山东省五县四种癌症发病情况和住院服务利用研究

发布时间：2018-07-11 17:11

本文选题：癌症 + 发病率　；参考：《山东大学》2017年硕士论文

【摘要】：研究目的随着人口的增长,老龄化的加剧,人们生活方式的改变,癌症已经成为严重威胁人类健康和发展的重大疾病之一。不断增加的癌症患者,意味着不断增长的卫生服务需求,给整个社会和患者家庭带来了极大的经济负担。本研究利用2011-2013年山东省五个县的肿瘤登记报告和当地县医院住院患者住院病历信息和住院费用数据了解五县四种常见癌症(肺癌、胃癌、肠癌、乳腺癌(女))患者发病和住院服务利用情况,并分析影响住院天数和住院费用的影响因素。为制定有效的癌症防治策略,优化资源配置,控制住院费用提供参考依据。研究方法本研究根据是否开展肿瘤登记工作、地理位置分布、经济发展水平等因素选择了山东省五个县作为研究地区,从五个地区分别收集四种癌症2011-2013年的肿瘤登记报告;然后,根据肿瘤登记报告中的信息在该地区患者主要就诊的县医院收集住院病历信息和住院费用信息。根据肿瘤登记报告信息,计算各地区四种癌症发病率,并对四种癌症患者的一般特征、医疗付费方式、临床分期、职业类型、死亡报告情况等进行描述性分析。通过将住院病历信息和住院费用信息相结合,分析住院患者的一般情况以及住院天数和住院费用。用非参数检验对住院天数和住院费用进行单因素分析;在单因素分析的基础上,将住院天数和住院费用进行对数转换,采用广义线性模型进行多因素分析。所有数据在Excel中进行整理和校对,用SPSS 18.0统计软件进行分析。研究结果(1)山东省五县四种癌症发病率从高到低分别为肺癌63.89/10万、胃癌50.34/10万、乳腺癌37.40/10万、肠癌22.10/10万。2011-2013年总体呈现上升趋势。除乳腺癌(女)外,其余三种癌症男性发病率高于女性。乳腺癌发病比例最高的年龄段为45-59岁,其余三种癌症发病比例最高的年龄段为60-74岁。肺癌患者处于Ⅳ期的比例最高,胃癌、肠癌患者患病人数最多的是Ⅱ、Ⅲ期,乳腺癌患者确诊时超过一半的患者处于Ⅱ期。截至到调查时,肺癌患者死亡比例最高,超过70%,其次为胃癌,死亡比例超过60%;肠癌死亡比例约为40%,乳腺癌最低,约为18%。(2)五县所有癌症患者在当地县医院的人均住院总费用为23575.4元,平均住院天数为29.01天,其中肠癌患者人均住院费用最高,达到25909.1元。肥城市四种癌症住院患者人均住院费用26248.46元,人均自付费用10162.84元,总体报销比例为58.81%,人均住院天数为37.84天;其中人均住院费用最高的是乳腺癌,为33377.5元。临朐县四种癌症患者人均住院费用22000.87元,人均住院天数为22.31天;其中人均住院费用最高的是乳腺癌,为25968.18元。乳山市四种癌症患者人均住院费用27630.02元,人均住院天数为43.93天;人均住院费用最高的是肠癌,为28957.99元。汶上县四种癌症患者人均住院费用12820.33元,人均住院天数为18.27天;其中人均住院费用最高的是胃癌,为15766.99元。牟平区四种癌症患者人均住院费用23748.29元,人均住院天数为23.80天,其中最低的是肺癌,为20831.84元。(3)五县四种癌症患者住院天数的影响因素:地区、癌症类型、确诊时间、"是否手术"、"是否化疗"、"是否放疗"、临床分期是五县四种癌症患者住院天数的影响因素。乳山和肥城、乳腺癌、2012年确诊、手术治疗、化疗治疗、放疗治疗、Ⅲ期、年龄越小的患者住院天数越长。对五县分别进行多因素分析,结果显示,"是否手术"是五个县住院天数的共同影响因素,手术患者的住院天数要多于非手术患者;"是否化疗"是肥城、临朐、乳山患者住院天数的影响因素,化疗患者的住院天数要多于非化疗患者;"是否放疗"是肥城和临朐癌症患者住院天数的影响因素,放疗患者的住院天数要多于非放疗患者;肥城、临朐和牟平地区,患者年龄越小,住院天数越长;确诊时间是影响肥城、乳山、汶上患者住院天数的因素;医疗付费方式影响乳山患者住院天数,城镇职工基本医疗保险和城镇居民基本医疗保险患者的住院天数要高于新型农村合作医疗和其他付费方式的患者。(4)五县四种癌症患者住院费用的影响因素:地区、癌症类型、确诊年份、"是否手术"、临床分期、住院天数和年龄是五县所有患者住院费用的影响因素。临朐、胃癌和肠癌、2013年确诊、手术治疗、Ⅱ、Ⅲ期、住院时间越长、年龄越小的患者住院费用高。五县分别进行分析,结果显示,住院天数和"是否手术"是五个县患者住院费用的共同影响因素,住院天数越长,手术治疗的患者住院费用越高。癌症类型是影响临朐、乳山、汶上、牟平住院患者住院费用的因素;"是否化疗"是临朐、汶上患者住院费用的影响因素,化疗患者住院费用高于未化疗患者;"是否放疗"是肥城患者住院费用的影响因素;确诊时间对肥城和乳山患者住院费用有影响;年龄对牟平患者住院费用有影响,年龄越小,住院费用越高;临床分期对乳山患者住院费用有影响,Ⅱ、Ⅲ期住院费用相对较高;临朐县患者住院费用还受到医疗付费方式的影响,城镇职工基本医疗保险患者的住院费用高于城镇居民基本医疗保险和新型农村合作医疗患者。结论山东省农村癌症发病水平较高,肺癌和胃癌粗发病率高于全国平均水平,四种癌症中除乳腺癌外,男性发病率均高于女性。乳腺癌平均发病年龄低于其他三种癌症。应积极开展健康教育,推进癌症防治工作,减少或延缓癌症的发生。针对重点高发癌症,继续开展筛查及早诊早治工作,并扩大覆盖范围,不断提高筛查技术和诊疗技术,以便早发现、早诊断、早治疗。癌症患者住院医疗费用是其经济负担的主要组成部分,可以通过开展临床路径,规范诊疗过程,提高医疗质量,同时缩短不合理的住院天数,减少不合理的资源浪费,达到控制医疗费用,提升医院医疗服务水平和管理水平的目的。同时加快医疗保险制度改革,落实重大疾病保障政策,提高疾病报销比例,同时加强对医疗服务过程的监督,保证医疗保险基金充分发挥作用。
[Abstract]:With the growth of the population, the intensification of aging and the change of people's lifestyles, cancer has become one of the major diseases that seriously threaten the health and development of human beings. The increasing number of cancer patients means a growing demand for health services, which has brought great financial burden to the whole society and the family. The incidence and hospital service utilization of four common cancers (lung, stomach, colon, breast cancer) in five counties were studied in five counties of Shandong province and the data of inpatient records and hospitalization expenses in the local county hospitals, and the factors affecting the number of hospitalization days and hospitalization costs were analyzed. Effective cancer prevention and control strategy, optimization of resource allocation, and control of hospitalization costs provide reference basis. Based on the study of whether to carry out tumor registration, geographical distribution, economic development level and other factors, five counties in Shandong province were selected as research areas, and four kinds of cancer for 2011-2013 years were collected from five regions. And then, according to the information of the tumor registration report, the medical records and hospitalization expenses are collected in the county hospital which is the main patient in the area. According to the information of the registration report of the tumor, the four kinds of cancer incidence in each area are calculated, and the general characteristics of the four cancer patients, the medical payment method, the clinical stage, the occupational type, and the death are dead. A descriptive analysis was carried out on the situation of the death report. By combining the information of hospitalization records with the information of hospitalization expenses, the general situation of hospitalized patients, the days of hospitalization and the cost of hospitalization were analyzed. A single factor analysis was carried out on the days of hospitalization and the cost of hospitalization by nonparametric tests. On the basis of single factor analysis, the number of hospitalization days and hospitalization costs were entered. The multifactor analysis was carried out with the generalized linear model. All data were collated and proofread in Excel and analyzed with SPSS 18 statistical software. Results (1) four kinds of cancer incidence in five counties of Shandong province were from high to low, respectively, 63.89/10 million lung cancer, gastric cancer 50.34 /10 million, breast cancer 37.40/10 million, and colorectal cancer 22.10/10 million.2011-201 In addition to breast cancer (female), the incidence of the other three kinds of cancer men was higher than that of women. The highest incidence of breast cancer was 45-59 years old and the highest proportion of the other three cancers was 60-74 years. The highest proportion of lung cancer patients was in stage IV, and the number of cancer patients was the most in gastric cancer and colon cancer patients. In the period, more than half of the patients in the diagnosis of breast cancer were in stage II. By the time of the investigation, the death rate of lung cancer patients was the highest, more than 70%, the second was gastric cancer, the proportion of death was over 60%, the proportion of cancer death was 40%, and the lowest in the breast cancer, about 18%. (2) five county cancer patients in the local county hospital with the total cost of 23575.4 yuan per capita in the local county hospital. The average hospitalization days were 29.01 days, of which the per capita hospitalization cost of colorectal cancer patients was the highest, reaching 25909.1 yuan. The average per capita hospitalization cost of four kinds of cancer patients in Feicheng was 26248.46 yuan, the per capita self payment was 10162.84 yuan, the total reimbursement rate was 58.81%, the per capita hospitalization day was 37.84 days, and the highest per capita hospitalization expenses was breast cancer, 33377.5. Yuan. The per capita hospitalization cost of four cancer patients in Linqu county was 22000.87 yuan, and the per capita hospitalization days was 22.31 days. The highest per capita hospitalization cost was breast cancer, which was 25968.18 yuan. The per capita hospitalization expenses of four kinds of cancer patients in Rushan were 27630.02 yuan, the per capita hospitalization days were 43.93 days, and the highest per capita hospitalization cost was 28957.99 yuan. The per capita hospitalization cost of four cancer patients in the county was 12820.33 yuan, and the per capita hospitalization days was 18.27 days. The highest per capita hospitalization cost was stomach cancer, which was 15766.99 yuan. The per capita hospitalization cost of four cancer patients in Muping district was 23748.29 yuan, and the per capita hospitalization days was 23.80 days. The lowest was lung cancer, 20831.84 yuan. (3) five counties and four cancer patients were hospitalized. Factors affecting the number of days: area, type of cancer, time of diagnosis, "surgery", "whether chemotherapy", "whether radiotherapy", and clinical staging are the factors affecting the number of days in hospital in five counties. Rushan and Feicheng, breast cancer, surgical treatment, chemotherapy, radiotherapy, stage III, and the younger, the longer the days of hospitalization. To five The county was analyzed by multiple factors. The results showed that "whether surgery" was a common factor in the number of days in the five counties, and the number of hospitalized days was more than those of non operative patients. "Whether chemotherapy" was the influence factor of the days of hospitalization in Feicheng, Linqu and Rushan, the number of hospitalized days in patients with chemotherapy was more than that of non chemotherapy patients; "whether radiotherapy" is fertilizer or not is fertilizer. The factors affecting the number of hospitalized days in city and Linqu cancer patients, the number of hospitalized days in patients with radiotherapy is more than that of non radiotherapy patients; in Feicheng, Linqu and Muping, the younger the age, the longer the days of hospitalization; the time of diagnosis is the factor affecting the number of days in the hospital in Feicheng, Rushan, and Wenshang; the medical pay affects the days of hospitalization of Rushan patients and the town position. The number of hospitalization days of basic medical insurance and basic medical insurance for urban residents should be higher than those of new rural cooperative medical care and other payment methods. (4) the factors affecting the hospitalization expenses of four kinds of cancer patients in five counties: area, type of cancer, year of diagnosis, "operation", clinical stages, days of hospitalization and age of all patients in five counties The influencing factors of hospitalization expenses. Linqu, gastric cancer and colon cancer, diagnosis in 2013, surgical treatment, stage II, stage III, the longer the hospitalization time, the higher the hospitalization cost of the younger patients. The five counties were analyzed respectively. The results showed that the number of hospitalization days and "whether operation" were the common factors of the hospitalization expenses of the five county patients, the longer the hospital days were, the surgical treatment was treated. The higher the cost of hospitalization for the patients. The cancer type is the factor affecting the hospitalization expenses in Linqu, Rushan, Wenshang and Muping. "Whether chemotherapy" is the influencing factor of the hospitalization expenses of the patients in Linqu and Wenshang, the hospitalization expenses of the chemotherapy patients are higher than those of the non chemotherapy patients; "whether the radiotherapy" is the influencing factor of the hospitalization expenses of the Feicheng patients; the time for the diagnosis is Feicheng and the diagnosis of the hospital. The hospitalization expenses of the patients in Rushan have an impact; the age has an impact on the hospitalization expenses of the patients in Muping, the younger the age and the higher the cost of hospitalization; the clinical stages have an impact on the hospitalization expenses of the patients in Rushan, and the cost of the hospitalization of the patients in the stage II is relatively high; the hospitalization expenses of the patients in Linqu county are also affected by the way of medical payment, and the residents of the basic medical insurance for urban workers live. The hospital cost is higher than the basic medical insurance of urban residents and the new rural cooperative medical patients. Conclusion the incidence of cancer in rural areas in Shandong is higher, the incidence of lung cancer and gastric cancer is higher than the national average. In addition to breast cancer in four kinds of cancers, the incidence of male is higher than that of women. The average age of breast cancer is lower than that of other three kinds of cancer. To carry out health education, promote cancer prevention and control, reduce or delay the occurrence of cancer. In order to focus on high incidence of cancer, continue screening and early diagnosis and treatment, and expand coverage, constantly improve screening technology and diagnosis and treatment technology, so that early detection, early diagnosis and treatment are the main economic burden of cancer patients. In the component part, we can carry out the clinical path, standardize the diagnosis and treatment process, improve the medical quality, shorten the irrational hospital days, reduce the irrational waste of resources, control the medical expenses, improve the medical service level and management level of the hospital, and accelerate the medical insurance system reform and implement the major disease guarantee policy. We should improve the proportion of reimbursement for diseases, strengthen supervision over the medical service process, and ensure the full play of medical insurance funds.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R73-31

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