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抑郁症患者再入院及其影响因素分析

廖诗艺 王洋洋 蔡燕 邱培媛 周晓媛

廖诗艺, 王洋洋, 蔡燕, 邱培媛, 周晓媛. 抑郁症患者再入院及其影响因素分析[J]. 中国公共卫生. doi: 10.11847/zgggws1137561
引用本文: 廖诗艺, 王洋洋, 蔡燕, 邱培媛, 周晓媛. 抑郁症患者再入院及其影响因素分析[J]. 中国公共卫生. doi: 10.11847/zgggws1137561
LIAO Shi-yi, WANG Yang-yang, CAI Yan, . Re-hospitalization and its impact factors among depression patients in Chengdu city, 2013 − 2017[J]. Chinese Journal of Public Health. doi: 10.11847/zgggws1137561
Citation: LIAO Shi-yi, WANG Yang-yang, CAI Yan, . Re-hospitalization and its impact factors among depression patients in Chengdu city, 2013 − 2017[J]. Chinese Journal of Public Health. doi: 10.11847/zgggws1137561

抑郁症患者再入院及其影响因素分析

doi: 10.11847/zgggws1137561
基金项目: 四川省软科学研究计划项目(2015ZR0209)
详细信息
    作者简介:

    廖诗艺(1998 – ),女,重庆人,硕士在读,研究方向:心理健康

    通讯作者:

    周晓媛,E-mail:zhouxyuan@scu.edu.cn

  • 中图分类号: R 395.1

Re-hospitalization and its impact factors among depression patients in Chengdu city, 2013 − 2017

  • 摘要:   目的  研究抑郁症住院患者再入院情况及影响因素。  方法  根据四川省成都市2013 — 2017年参保的抑郁症住院患者的住院报销记录,分析患者入院情况,使用秩和检验和卡方检验进行差异性分析,logistic回归模型分析影响因素。  结果  本研究纳入抑郁症患者共计16 556例,25 403条住院记录。抑郁症住院患者住院率随年份增加而增加,从2013年1.92次/万人增长到2017年5.35次/万人,且女性高于男性。30 d内的再入院人数1 519例,30 d再入院率为9.17 %,5年内的再入院人数3 854例,5年再入院率则升高为23.28 %。各个时段内城乡居民医疗保险的抑郁症患者再入院率低于城镇职工医疗保险的抑郁症患者。在再入院的记录中,因为精神和行为障碍(F00-F99)再入院的人次数最多,占比28.35 %。因为循环系统疾病(I00-I99)再入院的人次数排名第2,占比20.17 %;因为呼吸系统疾病(J00-J99)再入院的人次数排名第3,占比16.27 %。logistic回归分析结果显示,女性,年龄在20 ~ 39、40 ~ 59、60 ~ 79和 ≥ 80岁,是城镇职工医疗保险参保者,住院天数在8 ~ 14、15 ~ 30和 ≥ 31 d,抑郁类别是复发性抑郁(F33)是抑郁住院患者再入院的危险因素;有其他共病,在一级、二级和三级医院就诊是抑郁住院患者再入院的保护因素。  结论  成都市抑郁住院患者再入院率较高,性别、年龄、医保类型、住院天数、抑郁类别、患病情况和医院等级是抑郁住院患者的主要影响因素。
  • 图  1  2013 — 2017年抑郁症患者住院率变化趋势

    表  1  2013 — 2017年抑郁症住院患者特征分布

    类别2013年2014年2015年2016年2017年总计
    例次%例次%例次%例次%例次%例次%
    性别
     男性6018.3398513.651 56921.741 80525.012 25731.277 21728.41
     女性1 6649.152 42313.323 91521.534 86026.725 32429.2818 18671.59
    年龄(岁)
      0~195813.006715.025813.008919.9617439.014461.76
     20~3928712.0136515.2751821.6759224.7762826.282 3909.41
     40~5989711.061 12913.921 66220.492 11926.122 30528.418 11231.93
     60~799327.741 57613.082 68022.253 17926.393 68030.551204747.42
      ≥80913.7827111.2556623.5068628.4979432.972 4089.48
    医疗保险类型
     城乡居民医保4607.7770811.961 16219.631 46524.752 12435.885 91923.30
     城镇职工医保1 8059.262 70013.864 32222.185 20026.695 45728.0119 48476.70
    住院天数(d)
      0 ~ 73687.2859111.691 10321.821 33626.431 65732.785 05519.90
      8~147527.811 13011.742 02521.032 60827.093 11232.339 62737.90
     15~3081711.071 15615.661 63322.131 81424.581 96026.567 38029.05
      ≥313289.8253115.8972321.6490727.1585225.503 34113.15
    抑郁类别
     抑郁发作2 1138.703 22913.305 28821.776 38726.307 27029.9324 28795.61
     复发性抑郁15213.6217916.0419617.5627824.9131127.871 1164.39
    患病情况
     仅有抑郁1 12424.741 07223.5982318.1177717.1074816.464 54417.89
     第一诊断抑郁2197.8133511.9459821.3275626.9589731.982 80511.04
     第一诊断非抑郁9225.112 00111.084 06322.505 13228.435 93632.8818 05471.07
    医院等级
     一级医院32713.9740717.3965227.8549621.1945919.612 3419.22
     二级医院4657.4170611.251 23419.661 85529.562 01632.126 27624.71
     三级医院1 3578.562 15313.583 40821.504 15026.184 78330.1715 85162.40
     其他11612.4114215.1919020.3216417.5432334.559353.68
    下载: 导出CSV

    表  2  抑郁症住院患者再入院情况(%)

    特征30 d90 d6个月1年3年5年
    例数%例数%例数%例数%例数%例数%
    总体1 5199.172 13212.882 60315.723 12418.873 75922.703 85423.28
    性别
     男性4689.8165113.6577616.2790018.871 04621.931 06222.26
     女性1 0518.921 48112.571 82715.502 22418.872 71323.022 79223.69
     χ23.1503.4481.450< 0.0012.2383.781
     P0.0760.0630.2291.0000.1350.052
    医疗保险类型
     城乡居民医保3107.0045110.1953812.1563714.3975817.1277717.55
     城镇职工医保1 2099.971 68713.912 06517.032 48720.513 00124.743 07725.37
     χ233.92939.68657.85378.975107.060110.730
     P< 0.001< 0.001< 0.001< 0.001< 0.001< 0.001
    下载: 导出CSV

    表  3  一次住院与再住院患者基线特征比较

    类别一次住院再住院χ2P
    例数占比(%)例数占比(%)
    性别
     男性3 70877.741 06222.263.8610.049
     女性8 99476.312 79223.69
    年龄(岁)
     0~1935989.304310.70263.954 < 0.001
     20~391 58283.7530716.25
     40~594 84680.301 18919.70
     60~795 22572.751 95727.25
     80~69065.8435834.16
    医保类型
     城乡居民医保3 65182.4577717.55111.169 < 0.001
     城镇职工医保9 05174.633 07725.37
    住院天数(d)
     0 ~ 72 96781.5867018.42273.954 < 0.001
     8 ~ 145 43979.611 39320.39
     15 ~ 303 36173.071 23926.93
     31~93562.8855237.12
    抑郁类别
     抑郁发作12 34677.063 67622.9431.236 < 0.001
     复发性抑郁35666.6717833.33
    患病情况
     仅有抑郁2 52974.3487325.6631.159 < 0.001
     第一诊断抑郁1 19973.2443826.76
     第一诊断非抑郁8 97477.922 54322.08
    医院等级
     一级医院1 01771.7240128.2851.132 < 0.001
     二级医院2 67374.4291925.58
     三级医院8 59078.332 37721.67
     其他42272.8815727.12
    总计12 70276.723 85423.28
    下载: 导出CSV

    表  4  抑郁患者再入院发生率的多因素回归分析

    类别比较组参照组β$ {S}_{\stackrel{-}{x}} $χ2POR95 % CI
    性别 女性 男性 0.091 0.042 4.615 0.032 1.095 1.008~1.189
    年龄(岁) 20~39 0~19 0.360 0.179 4.064 0.044 1.433 1.010~2.034
    40~59 0.661 0.173 14.609 < 0.001 1.938 1.380~2.720
    60~79 1.145 0.174 43.443 < 0.001 3.141 2.235~4.415
    80~ 1.417 0.186 58.295 < 0.001 4.123 2.866~5.931
    医疗保险类型 城镇职工 城乡居民 0.355 0.048 53.778 < 0.001 1.426 1.297~1.568
    住院天数(d) 8~14 0~7 0.107 0.054 3.953 0.047 1.112 1.002~1.236
    15~30 0.452 0.058 61.047 < 0.001 1.572 1.403~1.760
    31~ 0.867 0.074 136.016 < 0.001 2.380 2.057~2.753
    抑郁类别 复发性抑郁 抑郁发作 0.290 0.102 8.043 0.005 1.336 1.094~1.632
    患病情况 第一诊断抑郁 仅患抑郁 − 0.178 0.074 5.792 0.016 0.837 0.724~0.968
    第一诊断非抑郁 − 0.419 0.054 60.880 < 0.001 0.658 0.592~0.731
    医院等级 一级医院 其他医院 − 0.304 0.116 6.895 0.009 0.738 0.588~0.926
    二级医院 − 0.262 0.104 6.348 0.012 0.769 0.627~0.943
    三级医院 − 0.677 0.102 44.340 < 0.001 0.508 0.416~0.620
    下载: 导出CSV
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  • 收稿日期:  2021-11-25
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