1、2000年全国结核病流行病学抽样调查 肺结核病人社会经济情况调查,Sociological & Economical Study on Pulmonary TuberculosisNationwide Random Survey for the Epidemiology of Tuberculosis in 2000,内容 Content,患病率结果 Results of Prevalence社会经济情况调查结果 Results of Sociological & Economical Study 一般情况 General Situation就诊及诊治情况 Clinical Consultat
2、ion, Diagnosis and Treatment,三次流调患病率结果 Prevalence results of 3 surveys,不同地区的患病率 Prevalence in different area,登记率与患病率的比较 Comparision between case rates and prevalence,卫V项目与非项目地区涂阳患病率的变化 Smear positive prevalence in project area and non-project area,1990年 2000年 下降% 项目地区 142 93 36.1Project area 非项目地区 1
3、30 126 3.1Non-project area 全国 Nationwide 134 110 17.9,一般情况 General Situation, 性别、年龄分布 Age and Gender经济收入能力及文化程度 With or without occupational income and education background家庭经济情况 Family Economical Situation医疗保障状况 Medical Insurance Situation,一般情况 General Situation,表1 性别、年龄分布Tab1. Age and Gender Distr
4、ibution年龄 男 Male 女 Femal 合计 TotalAge No. % No. % No. %0- 22 2.5 14 3.4 36 2.810- 41 4.7 31 7.5 72 5.620- 65 7.5 49 11.9 114 8.930- 93 10.6 57 13.8 150 11.740- 115 10.7 58 14.0 173 13.550- 144 16.6 59 14.3 203 15.960- 199 23.0 70 17.0 269 21.070- 163 18.8 59 14.3 222 17.480- 24 2.7 15 3.6 39 3.1小计 86
5、6 100.0 412 100.0 1278 100.0男性病人多：为女性的2倍青壮年病人多：20-59岁病人占50%老年病人多：60岁以上病人占41%,经济收入能力及文化程度 Occupational income & Education background,表2 有经济收入能力的病人所占比例Tab2. Proportion of patients who have occupational income病人总数 有经济收入With incomeNo. of PTB 病人数No. % 男 Male 866 630 72.7 女 Female 412 197 47.8 合计 Total 12
6、78 827 64.7女性病人有经济收入能力的比例仅为47.8%，明显低于男性。 有经济收入能力的病人中，77.1%为农林牧渔从业者。(Countryside field workers, CFW),1.Illiteracy 2.Primary school 3.Junior middle school 4.Senior middle school,家庭经济情况 Family Economical Situation,表3 病人家庭年人均收入及占当地年均收入的比例分布 Tab3. Family average income per person per year of PTB patients
7、 and the level in local areas 家庭年* 当地年均收入平均水平* 无当地*人均收入 以下 Lower 以上 Higher 资 料 合计（元 Yuan） No % No % 可参考 Total所有病人 All PTB 1307 976 78.0 276 22.0 26 1278 其中：农林牧渔 CFW 941 502 80.0 126 20.0 10 638* Family Average Income per person per Year * Compare with that in the local areas * No data for reference
8、in the local area,医疗保障状况 Medical Insurance Situation, 1278例病人中，1175人无医疗保障，占92%。 The proportion of all PTB patients who have no medical insurance is 92%.638例农林牧渔病人中，625人无医疗保障，占98%。 The proportion of CFW PTB patients who have no medical insurance is 98%.,就诊及诊治情况 Clinical Consultation, Diagnosis and Tr
9、eatment, 卫生宣教 Health Education症状 Symptoms就诊 Clinical Consultation诊断 Diagnosis转诊、登记及治疗 Transferring, Registry and Treatment治疗状态 Treatment Situation经济负担 Economic Burden,图2 病人在发病前接受TB 宣教的情况 Health education about TB received before illness,图 3 症状分布 Distribution of symptomatic, 有症状就诊 Clinical Consultati
10、on Among Symptomatic,表4 有症状就诊情况曾就诊 未就诊 合计Consultation made Not made TotalNo % No % No % 2000年 627 52.7 469 42.8 1096 100.0 1990年 1240 34.1 2393 65.9 3633 100.0,图4 初诊单位 Type of health clinics for first clinical consultation,表5 未就诊原因分析 Causes for delay of clinical consultation 原因 1.自己 2.工作忙 3.经济 4.交通
11、5.就诊 6.服务态 其他 合计 Causes 不在乎 没时间 困难 不便 点太远 度不好 Other No. 259 15 175 6 1 0 13 469 2000年 % 55.2 3.2 37.3 1.3 0.2 0.0 2.8 100.0 No. 366 36 169 未统计 37 2 42 652 1990年 % 56.2 5.5 25.9 5.7 0.3 6.4 100.0 1. Not mind 2. Had no time 3. Financial problem 4. Traffic problem 5. The health unit is too far 6. Bad s
12、ervice, 诊断 Diagnosis,627例就诊者，就诊期间接受过痰及X线检查的只有161人，占26.2%。 Among 627 patients who present consultation, 161 patients had received sputum and X-ray examination at the same time (26.2%). 流调前，有378人已被确诊为肺结核，占60%。 378 patients (60%) had been confirmed as PTB before the survey., 转诊、登记及治疗Transferring, Regis
13、try and Treatment 表6 转诊、登记及治疗 确诊病人数 转诊 登记 治疗 No. of Confirmed PTB Trans- Registry Treatment No % No % No % 结防机构 TB Dispensary 45 43 95.2 45 100.0 非结防机构Other health unit 333 44 13.2 50 15.0 329 98.8 合计 Total 378 90 23.8 374 97.9, 治疗状态 Situation of regular treatment 表8 治疗状态 1.规则治疗 2.中断、间断治疗 合计 No % No
14、 % Total A 结防机构 36 61.0 23 39.0 59 2000年 B 非结防机构 66 21.6 249 79.0 315 合计 Total 102 27.3 272 72.7 374 A 结防机构 255 55.5 204 44.1 459 1990年 B 非结防机构 296 13.4 1906 86.6 2202 合计 Total 551 20.7 2110 79.3 2661 1. Regularly treated 2. Intermittent and Interrupted Treatment A. TB dispensary B. Other health uni
15、t,1278 肺结核病人1096 有症状（86%） 182 无症状（14%）627 就诊（57%） 469 未就诊（43%）378 确诊（60%） 249 未确诊（40%）333 在非结防 45 在结防机构确诊（88%） 机构确诊（12%）283 未登记 50 43 2 未登记（4%） （85%） 登记93病人发现率 Case Detection Rate (%)1. 93/1278 = 7%2. 378/1278 = 30%,93 3781278,表9 间断或中断治疗原因Tab. 9 Causes of intermittent or interruption of treatment症状改
16、善* 药物反应 经济困难 其他 合计自行停药 Side effect Financial problem Other TotalNo. % No. % No. % No. % 涂阳病人 42 38.5 3 2.8 59 54.1 5 4.6 109 S+PTB 涂阴病人 74 45.4 10 6.1 62 38.0 17 10.4 163S-PTB 合计 Total 116 42.6 13 4.8 121 44.5 22 8.1 272* Self-stopping taking drugs after symptoms disappeared,经济负担 Economic Burden,诊疗
17、Clinical consultation and treatment627例有症状就诊的病人，人均诊疗费为1165元，占病人家庭年人均收入的89%。The average clinical consultation and treatment cost for symptomatic who presented clinical consultation was 1165 Yuan. It occupied 89% of the family average income per person.误工 Losing working721例有经济收入、有症状的病人中，有260 人因病误工，人均误
18、工125天，人均经济收入损失为890元。260 patients lost working time among 721 patients who had regular income and symptoms. The average losing days was 125 days. The average reducing income due to lost working days was 890 Yuan. It occupied 68% of the family average income per person.,结论 Conclusion 一、肺结核病人的特点 Charac
19、teristics of PTB patients,1、男性多于女性Male PTB patients were more than female PTB patients. 2、青壮年及老年病人多Most of the patients were adults and elder. 3、有经济收入能力的病人中，多为农林牧渔从业劳动者Most of patients were FFSF among patients who have earning ability. 4、有经济收入能力的病人中，文化水平低，女性尤为明显Education background was lower for the
20、 patients who have earning ability. It is more lower for female patients. 5、家庭经济水平大多低于当地水平Most of patients family economic level was lower than the local level. 6、绝多数无医疗保障Almost all patients had no medical insurance assured. 7. 经济负担过重 Higher economic burden,二、病人发现与治疗管理的总体评价 Evaluation on case detect
21、ion and case management,病人发现水平较低 Lower case detection level规则治疗率低 Lower regular treatment rate,病人发现水平低的主要原因 Causes of lower case detection,半数以上的病人未接受过卫生宣教More than half of patients had not received health education concerning TB before suffering TB. 有症状后，因警觉性低及经济困难未就诊Lower awareness on TB and financ
22、ial problem were the main causes why symptomatic had not present clinical consultation. 综合医院及乡镇卫生院是病人的首选就诊单位。这些医疗机构主要依据X线检查确诊，确诊比例低；确诊后的病人报告、登记比例低。General hospitals and township hospitals were the priority health units for the first consultation. Those health units made diagnosis mainly based on X-r
23、ay examination. The proportion of confirmation diagnosis was lower. The proportion of reported and registered in TB dispensaries of confirmed TB patients were lower,规则治疗率低的原因 Causes of lower regular treatment rate,88%的病人是在结防机构以外的医疗单位接受治疗的，无治疗管理 (即便是结防机构，规则治疗率也只有60%）88% patients received treatment in
24、 non-TB dispensaries. There were no management approaches （regular treatment rate was about 60% in TB dispensaries, it wasnt higher enough)经济困难以及对结核病的认识不足是造成间断、中断治疗的主要原因The main causes of interrupted treatment were: finical problem and lower level of understanding on TB,三、措施 Measures,1、实施免费诊断、治疗传染性结
25、核病人的政策。 Providing free diagnosis and treatment policy for infectious PTB patients. 2、加强卫生宣传，提高公众对结核病的警觉性。 Reinforcing health education to improve public awareness on TB. 3、加强结防机构自身的业务能力建设。 Strengthening capacity on TB control of TB dispensaries. 4、加强归口管理。 Coordinating and cooperation with other health units which including general hospitals, private clinics and so on.,
