increased by 1.94 times, and the proportion of stages changed, about 64.2:35.8.. The ratio of male to female patients did not change, about 44.2:55.8.
Conclusion: (1) the average disability adjusted life years of the elderly in the monitoring area is 7.59/, which indicates that the burden of AD patients is more serious, which affects the quality of life of the patients.
(2) the economic burden of AD patients was more serious than other related research results. The medical expenses accounted for 48.9%, the direct non medical expenses accounted for 9.7% and the indirect cost accounted for 41.4%. It indicated that the medical expenses of the patients were higher, the time of the loss of the patients and the time loss of the caregivers due to the care of the patients were also larger.
(3) in the study of AD patient caregivers, the cognitive level, the daily behavior ability, the severity of the mental behavior symptoms are closely related to the burden of the caregivers, the social support obtained by the caregivers, the degree of family care and the self positive feelings are closely related to their own burden, and the related problems of the patients are concerned and the humane customs of the caregivers are actively promoted. It helps to lighten the burden of the caregivers.
(4) family burden of AD patients, compared with other studies, family burden is heavier, and AD patients have great influence on family members' daily life and entertainment.
(5) prediction studies show that in 2030, 16032655 people will be infected with AD. in China. Active prevention and control measures will effectively reduce the number of AD cases and relieve family and social burdens.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.16

【引证文献】