中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (05): 330-334.doi: 10.3969/j.issn.1671-4091.2023.05.003

• 临床研究 • 上一篇    下一篇

中国慢性肾脏病患者跨地域就医的个体影响因素分析

王福琳   杨 超   李鹏飞   温丰羽   张路霞   

  1. 100191 北京，1北京大学医学部医学技术研究院
    100191 北京，2北京大学健康医疗大数据国家研究院
    100034 北京，3北京大学第一医院肾内科 北京大学肾脏病研究所
    100034 北京，4中国医学科学院免疫介导肾病诊治创新单元
    311215 杭州，5浙江省北大信息技术高等研究院

  • 收稿日期:2023-02-20 修回日期:2023-03-14 出版日期:2023-05-12 发布日期:2023-05-12
  • 通讯作者: 张路霞 E-mail:zhanglx@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(72125009，91846101，82003529)； 中国-世界卫生组织2018-2019双年度合作项目(2019/892000-0)；国家重点研发计划(2018AAA0102100)；北大百度基金(2020BD004，2020BD005，2020BD032)

Individual factors contributing to the intercity patient mobility for chronic kidney diseases in China

WANG Fu-lin, YANG Chao, LI Peng-fei, WEN Feng-yu, ZHANG Lu-xia   

  1. Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China;2National Institute of Health Data Science at Peking University, Beijing 100191, China; 3Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China; 4Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China; 5Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China
  • Received:2023-02-20 Revised:2023-03-14 Online:2023-05-12 Published:2023-05-12
  • Contact: 100191 北京，2北京大学健康医疗大数据国家研究院；100034 北京，3北京大学第一医院肾内科北京大学肾脏病研究所；100034 北京，4中国医学科学院免疫介导肾病诊治创新单元；311215 杭州，5浙江省北大信息技术高等研究院 E-mail:zhanglx@bjmu.edu.cn

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摘要： 目的 探究个体因素对我国18岁及以上慢性肾脏病(chronic kidney disease,CKD)患者跨地域就医行为的影响。 方法 基于2013～2018年全国范围的CKD住院患者数据，对患者跨地域就医情况进行描述性统计，并采用Logistic回归对患者跨地域就医的个体影响因素进行多因素分析。 结果 研究对象整体跨地域就医比例为17.73%；不同病因的CKD患者跨地域就医情况差异显著(χ2=33582.873，P＜0.001)；农村患者跨地域就医比例高于城市(农村29.40%，城市12.30%)，其中省内跨城市就医比例尤其高(农村24.69%，城市9.38%)；随年龄增长患者跨地域就医可能性降低(OR=0.982，95% CI:0.981～0.982，P＜0.001)；女性患者跨地域就医可能性较男性低(OR=0.934，95% CI:0.926～0.941，P＜0.001)；已婚患者跨地域就医可能性高于未婚患者(OR=1.045，95% CI:1.028～1.061，P＜0.001)；新型农村合作医疗患者跨地域就医可能性高于城镇基本医疗保险患者(OR=2.616，95% CI:2.585～2.647，P＜0.001)；与职业为工人的患者相比，职业为专业技术人员的患者跨地域就医可能性较高(OR=1.519，95% CI:1.473～1.566，P＜0.001)，退离休患者跨地域就医可能性较低(OR=0.894，95% CI:0.874～0.914，P＜0.001)。 结论 我国CKD患者跨地域就医比例较高、非医疗因素对CKD住院患者跨地域就医产生不容忽视的影响，提示在优化肾脏专科资源建设布局的基础上需合理引导就医需求。

关键词: 跨地域就医, 慢性肾脏病, 影响因素

Abstract: Objective  To explore the individual-level influencing factors of intercity mobility among adult patients with chronic kidney diseases (CKD) in China.  Methods   Based on a national hospitalization database of CKD inpatients from 2013 to 2018, descriptive statistics analysis and logistic regression were used to characterize the patient mobility for CKD and analyze the influencing factors.  Results  The overall proportion of intercity patient mobility for CKD was 17.73% in our study. There were significant differences in intercity mobility among patients with different causes of CKD (χ2=33582.873 P＜0.001). In addition, the proportion of patient mobility was higher in rural area compared to urban (29.40% for rural and 12.30% for urban), especially for the intra-province mobility (24.69% for rural while 9.38% for urban). Other individual characteristics including age, sex, marriage, medical insurance and occupation also affect the mobility of CKD inpatients. To be specific, there is a decreasing tendency for intercity mobility with patients getting older (OR=0.982, 95% CI: 0.981～0.982, P＜0.001); female patients are less likely to have intercity mobility behaviors than male patients (OR=0.934, 95%CI: 0.926～0.941, P＜0.001); married patients are more likely to seek medical treatment across cities than unmarried patients (OR=1.045, 95%CI: 1.028～1.061, P＜0.001); compared to patients with Urban Residents Basic Medical Insurance, patients with the New Rural Cooperative Medical Insurance have higher tendency for intercity mobility (OR=2.616, 95% CI: 2.585～2.647, P＜0.001)；in term of the patients’  occupation, taking workers as a reference, the professional and technical staff is more likely to have intercity mobility medical behaviors (OR=1.519, 95% CI: 1.473～1.566, P＜0.001), while retired patients are less likely to do so (OR=0.894, 95%CI: 0.874～0.914, P＜0.001).  Conclusions  There is a high mobility proportion of CKD inpatients in China, and the impact of non-medical factors on patient mobility should not be ignored. The results indicated that it is necessary to strength the guidance for reasonable medical behaviors on the basis of optimizing the layout of renal specialist resources.

Key words: Intercity patient mobility, Chronic kidney diseases, Influencing factors

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