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Title

基於 ICD-10 的中國基層醫療機構疾病分佈的現況研究

English Abstract

Research Background: Distribution of disease is a group phenomenon of disease affected by pathogenic factor, population characteristics, natural and social environment. The difference of diseases distribution is also obvious in China rural area. Due to the territoriality and time-based trait, distribution of disease should be updated in time, in order to adapt to the market development planning of the modern medical health and meet the social demand of healthcare. Objective: To analysis the diseases patterns of a county hospital in Shanxi province by using International Classification of Diseases ; To give advice for the further development of regional diseases patterns and the related policy in China. Methods: Guided by the relevant theories of the Tenth Revision of the International Classification of Diseases (ICD-10), we used the medical record data from in-patients’ front sheet of a county hospital in Shanxi province, coded the clinical diagnosis on discharge in terms of ICD-10, and evaluated the diseases patterns and distribution of this hospital in varies aspect. Result: All-inpatients in this hospital from 2008-2013 is 40385, Sex ratio is 1:1.21. 25- 34 years old patients accounted as the largest share 21.26% of the number of hospitalized cases, followed by the age group above 65 and 15-24 years old, the least number of age group is 6-14, only accounted for 4.15% of total number of cases. 19 categories of diseases is contained during the 6 years in-patients cases. Pregnancy, childbirth and the puerperium has 10485 cases, accounted 25.97% of the total number, Males advantage classification is Injury, poisoning and certain other consequences of external causes, females is Pregnancy, childbirth and the puerperium. Different age groups has significant difference in diseases distribution. The cases’ number of Cerebral infarction, Chronic obstructive pulmonary disease and Uterus scar are growing with time, but Noninfective enteritis and colitis are decreasing. The distribution of top 10 diseases has significant difference in different gender. The difference of distribution of disease in different age groups is significant. Conclusion: In 2008-2013, the overall trend of hospital inpatients disease composition remains stable ; male and female sex ratio of inpatients is 1:1.21, the age group of 25- 34 has the most inpatients cases, and the least number of cases age group is 6-14 years ; The ratio of Pregnancy, childbirth and the puerperium, Injury, poisoning and certain other consequences of external causes is near 50% of the total of inpatients cases; Age groups constitute a significant difference compared each other; With the increasing vi proportion of chronic non-infectious diseases, the inpatients cases mostly distributed in middle-aged and elderly population.

Chinese Abstract

研究背景:疾病分佈(distribution of disease)是指通過觀察疾病在人群的中發 生、發展和消退,描述疾病不同時間、不同地區和不同人群中的頻率與分佈的 現象。疾病的分佈是疾病的群體現象,它是動態的,隨時間、地點、人群變化 並受致病因數、人群特徵、自然和社會環境的影響而經常變動。疾病在我國基 層地區的分佈差異同樣較為明顯。鑒於疾病分佈具有地域性和時效性,應及時 跟進區域內疾病分佈的最新情況,為制定適應現代醫療市場的衛生發展規劃, 滿足社會對醫療衛生總需求提供科學依據。 研究目的:本研究通過對山西省某縣級醫院疾病分佈的實證研究,為區域疾病 譜的制定和更新以及衛生決策提供資料支援和參考。 研究方法:以國際疾病分類的相關理論為指導,對我國使用 ICD-10 的現狀進行 系統的文獻綜述;根據山西省某縣級醫院住院病人病案首頁相關數據,依照 ICD-10 對出院診斷進行編碼,根據 ICD-10 編碼將住院患者進行三級分類,用 EXCEL 和 SPSS 統計整理分類數據,並從性別和年齡別上的病種分佈情況評價 該院住院病人疾病分佈的現狀。 研究結果:山西省某縣級醫院住院病人疾病分類的實證研究結果: 該院 2008-2013年住院病人總數為 40385,男女性別比約為 1:1.21,25-34歲的住 院病例數占最大比重 21.26%,其次是 65 歲以上的老人和 15-24 歲年齡段,分別 占總病例數的 15.82%和 15.63%。住院病例數最少的年齡段是 6-14 歲,僅佔總 病例數的 4.15%;病人住院天數多集中在兩周之內,占總數的 86.14%,其中住 院 4-7 天最多,占總數的 35%,其次為住院 1-3 天,占 30%;六年間就診的住院 病人幾乎全部為自費患者和農村合作醫療患者,居民醫保和市級醫療保險患者 僅有不到 100 人。 6 年間住院系統疾病分類共 19 類,病種數 2310,。病例數前五類疾病分別為妊娠 分娩與產褥類疾病、損傷中毒與死亡的外因類疾病、循環系統疾病、呼吸系統 疾病和消化系統疾病。妊娠、分娩及產褥類病例數為 10485 例,占總病人數的 25.97%,損傷中毒類病例數為 8419 例,占總病人數的 20.85%;男性優勢分類 為損傷中毒及疾病和死亡的外因,女性則為妊娠分娩與產褥類疾病;不同年齡 別疾病分佈呈現較大的差異。 iv 病種分佈中該院住院病人前十位病種為單胎順產、支氣管肺炎、腦梗塞、冠狀 動脈粥樣硬化性心臟病、慢性阻塞性肺疾病、顱內損傷、腹股溝疝、腦出血、 子宮瘢痕、非感染性胃腸炎和結腸炎;腦梗塞、慢性阻塞性肺疾病、子宮瘢痕 三類疾病隨著時間的推進增長明顯,非感染性胃腸炎和結腸炎則逐年減少;性 別特徵性的疾病,除去性別特有性疾病外,前十位單病種病例數男性均多於女 性;各病種在不同年齡段的分佈差異明顯。 研究結論:2008-2013 年間該院住院患者疾病構成總體趨勢平穩;住院患者男女 性別比為 1:1.21,病例數最多的年齡段為 25-34歲,最少為 6-14歲;住院患者中 妊娠分娩與產褥期疾病和損傷中毒類疾病構成比總和接近 50%;各年齡段之間 疾病構成差別明顯,老年患者常見病慢性病多見,兒童患者呼吸系統疾病較為 多見;慢性非傳染性疾病占比逐年增多,多分佈在 55 歲以上中老年人群。\ 關鍵詞:疾病分佈,縣級醫院,國際疾病分類,疾病編碼

Issue date

2015

Author

趙茜

Faculty

Institute of Chinese Medical Sciences

Degree

M.Sc.

Subject

Diseases -- Classification

疾病 -- 分類

Health facilities -- China

醫護保健之設施 -- 中國

Medicinal Administration -- Institute of Chinese Medical Sciences

醫藥管理 -- 中華醫藥研究院

Supervisor

卞鷹

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