ABSTRACT
Objective To analyze the economic burden and its influencing factors of brucellosis for providing scientific basis to targeted epidemic prevention and control in Gansu Province.Methods A total of 226 outpatients and inpatients treated at different levels of medical institutions in Jingyuan County of Gansu Province during 2013 to 2016 were selected as research subjects.The basic information (sex,age,education level,family income,etc.) of the subjects was collected according to the questionnaire.By consulting the patient's hospital billing settlement list,outpatient billing invoices,and related bills,the information about the cost of visiting the patient due to brucellosis,cost information of the paramedics and the visiting staff was obtained.A Kruskal-Wallis rank-sum test was used for univariate analysis to analyze the direct medical costs and total costs of patients with various diseases,including gender,occupation,age,education level,per capita income,misdiagnosis,medical institution level,different stages,and different types of disease.The generalized multiple linear regression model was used to analyze the relationship between misdiagnosis,different stages,different types of brucellosis,medical institution levels,and the direct medical expenses and total costs of ill patients.Results Of the 226 patients with brucellosis,each person was hospitalized twice a year and stayed in hospital for 28 days.Direct medical expenses of 115 cases with acute brucellosis and 111 cases of chronic patients,direct non-medical expenses,indirect economic losses and total expenses were 11 835,1 850,2 475,16 396 and 16 733,3 240,4 748,24 188 Yuan RMB,respectively.The western medicine fee of direct medical treatment of acute brucellosis was 67.95％ (8 042/11 835),the inspection fee was 16.92％ (2 002/11 835) and the examination fee was 9.02％ (1 068/11 835).The cost of western medicine for chronic and complications was 39.82％ (6 663/16 733),37.50％ (6 339/16 904),the inspection fee was 27.37％ (4 580/16 733),24.30％ (4 108/16 904),the examination fee was 13.32％ (2 229/16 733),15.46％ (2 613/16 904),and the traditional Chinese medicine cost was 9.34％ (1 563/16 733) and 10.11％ (1 709/16 904).The results of univariate analysis showed that there were significant differences in the direct medical expenses and total costs of patients with misdiagnosis,medical institution level,different stages,and different types of brucellosis (P ＜ 0.05).The results of multivariate analysis showed that there was a positive correlation between misdiagnosis and provincial medical institutions and patients' direct medical expenses and total expenses (P ＜ 0.05).Conclusions It should give rise to enough attention that the burden of different types of brucellosis is heavy.Local medical institutions should refer to "Guidelines for the Diagnosis and Treatment of Brucellosis" (2012) to carry out standardized diagnosis and treatment,reduce the complications of brucellosis and chronic brucellosis.Therefore,strengthening the training of medical personnel,standardize diagnosis and treatment of brucellosis in hospitals at all levels is very urgent.
ABSTRACT
Objective To analyze the knowledge and perceptions of brucellosis and human behavior in different populations in Jingyuan County Gansu Province,and to provide a scientific basis for carrying out health education and prevention accurately on brucellosis.Methods In 2015,using two-stage cluster sampling method,nine towns with more accumulative incidence of brucellosis in the past 3 years in Jingyuan Country were selected,5 villages were selected from each town,occupational exposure and patients with brucellosis were selected in each village as respondents.A questionnaire survey was carried out to collect basic information,brucellosis related knowledge,population's behavio.Results The overall awareness rate of prevention and control knowledge on brucellosis was 44.10％ (12 943/29 348),included 809 people with the occupation exposure population and 203 patients with brucellosis,among them,the rate of patients with brucellosis knowledge was 50.40％ (2 967/5 887),occupational exposure population was 42.52％ (9 976/23 461);There were significant differences in the awareness rate of knowledge on prevention and control of brucellosis in population of different gender,age,education and years of work experience (x2 =84.413,166.100,207.200,16.822,P ＜ 0.01);of the following parameters:shared water,peel dead lamb,How to deal with flow products,treatment of abortion without gloves,masks,not wearing gloves,masks when lambing ,to give livestock vaccines and drugs,eat dead cow,lamb,and sale of diseased,dead livestock,slaughter livestock,there were statistical significant differences between patients with brucellosis and exposure people (x2 =13.940,27.965,30.031,19.575,22.597,21.139,14.524,436.450,8.482,P ＜ 0.05).Conclusions The occupational exposure population has a low knowledge awareness rate;high risk behaviors have higher risk of brucellosis infection in Jingyuan County.We should carry out health education and high-risk behavior intervention in targeted population.