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目的:探讨农村家庭经济条件与肺结核发病的关系及在DOTS化疗管理、免费诊断和治疗策略下,肺结核对病人家庭经济条件的影响。方法:首先,选取160例新发初治涂阳肺结核病人作为病例,每个病例选取2名与病例住所相邻、同性别和同年龄组的正常人作为对照组,采用发病前的家庭年收入与家庭财产2项指标衡量家庭经济条件,进行1:2配对病例对照研究;然后,对选取的所有病例进行随访收集有关费用;应用OR值及其95%的可信区间来估计其相对危险度;采用平均每例病人的家庭费用及其占家庭年收入的百分比来衡量结核病对家庭经济条件的影响。结果:160例肺结核病人发病前家庭年收入和家庭财产位于上等水平的分别占28.1%和25.6%,位于中等水平的分别占42.5%和35.6%,位于下等水平的分别占29.4%和38.8%,320例对照组同期的家庭年收入和家庭财产位于上等水平的分别占34.7%和37.2%,位于中等水平的分别占42.8%和33.1%,位于下等水平的分别占22.5%和29.7%;以上等水平作参照,单因素条件Logistic回归分析,家庭年收入的中等和下等OR值及其95%的可信区间分别为1.6(1.1￣2.8)和2.3(1.2￣4.4),家庭财产的中等和下等OR值及其95%的可信区间分别为1.7(1.1￣2.8)和2.1(1.3￣3.6),采用多因素条件Logistic回归分析后,家庭财产仍具有统计学意义,且OR值仍随着家庭经济条件水平的降低而增高,趋势性检验P值均小于0.05;肺结核病人家庭的直接费用平均为2772.0元,占平均病人家庭年收入的55.5%。我国结核病控制项目治疗下病人家庭的直接费用平均为2504.0元,占病人家庭年收入的50.1%;其他国家结核病控制项目治疗下病人家庭的直接费用平均为3360.0元,占病人家庭年收入的67.3%。结论:虽然,我国经济取得了快速发展,人民生活水平大幅度提高,但农村家庭经济条件差仍是肺结核病的重要危险因素,在实施DOTS策略及免费诊断和治疗策略下,肺结核病人家庭经济负担有所减轻,然而,肺结核病仍给病人家庭造成了沉重的经济负担,使原来本已贫困的家庭雪上加霜。
OBJECTIVE: To investigate the relationship between rural family economic conditions and the incidence of tuberculosis and the impact of tuberculosis on the family economic conditions of patients under DOTS chemotherapy management, free diagnosis and treatment strategies. Methods: First of all, 160 newly diagnosed smear-positive pulmonary tuberculosis patients were selected as cases. Two cases were selected from each case as normal subjects with same sex and same age as the control group. Before the onset of illness, And family property two indicators to measure the family economic conditions, a 1: 2 matching case-control study; then, all the selected cases were followed up to collect the relevant costs; OR value and its 95% confidence interval to estimate the relative risk ; Using the average family cost of each patient as a percentage of annual family income to measure the impact of tuberculosis on the family economic conditions. Results: Before the onset of illness, 160 cases of tuberculosis patients accounted for 28.1% and 25.6% respectively of the family income and family property, 42.5% and 35.6% respectively in the middle level and 29.4% and 38.8 in the lower level respectively %. The annual income and family property of the 320 control groups were 34.7% and 37.2% respectively, while the middle level accounted for 42.8% and 33.1%, while the lower level accounted for 22.5% and 29.7% respectively %. According to the above equal level and univariate conditional logistic regression analysis, the median and lower OR of 95% of family annual income were 1.6 (1.1 ~ 2.8) and 2.3 (1.2 ~ 4.4), respectively The median and lower OR values for assets and their 95% confidence intervals were 1.7 (1.1-2.8) and 2.1 (1.3-3.6), respectively, and family wealth remained statistically significant after multivariate logistic regression analysis The odds ratio (OR) still increased with the reduction of family economic conditions, and the trend test P values were less than 0.05. The direct costs of tuberculosis patients were 2772.0 yuan on average, accounting for 55.5% of the average annual family income. The average direct costs of the families under the TB control project in China are 2504.0 yuan, accounting for 50.1% of the annual family income of the patients; the average direct costs of other families under the TB control project are 3360.0 yuan, accounting for 67.3% of the annual family income of the patients, . Conclusion: Although China has achieved rapid economic development and substantial improvement of people’s living standards, the poor economic conditions of rural families are still an important risk factor for tuberculosis. Under the DOTS strategy and the free diagnosis and treatment strategy, the family financial burden of tuberculosis patients However, tuberculosis still poses a heavy financial burden on the families of the patients, making the already poor families even worse.