Disease Burden Of Pneumoconiosis Patients In Chongqing

Objective: The goal of the study is to understand the burden of disease (BOD) for pneumoconiosis patients in Chongqing, using disability-adjusted life years (DALY), an indicator presented recently, and evaluate their health status from different aspects with economic loss and quality of life (QOL), and provide scientific guide for taking measures to prevent and treat pneumoconiosis patients, decrease the number of new pneumoconiosis patients, and improve life quality.Methods: The confirmed 600 pneumoconiosis patients from CDC of Chongqing and Chongqing Occupational Disease Hospital and 20 cases from vital registration system have been sampled and the data concerning age of onset/death, pneumoconiosis grades, tuberculosis complicated or not, the condition of pulmonary function,and the grade of disability was collected. Using the formula that World Bank and Harvard University proposed in the research report of global burden of diseases, calculated patients' healthy life years loss due to disability and early death, that is, the Disability-Adjusted Life Years (DALY) .Based on the number of onset and death of pneumoconiosis in Chongqing, the total DALY loss of pneumoconiosis in Chongqing was estimated. A standard questionnaire survey was conducted among 180 c1inically diagnosed pneumoconiosis patients from Chongqing Occupational Disease Hospital. Through the survey, patients were asked their direct expenses (outpatient and inpatient expenses) and indirect expenses (transportation fee,nutrition expenses, working time income loss of themselves and their accompaniers) in the past one year. Multivariate regression analysis on direct expense was carried out. Direct expense, transportation fee and nutrition expenses were merged as direct economic burden of the disease. Human Capital Approach (HCA) was used to estimate the social indirect economic loss which includes patients' and accompaniers' working income loss. The method of combing DALY and Value of Statistic Life (VOSL) was used to estimate invisible loss of pneumoconiosis patients. Based on the number of onset of pneumoconiosis in Chongqing, the total economic loss was estimated. In health related quality of life assessment, the Medical Outcomes Study 36-Iterm Short-Form Health Survey (SF-36) was used to self-reported health data from pneumoconiosis patients. Comparing the scores of pneumoconiosis patients with the controls, the change in every health domain was obtained, and to find the impact factors of pneumoconiosis patients` total score, multiple stepwise regression analysis on was carried out. The method named"Factor Analysis"was employed to obtain the domain of BOD of pneumoconiosis patients and the fuzzy synthetic evaluation method was established to learn about the comprehensive HRQOL (health related quality of life) distribution of pneumoconiosis patients.Results:1. The disability-adjusted life years of pneumoconiosis patients in ChongqingIt was found out that 8825.85 health years were lost due to pneumoconiosis patients in 15 years and older population in Chongqing, in which Years Lived with Disability were 6134.40 years (69.50% for YYD) and Years of Life Lost were 2691.45 years (30.50% for YYD).There were 0.89 health life years per 1000 15 years and older male persons per year lost resulted from pneumoconiosis patients in Chongqing. There were 10.36 health life years per patient lost in his life resulted from pneumoconiosis patients in Chongqing. There were 25334 pneumoconiosis patients occurred in Chongqing before the year of 2008. So, there were 262.5 thousand heath years lusted due to pneumoconiosis patients before the year of 2008.2. The economic cost of pneumoconiosis patients in Chongqing Of 180 pneumoconiosis patients, direct economic burden was 14642.04 Yuan per person every year, indirect economic burden was 62481.50 Yuan per person, invisible cost loss was 2167062 thousand Yuan. The number of new pneumoconiosis patients occurred in 2007 was 852, so in 15 years and older male population, the over wall economic cost of pneumoconiosis patients was 22.3 billion (Yuan)in Chongqing in 2007,in which, invisible cost loss was 21.7billion (Yuan),that account for 97%.If out including the cost resulted from DALY, the overall economic cost of pneumoconiosis patients was 17.5 million (Yuan), in which, the direct cost was 12.5 million (Yuan) ,that account for 71.16%,the indirect cost was 5.1 million (Yuan) , that account for 28.84%. The over wall economic cost of pneumoconiosis patients was 664.2 billion (Yuan) in Chongqing before the year of 2008. Accord to the data, we can draw the conclusion that the cost loss of pneumoconiosis patients has negative effect on economic development in Chongqing.Main factors contributing to patients` direct economic burden were days staying in hospital, disability grade, subsidy,et al. And the main factors influencing the days staying in hospital were source of expenses, occupation, place of work, subsidy, transportation fee, family income, working time lost. Main factors influencing DALY were grade of disability, age and stage of pneumoconiosis.3. The evaluation of quality of lifeThe score of every health domain in pneumoconiosis patients was lowered than rural males, even lowered than urban males. Compared with rural males, the score in"Role Physical"domain declined most significantly, declined 85.35%, and the next was the score in"General Health"domain, declined 66.39%.The last was the score in"Mental Health"domain, declined 17.72%.The influencing factors about total score of pneumoconiosis patients were marriage, educational level, working years in the environment with dust, respiratory symptoms, the welfare, place of work and grade of disability.4. Fuzzy comprehensive judgment on pneumoconiosis patients` BODThe weights of BOD domains :"DALY","Direct Cost","Physical Function","Social Function","Role Physical","Role Emotional","Mental Health","Vitality","Body Pain","General Health"are respectively 0.106,0.104,0.104,0.100,0.097,0.104,0.090,0.096,0.097,0.101. Total of the weights of"Physical Function","Social Function","Role Physical","Role Emotional","Mental Health","Vitality","Body Pain","General Health"is 0.8,this indicated that QOL account for 80% BOD . Pneumoconiosis patients` BOD had the probability of 40.5% was judged to"severe degree".Conclusions:1. From the point of DALY, the disease burden of pneumoconiosis patients for individual patient is very heavy. The disease burden for male population also should not be ignored.2. The economic burden caused by pneumoconiosis patients is heavy, in which, invisible economic loss caused by the decreasing of HRQOL is the biggest part. That means HRQOL played an important role in the assessment of pneumoconiosis patients` BOD.3. Pneumoconiosis declined patients` health HRQOL in every health domain, especially in"Role Physical"and"General Health"domains.In conclusion,measures should be taken to decline the heavy BOD of pneumoconiosis patients in Chongqing, such as Strengthening the supervision in accordance with the law, reinforcing dust control and equipment renewal, promoting personal protection ,and conducting periodical physical examination on workers. In word to decrease the invisible economic loss by improving HRQOL, the patients should accept better treatment for free and psychological guidance. These measures will decline or eleminate the new cases and their disease burden, then do a good fever for economic development, improving people's health level, and social harmony.