| ObjectivesIn recent years,both the morbidity and mortality of lung cancer have shown an upward trend,which is one of the most common malignant tumors in the world and also the ranked first cause of tumor death at present.Previous epidemiological surveys have shown that the majority of lung cancer patients are male smokers,the proportion of squamous cell carcinoma was higher than that of adenocarcinoma,and men are more than women.However,recent studies have shown that the proportion of female patients with lung cancer was gradually increasing,and the proportion of adenocarcinoma was becoming higher and higher.At the same time,the clinical epidemiological trends of lung cancer in different regions were different,such as statistics on age-group distribution,gender distribution,pathological conditions,etc.In addition,the treatment period of lung cancer patients was long,and the medical expenses of patients were relatively high,which caused a heavy disease burden to the family and society.This study analyzed the changing trend of clinical epidemiology of hospitalized patients with primary lung cancer and the composition and changing trend of each cost type in the total hospitalization expenses among patients with lung cancer in a grade-A tertiary general hospital in Shandong Province,compared the composition of the total hospitalization expenses and each cost type for first-time and non-first-time visit patients,and explored the influencing factors of the total hospitalization expenses of patients with lung cancer,so as to provide reference basis for finding out the epidemic pattern of lung cancer and the control of medical expenses.MethodsThrough the hospital medical record information system,the homepage information of inpatients discharged from a grade-A tertiary hospital in Shandong Province from January 1,2015 to December 31,2019 was collected,and the data of patients diagnosed with lung cancer were screened out,and then exported for data sorting.Descriptive analysis,difference comparison and trend test were conducted on the lung cancer patients’ information,such as gender,age,medical insurance type,occupation,pathological type,hospitalization expenses etc.Descriptive analysis was carried our using rate and proportion for categorical variables,and the comparison between groups were performed by χ2 test and kruskal-wallis H test.The numerical variables were described by(x±s),median and percentile according to the distribution,and the comparisons between groups were made by T test,F test,wilcoxon rank sum test and kruskal-wallis H test.Multiple linear regression and path analysis were used to analyze the influencing factors of hospitalization expenses of patients with lung cancer.Results1.Among the 8323 patients with lung cancer,the youngest age was 2 years old and the oldest was 98 years old.The average age was(61.61±10.26)years old,of which the average age of men was 62.52 years old and that of women was 60.17 years old.The 61-70 age group had the highest proportion of 38.78%.With the increase of age,the proportion of lung cancer patients showed a trend of rise first and then declined.The proportion of female lung cancer patients showed an upward trend,which increased from 35%in 2015 to 42%in 2019.For the occupation of lung cancer patients,farmers had the largest number of patients,accounting for 41.0%of all patients.The proportion of civil servants,staff and workers was low,which was 1.1%,4.8%and 5.6%respectively.2.Among the patients with lung cancer,adenocarcinoma had the largest number,accounting for 56.5%of all patients with lung cancer,and the proportion of adenocarcinoma increased from 48.6%in 2015 to 64.9%in 2019.The proportion of squamous cell carcinoma showed a downward trend,which decreased from 23.6%in 2015 to 16.1%in 2019.The main pathological type of lung cancer patients under 50 years old was adenocarcinoma;the main pathological types of lung cancer patients in the age group of 51-80 years old were adenocarcinoma and squamous cell carcinoma,and the main pathological types of lung cancer patients over 80 years old were adenocarcinoma,squamous cell carcinoma and unclassified carcinoma.Adenocarcinoma was the main pathological type among civil servants and employees;the main pathological types of workers were adenocarcinoma and squamous cell carcinoma,accounting for 56.6%and 19.9%of all workers with lung cancer,respectively;the main pathological types of farmers with lung cancer were adenocarcinoma,squamous cell carcinoma and unclassified carcinoma;the pathological types of freelancers,self-employed workers and retired personnel were mainly adenocarcinoma and squamous cell carcinoma.3.The average hospitalization cost of lung cancer patients showed an upward trend with fluctuation,and the hospitalization cost increased from 41,724.6 yuan in 2015 to 44795.6 yuan in 2019.Among the composition of different types of hospitalization expenses,western medicine accounted for the highest proportion of 26.35%,but the proportion of western medicine expenses decreased year by year,from 30.97%in 2015 to 22.42%in 2019.The proportion of operation expenses and laboratory examination expenses increased year by year.Types of hospitalization expenses in different pathological types accounted for different proportions.The lowest proportion of western medicine expenses was in patients with adenocarcinoma(23.34%),who also havd the highest proportion of operation expenses(18.26%).The proportion of western medicine expenses for patients with small cell carcinoma and unclassified lung cancer was higher,but the proportion of operation expenses was lower.The median total cost of non-first hospitalized patients with lung cancer was 12,203.93 yuan,which was significantly lower than 35176.86 yuan for first hospitalized patients.Among the first hospitalized patients with lung cancer,the median total cost of patients without pathological diagnosis was 12,497.56 yuan,which was significantly lower than that of first hospitalized patients with pathological diagnosis.4.The results of multiple linear regression analysis showed that factors influencing the total hospitalization expenses were the days of hospitalization,operation condition and pathological type in turn.The importance of the factors influencing the days of hospitalization were the operation condition,clinical time and the condition of admission.Operation situation,Clinical time and pathologic types indirectly affected hospitalization cost by influencing the length of stay.5.In the path analysis,the size of the direct path coefficient was hospital stay(0.686),operation situation(0.186),pathologic types(small carcinoma,-0.180),(squamous cell carcinoma,-0.109),occupation(0.064),sex(0.027),and age(0.023).Conclusion1.Most lung cancer patients were in the age group of over 60 years old.There were more male patients than female patients with lung cancer and the proportion of female patients was increasing.2.Among different occupational categories of lung cancer patients,farmers accounted for the highest proportion,while civil servants and employees accounted for a lower proportion.3.Among different pathological types of lung cancer,with the passage of time,the proportion of adenocarcinoma showed an increasing trend,surpassing squamous cell carcinoma as the main histological subtype.Male patients were mainly adenocarcinoma and squamous cell carcinoma,while female patients were mainly adenocarcinoma.4.The proportion of Chinese patent medicine and western medicine in the total hospitalization expenses of lung cancer patients has decreased year by year.The factors influencing the total medical expenses were the length of stay,operation situation and pathological type. |
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