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Article(id=1241759334250647559, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202403199, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1710172800000, receivedDateStr=2024-03-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773988095981, onlineDateStr=2026-03-20, pubDate=1727193600000, pubDateStr=2024-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773988095981, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773988095981, creator=13701087609, updateTime=1773988095981, updator=13701087609, issue=Issue{id=1241759317016252418, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='18', pageStart='3265', pageEnd='3456', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773988091898, creator=13701087609, updateTime=1773991617194, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774103024174010, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774103024174011, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3346, endPage=3350, ext={EN=ArticleExt(id=1241759335899009049, articleId=1241759334250647559, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Excess hospitalizations and changes in the structure of hospitalization costs for acute respiratory infections after managing COVID-19 with measures against Class B infectious diseases, Yantian District, Shenzhen, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the excess hospitalization and structural change in hospitalization costs of acute respiratory infections (novel coronavirus infection excluded) in Yantian, Shenzhen, as the changing epidemiological patterns of respiratory infections. To provide information for the development of evidence-based public health policies and the burden of disease control measures.

Methods

Adjusted Serfling regression models were used to estimate the excess hospitalization and degree of structural change and grey correlation analysis was employed to analyze the change in structure of hospitalization costs and the association of items, based on the data from the regional health information platform in Yantian District from 2020 to 2023.

Results

In 2023, there were 1 698 excess hospitalization cases of acute respiratory infection, with an excess rate of 170.82%, accounting for 63.08% of the total number of hospitalizations. An increase in the number of viral and mycoplasma infections may be the reason for the excess hospitalization. There was a change in the structure of hospitalization costs, with the diagnostic category having the greatest value, contribution, and association with the structural change in costs.

Conclusion

There was a high excess hospitalization for acute respiratory infections and structural change in hospitalization costs was observed in 2023. Surveillance systems should be continuously improved to capture abnormal epidemics or excess hospitalizations to provide evidence for medical resource preparation and allocation. Clinical pathway management should be continuously strengthened to reduce the medical cost of patients.

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目的

探讨在呼吸道感染疾病的流行模式发生变化背景下的深圳市盐田区急性呼吸道感染(不含新型冠状病毒感染)超额住院情况以及住院费用结构变化情况，为制定循证公共卫生政策以及疾病负担做出合理控制提供信息。

方法

基于区域卫生信息平台，采集2020—2023年盐田区急性呼吸道感染住院患者的数据资料，应用调整Serfling回归模型估计超额住院情况，应用结构变动度分析法、灰色关联分析法对住院费用结构及项目关联情况进行定量分析。

结果

2023年急性呼吸道感染超额住院发病1 698例，超额率170.82%，占该年总住院人数的63.08%，病毒、支原体感染的病例增加，可能是发生超额住院的主要原因之一。住院费用结构发生变化，诊断类费用结构变动值、贡献率和关联度均最大。

结论

2023年急性呼吸道感染超额住院超额率高，住院费用结构也发生变化。应不断健全监测系统，以捕获异常流行或超额住院情况，为医疗资源准备、分配提供依据；不断加强临床路径管理，减轻患者经济负担。

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李雪梅，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=0+EMktQftG/DIN0Qyg0llw==, magXml=vrdTD04N+FeNqJY4rdhFOQ==, pdfUrl=null, pdf=SQS/kAX4PTZvH+zVubc5TA==, pdfFileSize=685735, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=yXE/Lhm2gNpIWcvMPPlqpw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=jMMtl6o85KgXqlsVL/AfyQ==, mapNumber=null, authorCompany=null, fund=null, authors=

林凯（1990—），男，本科，主管医师，研究方向：传染病预防控制

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林凯（1990—），男，本科，主管医师，研究方向：传染病预防控制

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林凯（1990—），男，本科，主管医师，研究方向：传染病预防控制

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Lancet, 2010, 375(9725): 1545-1555., articleTitle=Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis, refAbstract=null), Reference(id=1241759377732997401, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[19], rfOrder=22, authorNames=国家统计局深圳调查队, journalName=null, refType=null, unstructuredReference=国家统计局深圳调查队．2023年深圳居民收入和消费支出情况[EB/OL]．[2024-08-13]．https://gdzd.stats.gov.cn/szdcd/sz_tjsj/nd/202403/t20240304_181855.html．, articleTitle=2023年深圳居民收入和消费支出情况, refAbstract=null), Reference(id=1241759377963684130, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[19], rfOrder=23, authorNames=Survey Officeofthe NationalBureauof Statisticsin Shenzhen, journalName=null, refType=null, unstructuredReference=Survey Officeofthe NationalBureauof Statisticsin Shenzhen. Income and consumption expenditures of Shenzhen residents in 2023[EB/OL].[2024-08-13].https://gdzd.stats.gov.cn/szdcd/sz_tjsj/nd/202403/t20240304_181855.html. （In Chinese), articleTitle=Income and consumption expenditures of Shenzhen residents in 2023, refAbstract=null), Reference(id=1241759378316005682, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, doi=null, pmid=null, pmcid=null, year=2014, volume=371, issue=17, pageStart=1619, pageEnd=1628, url=null, language=null, rfNumber=[20], rfOrder=24, authorNames=Musher DM, Thorner AR, journalName=New England Journal of Medicine, refType=null, unstructuredReference=Musher DM, Thorner AR. Community-acquired pneumonia[J].New England Journal of Medicine, 2014, 371(17): 1619-1628., articleTitle=Community-acquired pneumonia, refAbstract=null), Reference(id=1241759378492166457, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, doi=null, pmid=null, pmcid=null, year=2014, volume=2014, issue=4, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[21], rfOrder=25, authorNames=Jefferson T, Jones MA, Doshi P, journalName=The Cochrane Database of Systematic Reviews, refType=null, unstructuredReference=Jefferson T, Jones MA, Doshi P, et al. Neuraminidase inhibitors for preventing and treating influenza in adults and children[J]. The Cochrane Database of Systematic Reviews, 2014, 2014(4): CD008965., articleTitle=Neuraminidase inhibitors for preventing and treating influenza in adults and children, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241759345562685594, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, xref=null, ext=[AuthorCompanyExt(id=1241759345592045723, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, companyId=1241759345562685594, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Communicable Disease Control and Prevention,Yantian Center for Disease Control and Prevention, Shenzhen, Guangdong 518000, China), AuthorCompanyExt(id=1241759345642377372, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, companyId=1241759345562685594, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=深圳市盐田区疾病预防控制中心传染病防制科，广东 深圳 518000)])], figs=[ArticleFig(id=1241759368388088638, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=EN, label=Fig.1, caption=Schematic diagram of the adjusted Serfling regression model, figureFileSmall=H5pkiJCy+JIgeyKYuiBJEA==, figureFileBig=yXE/Lhm2gNpIWcvMPPlqpw==, tableContent=null), ArticleFig(id=1241759368610386757, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=CN, label=图1, caption=调整Serfling回归模型迭代步骤, figureFileSmall=H5pkiJCy+JIgeyKYuiBJEA==, figureFileBig=yXE/Lhm2gNpIWcvMPPlqpw==, tableContent=null), ArticleFig(id=1241759369352778609, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=EN, label=Table 1, caption=

Hospitalized cases of acute respiratory tract infections by age groups in Yantian District, Shenzhen, 2020-2023

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄组（岁）2020—2022年年均病例数（例）2023年病例数（例）环比（%）
0~145671 810219.22
15~64198628217.17
≥6522425413.39
), ArticleFig(id=1241759369466024828, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=CN, label=表1, caption=

2020—2023年深圳市盐田区不同年龄组急性呼吸道感染住院病例变化情况

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄组（岁）2020—2022年年均病例数（例）2023年病例数（例）环比（%）
0~145671 810219.22
15~64198628217.17
≥6522425413.39
), ArticleFig(id=1241759369554105217, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=EN, label=Table 2, caption=

Pathogenetic result of hospitalized cases of acute respiratory tract infections in Yantian District, Shenzhen, 2020-2023

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体2020—2022年2023年χ2值P值
阳性数（例）检出率（%）阳性数（例）检出率（%）
细菌
铜绿假单胞菌335.00251.1935.641<0.001
鲍曼不动杆菌性243.64180.8526.042<0.001
肺炎克雷伯菌243.64180.8526.042<0.001
金黄色葡萄球菌91.3660.2810.8580.001
肺炎链球菌60.91331.571.5590.212
病毒
流感8713.1848422.9629.352<0.001
鼻病毒568.4827212.909.3940.002
呼吸道合胞病毒456.8223911.3411.1510.001
腺病毒395.911637.732.4700.116
EB病毒324.8521210.0616.964<0.001
肺炎支原体9213.941 04649.62264.318<0.001
), ArticleFig(id=1241759369780597648, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=CN, label=表2, caption=

2020—2023年深圳市盐田区急性呼吸道感染住院病例主要病原学监测情况

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体2020—2022年2023年χ2值P值
阳性数（例）检出率（%）阳性数（例）检出率（%）
细菌
铜绿假单胞菌335.00251.1935.641<0.001
鲍曼不动杆菌性243.64180.8526.042<0.001
肺炎克雷伯菌243.64180.8526.042<0.001
金黄色葡萄球菌91.3660.2810.8580.001
肺炎链球菌60.91331.571.5590.212
病毒
流感8713.1848422.9629.352<0.001
鼻病毒568.4827212.909.3940.002
呼吸道合胞病毒456.8223911.3411.1510.001
腺病毒395.911637.732.4700.116
EB病毒324.8521210.0616.964<0.001
肺炎支原体9213.941 04649.62264.318<0.001
), ArticleFig(id=1241759369994507161, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=EN, label=Table 3, caption=

Model estimates of Adjusted Serfling estimates of hospitalized cases of acute respiratory tract infections using Adjusted Serfling model in Yantian, Shenzhen, 2020-2023

, figureFileSmall=null, figureFileBig=null, tableContent=
参数0~14岁15~64岁≥65岁
估计值t值P值估计值t值P值估计值t值P值
β0-46.498-2.1200.048-4.574-0.8070.04313.07311.961<0.001
β114.1863.956<0.0013.9424.303<0.001-0.56-2.4340.059
β2-0.765-4.906<0.001-0.245-6.084<0.0010.0312.7210.042
β30.0126.130<0.0010.0047.876<0.001-0.012-2.7000.043
β4-9.987-1.9710.0642.7922.0570.0562.0504.2040.008
β5-12.501-1.8060.876-3.322-2.3480.032-2.154-4.5140.006
), ArticleFig(id=1241759370229388197, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=CN, label=表3, caption=

2020—2023年深圳市盐田区不同年龄组急性呼吸道感染住院调整Serfling回归拟合系数

, figureFileSmall=null, figureFileBig=null, tableContent=
参数0~14岁15~64岁≥65岁
估计值t值P值估计值t值P值估计值t值P值
β0-46.498-2.1200.048-4.574-0.8070.04313.07311.961<0.001
β114.1863.956<0.0013.9424.303<0.001-0.56-2.4340.059
β2-0.765-4.906<0.001-0.245-6.084<0.0010.0312.7210.042
β30.0126.130<0.0010.0047.876<0.001-0.012-2.7000.043
β4-9.987-1.9710.0642.7922.0570.0562.0504.2040.008
β5-12.501-1.8060.876-3.322-2.3480.032-2.154-4.5140.006
), ArticleFig(id=1241759370971780024, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=EN, label=Table 4, caption=

Excess hospitalization for acute respiratory infections by age groups in Yantian District, Shenzhen, 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄组
（岁）		观察住院数
（例）		期望住院数
（例）		超额住院数
（例）		超额率
（%）
0~141 8105761 234214.24
15~64628200428214.00
≥652542183616.51
合计2 6929941 698170.82
), ArticleFig(id=1241759371181495235, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=CN, label=表4, caption=

2023年深圳市盐田区不同年龄组急性呼吸道感染超额住院情况

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄组
（岁）		观察住院数
（例）		期望住院数
（例）		超额住院数
（例）		超额率
（%）
0~141 8105761 234214.24
15~64628200428214.00
≥652542183616.51
合计2 6929941 698170.82
), ArticleFig(id=1241759371332490184, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=EN, label=Table 5, caption=

Hospitalization costs of acute respiratory tract infections by age groups in Yantian, Shenzhen,2020-2023

, figureFileSmall=null, figureFileBig=null, tableContent=
项目0~14岁15~64岁≥65岁
2020—2022年2023年2020—2022年2023年2020—2022年2023年
次均费用3 504.203 748.509 024.907 027.9335 958.2724 231.24
综合医疗服务类983.08919.021 901.371 473.169 415.856 260.91
诊断类1 623.761 941.774 022.153 903.189 251.338 927.97
治疗类288.32363.05440.78245.483 934.432 417.38
药类459.44327.091 977.211 228.5210 113.595 214.31
耗材类41.449.17401.4972.122 136.97588.75
其他108.17188.41281.90105.471 106.10821.94
), ArticleFig(id=1241759371609314263, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=CN, label=表5, caption=

2020—2023年深圳市盐田区不同年龄组急性呼吸道感染住院费用情况（单位：元）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目0~14岁15~64岁≥65岁
2020—2022年2023年2020—2022年2023年2020—2022年2023年
次均费用3 504.203 748.509 024.907 027.9335 958.2724 231.24
综合医疗服务类983.08919.021 901.371 473.169 415.856 260.91
诊断类1 623.761 941.774 022.153 903.189 251.338 927.97
治疗类288.32363.05440.78245.483 934.432 417.38
药类459.44327.091 977.211 228.5210 113.595 214.31
耗材类41.449.17401.4972.122 136.97588.75
其他108.17188.41281.90105.471 106.10821.94
), ArticleFig(id=1241759371793863652, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=EN, label=Table 6, caption=

Change in cost structure, contribution rate and degree of change, 2020-2022 vs. 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
项目0~14岁15~64岁≥65岁
变动值贡献率变动度变动值贡献率变动度变动值贡献率变动度
综合医疗服务类-3.5419.9617.72-0.110.4921.94-0.351.5222.87
诊断类5.4630.8310.9750.0011.1248.62
治疗类1.468.22-1.396.34-0.974.22
药类-4.3924.75-4.4320.18-6.6128.89
耗材类-0.945.29-3.4215.60-3.5115.36
其他1.9410.94-1.627.400.321.38
), ArticleFig(id=1241759372041327600, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=CN, label=表6, caption=

2020—2022年与2023年对比的费用结构变动、贡献率及变动度（单位：%）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目0~14岁15~64岁≥65岁
变动值贡献率变动度变动值贡献率变动度变动值贡献率变动度
综合医疗服务类-3.5419.9617.72-0.110.4921.94-0.351.5222.87
诊断类5.4630.8310.9750.0011.1248.62
治疗类1.468.22-1.396.34-0.974.22
药类-4.3924.75-4.4320.18-6.6128.89
耗材类-0.945.29-3.4215.60-3.5115.36
其他1.9410.94-1.627.400.321.38
), ArticleFig(id=1241759372217488377, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=EN, label=Table 7, caption=

Correlation of different items of hospitalization costs per visit, 2020-2023

, figureFileSmall=null, figureFileBig=null, tableContent=
项目0~14岁15~64岁
2020—2022年关联系数2023年关联系数关联度关联序列2020—2022年关联系数2023年关联系数关联度关联序列
综合医疗服务类0.840.780.8120.650.760.702
诊断类0.981.000.9910.801.000.901
治疗类0.720.700.7140.580.670.634
药类0.750.690.7230.660.740.703
耗材类0.690.660.6760.580.660.625
其他0.700.680.6950.570.660.626
项目≥65岁
2020—2022年关联系数2023年关联系数关联度关联序列
综合医疗服务类0.740.920.832
诊断类0.741.000.871
治疗类0.660.830.754
药类0.760.900.833
耗材类0.640.800.725
其他0.630.800.716
), ArticleFig(id=1241759372385259523, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334250647559, language=CN, label=表7, caption=

2020—2023年次均住院费用不同项目关联情况

, figureFileSmall=null, figureFileBig=null, tableContent=
项目0~14岁15~64岁
2020—2022年关联系数2023年关联系数关联度关联序列2020—2022年关联系数2023年关联系数关联度关联序列
综合医疗服务类0.840.780.8120.650.760.702
诊断类0.981.000.9910.801.000.901
治疗类0.720.700.7140.580.670.634
药类0.750.690.7230.660.740.703
耗材类0.690.660.6760.580.660.625
其他0.700.680.6950.570.660.626
项目≥65岁
2020—2022年关联系数2023年关联系数关联度关联序列
综合医疗服务类0.740.920.832
诊断类0.741.000.871
治疗类0.660.830.754
药类0.760.900.833
耗材类0.640.800.725
其他0.630.800.716
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新型冠状病毒感染“乙类乙管”后深圳市盐田区急性呼吸道感染的超额住院及住院费用结构变化分析
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林凯 , 刘雅文 , 古丽斯 , 徐震东 , 黄仁湛 , 罗诗丽 , 于海航 , 李雪梅
现代预防医学 | 基层卫生服务 2024,51(18): 3346-3350
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现代预防医学 | 基层卫生服务 2024, 51(18): 3346-3350
新型冠状病毒感染“乙类乙管”后深圳市盐田区急性呼吸道感染的超额住院及住院费用结构变化分析
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林凯, 刘雅文, 古丽斯, 徐震东, 黄仁湛, 罗诗丽, 于海航, 李雪梅
作者信息
  • 深圳市盐田区疾病预防控制中心传染病防制科，广东 深圳 518000

    • 林凯（1990—），男，本科，主管医师，研究方向：传染病预防控制

通讯作者:

李雪梅，E-mail:
Excess hospitalizations and changes in the structure of hospitalization costs for acute respiratory infections after managing COVID-19 with measures against Class B infectious diseases, Yantian District, Shenzhen
Kai LIN, Ya-wen LIU, Li-si GU, Zhen-dong XU, Ren-zhan HUANG, Shi-li LUO, Hai-hang YU, Xue-mei LI
Affiliations
  • Department of Communicable Disease Control and Prevention,Yantian Center for Disease Control and Prevention, Shenzhen, Guangdong 518000, China
出版时间: 2024-09-25 doi: 10.20043/j.cnki.MPM.202403199
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摘要
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目的

探讨在呼吸道感染疾病的流行模式发生变化背景下的深圳市盐田区急性呼吸道感染(不含新型冠状病毒感染)超额住院情况以及住院费用结构变化情况，为制定循证公共卫生政策以及疾病负担做出合理控制提供信息。

方法

基于区域卫生信息平台，采集2020—2023年盐田区急性呼吸道感染住院患者的数据资料，应用调整Serfling回归模型估计超额住院情况，应用结构变动度分析法、灰色关联分析法对住院费用结构及项目关联情况进行定量分析。

结果

2023年急性呼吸道感染超额住院发病1 698例，超额率170.82%，占该年总住院人数的63.08%，病毒、支原体感染的病例增加，可能是发生超额住院的主要原因之一。住院费用结构发生变化，诊断类费用结构变动值、贡献率和关联度均最大。

结论

2023年急性呼吸道感染超额住院超额率高，住院费用结构也发生变化。应不断健全监测系统，以捕获异常流行或超额住院情况，为医疗资源准备、分配提供依据；不断加强临床路径管理，减轻患者经济负担。

流行模式  /  急性呼吸道感染  /  超额发病  /  住院费用结构
Objective

To explore the excess hospitalization and structural change in hospitalization costs of acute respiratory infections (novel coronavirus infection excluded) in Yantian, Shenzhen, as the changing epidemiological patterns of respiratory infections. To provide information for the development of evidence-based public health policies and the burden of disease control measures.

Methods

Adjusted Serfling regression models were used to estimate the excess hospitalization and degree of structural change and grey correlation analysis was employed to analyze the change in structure of hospitalization costs and the association of items, based on the data from the regional health information platform in Yantian District from 2020 to 2023.

Results

In 2023, there were 1 698 excess hospitalization cases of acute respiratory infection, with an excess rate of 170.82%, accounting for 63.08% of the total number of hospitalizations. An increase in the number of viral and mycoplasma infections may be the reason for the excess hospitalization. There was a change in the structure of hospitalization costs, with the diagnostic category having the greatest value, contribution, and association with the structural change in costs.

Conclusion

There was a high excess hospitalization for acute respiratory infections and structural change in hospitalization costs was observed in 2023. Surveillance systems should be continuously improved to capture abnormal epidemics or excess hospitalizations to provide evidence for medical resource preparation and allocation. Clinical pathway management should be continuously strengthened to reduce the medical cost of patients.

Epidemic pattern  /  Acute respiratory infection  /  Excess morbidity  /  Hospitalization cost structure
林凯, 刘雅文, 古丽斯, 徐震东, 黄仁湛, 罗诗丽, 于海航, 李雪梅. 新型冠状病毒感染“乙类乙管”后深圳市盐田区急性呼吸道感染的超额住院及住院费用结构变化分析. 现代预防医学, 2024 , 51 (18) : 3346 -3350 . DOI: 10.20043/j.cnki.MPM.202403199
Kai LIN, Ya-wen LIU, Li-si GU, Zhen-dong XU, Ren-zhan HUANG, Shi-li LUO, Hai-hang YU, Xue-mei LI. Excess hospitalizations and changes in the structure of hospitalization costs for acute respiratory infections after managing COVID-19 with measures against Class B infectious diseases, Yantian District, Shenzhen[J]. Modern Preventive Medicine, 2024 , 51 (18) : 3346 -3350 . DOI: 10.20043/j.cnki.MPM.202403199
正文
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急性呼吸道感染（acute respiratory infection, ARI）是一组由病毒、细菌、真菌、支原体和衣原体感染引起的疾病，为高发病率和高死亡率的全球性健康问题[1]。2020—2022年，受新型冠状病毒感染疫情（以下简称“新冠疫情”）防控的非药物干预措施的影响，可能减缓了ARI的发生[2-3]，但另一方面也可能降低了通过自然感染而获得的免疫水平[4]，非药物干预措施取消或放松后，传染性病疾病尤其ARI的发病水平将出现返峰或超过往年峰值[5-6]。为了解新冠疫情防控政策调整为“乙类乙管”后，ARI超额住院情况以及住院费用结构变化情况，本研究基于深圳市盐田区区域卫生信息平台，采集2020—2023年盐田区医疗机构收治的ARI（不含新冠病毒感染）住院病例的数据资料，应用调整Serfling回归模型估计2023年超额住院发生情况，应用结构变动度分析法、灰色关联度分析法分析住院费用结构改变情况，为制定ARI的循证公共卫生政策以及疾病负担做出合理控制提供信息。
1　材料和方法
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1.1　研究方法
应用整群抽样方法，基于盐田区区域卫生信息平台采集2020年1月至2023年12月盐田区医疗机构收治的急性呼吸道感染（不含新型冠状病毒感染）住院患者的基本信息（姓名、身份证号码、性别、年龄）、诊疗信息（疾病诊断、疾病诊断ICD编码、病原学检测结果）、医疗费用，建立数据库。
1.2　相关定义
1.2.1　根据国际疾病分类（ICD-10），急性呼吸道感染编码为J00~J22。
1.2.2　住院费用分类，根据《卫生部关于修订住院病案首页的通知》（卫医政发[2011]84号），将住院费用分为6类：综合医疗服务类（一般医疗服务费、一般治疗操作费及护理费等）、诊断类（病理、实验室、影像学及临床诊断项目费）、治疗类（非手术治疗、手术治疗费）、药类（西药、中药费）、耗材类（检查。治疗及手术用一次性医用材料费）及其他类。
1.3　分析方法
1.3.1　建立调整Serfling回归模型
建立时间（年/月）、住院例数时间序列，构建可加形式模型对时间序列的长期趋势、季节性及随机扰动进行分解。模型结构如下：
其中Yt是第t月拟合住院病例数，β0为t月截距，β2、β3、β4为模型需要估计的回归系数。ε为误差项。β1t+β2t2+β3t2反映时间序列的长期趋势，反映季节周期性。
采用决定系数R2（0≤R2≤1）判断模型的拟合优度，表示因变量Yt的变异能被自变量解释的比例，R2越接近1，表示模型拟合住院例数的效果越好。对模型进行多次迭代回归，采用R2最大的一次拟合为本研究的最终模型，步骤见图1。最终模型的拟合值作为基线值，95%上限为流行阈值，连续2月实际住院例数超过流行阈值定义为流行期，流行期内实际住院例数与基线值的差值为超额住院例数。
1.3.2　采用直接医疗费用评价疾病负担[7]。应用结构变动度分析法分析费用的结构变化，其中项目费用的正、负向变动采用结构变动值衡量，费用结构的综合变化采用结构变动度衡量，项目费用的变化对结构的影响大小采用结构变动贡献率衡量；应用灰色关联度分析法分析不同项目与次均住院费用的关联度及关联强度顺位[8]。
1.4　统计学方法
使用R 4.2.1软件进行统计处理分析。调整Serfling回归模型的回归系数采用最小二乘法估计，采用方差分析对回归系数进行检验，检验水准为α=0.05。
2　结果
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2.1　基本情况
2020—2023年，盐田区医疗机构共收治ARI住院病例5 655例，2020—2022年、2023年分别占52.40%、47.60%，月收治中位数分别为75例（Q25-Q75:47~108）、232（Q25-Q75:178~310）。2023年，不同年龄组住院病例数均增加，0~14岁、15~64岁增幅均较大（219.22%、217.17%）。见表1。
2.2　病原学监测情况
对2 768份标本进行呼吸道病原体多重检测，2023年与2020—2022年相比，细菌类病原检出率总体呈现下降趋势，病毒类病原体（不含新型冠状病毒）检出率呈上升趋势，肺炎支原体检出率呈上升趋势。见表2。
2.3　调整Serfling回归模型拟合结果
2.3.1　模型拟合情况
以月为自变量，应用调整Serfling回归模型进行拟合，0 ~14岁、15~64岁及≥65岁年龄组各经3次拟合后，均在第2次拟合出现R2最大（0.908、0.942、0.892），9次拟合模型均有统计学意义（P均<0.001）。回归系数提示，长期趋势明显，季节周期性弱。见表3。
2.3.2　超额住院估计
2023年，合计超额住院1 698例，超额率170.82%。不同年龄组均发生超额住院，其中0 ~14岁、15~64岁年龄组超额率均达200%以上，≥65岁年龄组超额率16.51%最低。见表4。
2.4　住院费用结构变化分析
将2021—2023年的住院费用贴现至2020年。次均住院费用方面，0~14岁年龄组次均住院费用呈上升趋势，15~64岁、≥65岁年龄组呈下降趋势，见表5。费用结构变动方面，诊断类在各年龄段均呈正向变动，综合医疗服务类、药类在各年龄段均呈负向变动；结构变动度≥65岁年龄组最大（22.87%）、15~64岁次之（21.94%）、0 ~14岁最低（17.72%）；诊断类、药类在各年龄组中对结构变动贡献率均较大，见表6。次均费用变化项目关联方面，诊断类对次均费用影响最大，综合医疗服务类次之，药类居第三，见表7。
3　讨论
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近年来调整Serfling回归模型多应于流感、手足口病及腹泻等季节性明显的传染病超额病例数、发病率的估计[9-11]，暂无应用估计ARI超额住院的报道。既往研究表明ARI的发生具有明显的季节性[12]，但由于受新冠疫情不同阶段防控措施的影响，全球的呼吸道感染疫情的流行模式发生变化[13-14]，本研究结果亦显示，2020—2023年ARI住院的季节性变弱，但建立的调整Serfling回归模型拟合效果仍优（R2>0.850），说明能够较好解释不同年龄组发病住院的变异。
本研究应用调整Serfling回归模型估计2023年深圳市盐田区ARI超额住院发病1 698例，超额率170.82%，占该年总住院人数的63.08%。非药物干预措施（NPI）取消或放松，ARI发病住院出现增加，与多个研究结果一致[15-17]，可能与疫情期间的NPI降低了通过自然感染而获得的免疫水平有关。本研究发现，2023年不同年龄组均发生ARI超额住院，但主要发生在0 ~64岁人群中，可能不同年龄组感染病原谱存在差异，儿童感染多以支原体、病毒为主，中青年人群多以病毒为主，而老年人则多以细菌为主[12]，盐田区的病原学监测结果显示，2023年病毒类病原体（不含新型冠状病毒）检出率呈明显的上升趋势，而细菌类病原体检出率则呈下降趋势，可能是导致超额住院主要发生在0~64岁年龄组的主要原因之一。
次均住院费用方面，2023年0 ~14岁年龄组呈增长趋势，可能因为NPI取消或放松后，儿童“免疫落差”相比成年人更大且其免疫系统发育不全，更加容易发生多重病原体感染且感染后症状更重[4,18]，因此2023年产生更高的次均费用，这与全国公立医院次均住院费用下降的情况不一致，提示在急性呼吸道感染超额住院负担增加的背景下，应加强医院住院费用的控制与管理，以减轻患者的经济负担，但增加的费用仍低于深圳市城镇居民可支配收入[19]，提示卫生经济负担的增加总体可控。15~64岁、≥65岁年龄组的次均费用均出现下降，可能是因为病毒感染的比例增加有关，细菌与病毒的治疗策略和药物应用存在差异[20-21]，病毒治疗的药费往往更低，与本研究发现的药类费用的呈负向变动相一致。
诊断类费用的增长及构成比改变是费用结构改变的主要原因，在不同年龄组均呈明显的正向变动，贡献率也最高，在灰色关联序列中也居首位，原因可能是急性呼吸道感染疫情的流行模式发生变化后，为筛查、鉴别病原体以明确治疗方案，需开展较以往更多的实验室诊断，同时，多种病原体的叠加感染风险增加，对影像学诊断的需求亦提高。但需要警惕药品费用下降诱导过度检查诊断，从而增加患者经济负担的可能。
综上所述，2023年，在全球呼吸道感染疫情的流行模式发生变化的环境下，因NPI延缓流行的病原体发生复燃，驱动了急性呼吸道感染超额住院发生且超额率高，住院费用结构亦发生改变。提示应不断健全急性呼吸道感染的症状、疾病、病原学等多数据来源的监测系统，以捕获异常流行或超额发病情况，为医疗资源准备、分配提供依据；超额住院增加，应不断加强临床路径管理，实行全流程的路径节点费用消耗监控，减轻患者经济负担，保障患者利益。
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2024年第51卷第18期
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doi: 10.20043/j.cnki.MPM.202403199
  • 接收时间：2024-03-12
  • 首发时间：2026-03-20
  • 出版时间：2024-09-25
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  • 收稿日期：2024-03-12
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    深圳市盐田区疾病预防控制中心传染病防制科，广东 深圳 518000

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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