| ObjectiveThe aim of this study based on Yichang health big data platform is to determine the epidemiological characteristics of osteoarthritis in Yichang City and its variation by osteoarthritis subtype;to describe the distribution characteristics of medical expenses of osteoarthritis in Yichang City;to determine the relationship between epidemiological characteristics and medical expenses;to explore the impact factors of the cost burden to osteoarthritis patients;and to provide a scientific basis for a healthy bone strategy in national health promotion actions.MethodsThe demographic,diagnostic,and cost data from electronic medical records of all osteoarthritis patients in the Yichang Health Management Data Information Platform were obtained from January 1,2017 to December 31,2018;International Classification of Diseases-10 was used to code primary discharge diagnoses M15 through M19(M15 polyarthropathy,M16 coxarthropathy,M17 knee OA,M18 arthrosis of first carpometacarpal joint,and M19 other joint diseases);Excel and SAS9.4 software were used to conduct descriptive epidemiological analyses osteoarthritis patients;The bootstrap method was applied to estimate means and median intervals of outpatient and inpatient costs;The epidemiological and cost data were analyzed to determine economic burden to osteoarthritis patients.Statistical analyses used nonparametric Mann Whitney U and Kruskal-Wallis tests as appropriate for univariate,bivariate,and multi-class variables.Multiple linear regression was used to explore significant(P<0.05)variables to identify factors influencing direct medical expenses of osteoarthritis inpatients.Results1.Epidemiological characteristics of osteoarthritis in Yichang City1.1 A total of 16,745 patients with osteoarthritis were enrolled based on the Yichang health big data platform.There were 6133 males(36.63%)and 10612 females(63.37%).Females were higher than males.Osteoarthritis patients aged 60-69 accounted for the highest proportion of 27.90%in different age groups.The different prevalence subtypes from high to low are M17 knee arthropathy(single joint involving both sides),which accounts for the highest proportion of 57.67%,followed by M19 other arthropathy(single joint involving both sides),and M15 polyarthropathy.(Mention of polyarthropathy in more than one place),M16 hip arthropathy(single joint involving both sides),and M18 first carpal metacarpal joint arthropathy(single joint involving both sides)are the lowest.1.2 After analysis according to the classification criteria of the definition of osteoarthritis,patients with primary osteoarthritis are higher than those with secondary joints.M19 Other arthropathy(single joint involving both sides)in the M19.9 classification,M19.905 ankle arthropathy accounted for the highest proportion,followed by M19.901 shoulder arthropathy,M19.903 wrist arthropathy,M19.902 elbow arthropathy,M19.906 foot joint Arthropathy,M19.904 interosseous joint disease of the hand,and women are higher than men.1.3 According to the monthly analysis of the visit time of osteoarthritis patients,the number of outpatient visits in 2017～2018 fluctuates significantly in spring and winter,and the number of inpatient visits in 2017-2018 basically shows an upward trend,with a higher number of visits in spring and winter.,Outpatient and inpatient visits of osteoarthritis accounted for the proportion of total visits to osteoarthritis,the proportion of outpatient visits showed a downward trend,and the proportion of inpatient visits increased.1.4 The proportion of the population of patients with osteoarthritis in Yichang City:combined with the population distribution in the population information database of Yichang City,the proportion of patients with osteoarthritis in 2017 and 2018 were 866.95/100,000 and 905.34/100,000,respectively,female proportion of the population is higher than that of the male population.The highest proportions of people over 70 years old in different age groups were 2721.81 per 100,000 and 3176.03 per 100,000 respectively,and they gradually increased with age.Knee osteoarthritis patients accounted for the highest proportion of different disease types,with 2017 and 2018 being 423.26/100,000 and 598.02/100,000 respectively.According to the results of GBD,the standardized prevalence rate of osteoarthritis in 2017 was 5.34%,and the standardized prevalence rate in 2018 was 5.44%.Based on the population covered by the big data of Yichang City in 2017,it is estimated that there are 43665 patients with osteoarthritis in the urban area of Yichang City,and only 18.72%of patients with osteoarthritis go to the hospital.2.Cost analysis of osteoarthritis clinic in Yichang CityFrom 2017 to 2018,the outpatient cost was 55.47 million CNY,a total of 12,612 cases,a total of 15,700 visits,and an average of 1.40 visits.In 2017,the outpatient cost was 29.12 million CNY.There were 6,683 patients with a total of 8,297 visits,with an average of 1.24 visits,and the average outpatient expense was 4357 CNY.In 2018,the outpatient cost was 26.35 million CNY.There were 5,929 patients with a total of 7,403 visits,with an average of 1.25 visits,and the average outpatient expense was 4444 CNY.From 2017 to 2018,the highest outpatient cost for people aged 50-59 in different age groups was 16.25 million CNY,and the average cost per case was 5143 CNY respectively,followed by 15.36 million CNY for 60-69 years old.The range of changes in different age groups was large,60-69-year-olds have the highest number of outpatient visits,and outpatient expenses for people over 50 accounted for 79.09%of the total outpatient expenses.From 2017 to 2018,the male outpatient expenses were 19.7 million CNY,a total of 4597 cases,a total of 5,729 visits,and an average of 1.24 visits.The total cost of 70 years old and above accounts for 26.40%of the total cost of male outpatient clinics,and the highest cost per case for men aged 60-69 is 4778 CNY.The female outpatient fee was 35.77 million CNY,with a total of 8015 cases,and a total of 12,612 visits,with an average of 1.24 visits.The average outpatient cost per visit and the average cost per case for people over the age of 50-59 are the highest at 4,414 CNY and 5,336 CNY,which account for 31.84%of the total outpatient cost for women.Among different disease types,M17 knee joint disease patients are the highest,and the outpatient cost is also the highest Its total cost accounts for 49.86%of the total outpatient cost,followed by M19 other joint diseases,M15 polyarthropathy,M16 hip joint disease,and M18 arthrosis of first carpometacarpal joint.In 2017 and 2018,the highest proportions of medicine expenses for different cost components were 57.94%and 54.38%,followed by inspection fees,treatment fees,material fees,and comprehensive medical service fees.3.Analysis of hospitalization expenses for osteoarthritis in YichangThe hospitalization expenses from 2017 to 2018 were 91.76 million CNY,a total of 4133 cases,a total of 7760 hospitalizations,and an average of 1.88 hospitalizations.The highest hospitalization expenses for people over 70 years old is 39.7 million CNY,accounting for 43.26%of the total hospitalization expenses,followed by 32.81 million CNY for the 60-69 years old.The hospitalization expenses increase with age.From 2017 to 2018,the hospitalization expenses for men were 15.92 million CNY,and the highest hospitalization expenses for men over 70 years old was 7.66 million CNY.The average hospitalization expenses per case were 22925 CNY,accounting for 47.20%of the total hospitalization expenses for men.The hospitalization expenses for females were 75.54 million CNY,and the highest hospitalization expenses for women over 70 years old was 32.04 million CNY.The average hospitalization expenses per case were 25,532 CNY,accounting for 42.42%of the total hospitalization expenses for women.Among different disease types,patients with M17 knee arthropathy are still the highest,and hospitalization costs are also the highest,accounting for 78.75%of the total cost,followed by M19 other arthropathy,M15 polyarthropathy,M16 hip joint disease,and M18 arthrosis of first carpometacarpal joint.In 2017 and 2018,the highest proportions of medicine expenses for different cost components were 32.38%and 33.97%,followed by treatment fees,material fees,inspection fees,comprehensive medical service fees,inspection fees,and other expenses.From 2017 to 2018,there were a total of 302 surgical patients,accounting for 16.34%of the hospitalization expenses,and the average surgical cost was 49,694 CNY,which was significantly different from patient to patient.4.Analysis of influencing factors of hospitalization expenses for patients with osteoarthritis in YichangStatistical tests were performed on the included variables in the univariate analysis.Among them,gender(χ2=4.21,P=0.04),age(χ2=25.11,P=0.001),whether or not surgery(χ2=41.00,P=0.001),the number of days of hospitalization(χ2=49.97,P=0.001),type of illness(χ2=36.52,P=0.001),and visiting season(χ2=29.81,P=0.001)were statistically significant.The number of visits(χ2=1.55,P=0.21)was not statistically significant.The significant variables in the univariate analysis were entered into the multivariate linear regression model,and the analysis results showed that surgery or not,age,gender,length of stay,type of illness,and season of visit were independent influencing factors of hospitalization expenses.According to the regression effect index determination coefficient of the evaluation model R2=0.39,39%of the hospitalization expenses can be explained by the changes in the independent variables selected above.Conclusion1.Among the different subtypes of osteoarthritis patients in Yichang,women are higher than men,and the proportion of medical visits and hospitalizations gradually increases with the increase of age after 50 years of age.60-69 years old accounted for the highest proportion.The affected parts were knee joint disease,other joint disease,polyarthropathy,hip joint disease,and arthropathy of the first carpal metacarpal joint in descending order.The number of patients with osteoarthritis is large,and the treatment rate is low.2.The medical expenses of osteoarthritis patients in Yichang City are relatively high and increase with age.Women expenses are higher than men.Outpatient expenses are concentrated in people over 50 years of age.Hospitalization expenses are concentrated in people over 70 years old.Knee joint disease is the highest among both inpatient and outpatient disease types.The outpatient department mainly focuses on medical expenses and diagnosis.Hospitalization is mainly based on medical expenses and treatment expenses.3.The influencing factors that affect the hospitalization cost of osteoarthritis are age,gender,whether to operate,the type of illness,the season of treatment,and the length of hospitalization.4.In view of the high prevalence of osteoarthritis,especially knee arthropathy in female population,intervention should start early.For population,health education on healthy bones and early identification,early intervention,early detection,early diagnosis,and early treatment of people at high risk of osteoarthritis should be carried out in advance.Medical resources also should be allocated reasonably according to the progress of osteoarthritis in the population. |
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