Page 37 - 中国全科医学2022-13

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2.Guiyang Public Health Treatment Center，Guiyang 550004，China
3.Shangqiu Center for Disease Control and Prevention，Shangqiu 476100，China
4.Beijing Youan Hospital，Capital Medical University，Beijing 100069，China
5.Hefei Infectious Hospital，Hefei 230022，China
*
Corresponding author：LIU Min，Professor，Doctoral supervisor；E-mail：liumin@bjmu.edu.cn
【Abstract】 Background The promotion of use of antiretroviral therapy（ART） prolongs the life expectancy of
people living with HIV. But age-related diseases are increasingly common，and the risks of opportunistic infections，coinfections
and poor health condition are also increased significantly in this group，resulting in high medical costs and heavy economic
burden. However，there are few studies on the household economic burden of HIV/AIDS patients. Objective To investigate
the household economic burden in HIV/AIDS patients and associated factors in four regions（Beijing，Henan，Guizhou and
Anhui） of China. Methods From December 2020 to May 2021，by use of typical sampling，three medical institutions（one in
Beijing，another in Guizhou and another in Anhui），and a center for disease control and prevention（located in Henan） were
selected，where HIV/AIDS patients who received health services in 2020 were chosen by convenient sampling. A questionnaire
developed by our research team was used to collect information on the patients' sociodemographic and economic features，
disease-related conditions，and treatment. Household economic burden was defined as ratio of out-of-pocket medical expenses
to annual household income（OME/AHI） in 2020 exceeded 25%. Results A total of 1 446 patients were included. The patients
were classified into two major groups by the OME/AHI ratio：≤ 1% group（n=400，27.7%），and >1%-5% group（n=418，
28.9%）. Two hundred and thirty-seven cases（16.4%） had household economic burden. The prevalence of household economic
burden differed significantly by region，sex，age，marital status，education level，occupation，urban or rural hukou，floating
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or permanent population，type of medical insurance，annual household income level，route of infection，CD 4 T cell count
level，and type of medical treatment（P<0.001）. Stepwise multinomial Logistic regression analysis revealed the following：
women had higher risk of household economic burden than men〔OR（95%CI）=1.729（1.050，2.853）〕；Sixty-five-
year-olds and above had higher risk of household economic burden than 18-24-year-olds〔OR（95%CI）=3.445（1.188，
10.227）〕；The divorced had higher risk of household economic burden than those unmarried〔OR（95%CI）=2.241（1.073，
4.678）〕；Public institution employees had lower risk of household economic burden than housekeepers，jobseekers，or
those unemployed〔OR（95%CI）=0.287（0.081，0.898）〕；Individuals with low〔OR（95%CI）=29.614（12.348，
79.211）〕 or low-to-middle annual household income〔OR（95%CI）=3.556（1.471，9.428）〕 had higher risk of
household economic burden compared with those with high annual household income；Heterosexual individuals had lower risk of
household economic burden than homosexual individuals〔OR（95%CI）=0.356（0.186，0.670）〕；ART non-recipients had
lower risk of household economic burden than ART recipients〔OR（95%CI）=0.241（0.055，0.835）〕；Individuals with
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CD 4 T cell count 201-350 cells/μl〔OR（95%CI）=2.347（1.237，4.515）〕 or ≤ 200 cells/μl〔OR（95%CI）=2.365
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（1.200，4.702）〕 had higher risk of household economic burden compared with those with CD 4 T cell count >500 cells/μl；
Inpatient service recipients〔OR（95%CI）=12.492（5.592，27.818）〕，and both outpatient and inpatient services recipients
〔OR（95%CI）=23.69（14.519，39.933）〕 had higher risk of household economic burden compared with outpatient service
recipients. Conclusion HIV/AIDS patients had relatively low OME/AHI ratio generally，but some of them had household
economic burden. Factors associated with household economic burden may include sociodemographic and economic factors such as
sex，age，marital status，occupation，annual household income，and features related to HIV/AIDS and treatment such as route
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of infection，use of ART treatment，CD 4 T cell count level，and type of medical treatment. To tangibly reduce the household
economic burden of in this group，more attention should be paid to women，the elderly，those with very poor condition or low
annual household income. Besides，it is essential to continue to implement and improve relevant medical insurance policies.
【Key words】 Acquired immunodeficiency syndrome；HIV；Cost of illness；Root cause analysis

2020 年我国新报告发现 HIV 感染者 6.22 万例，报 于抗艾滋病病毒药物的副作用、反复出现的合并感染，
［1］
告死亡数达1.88万，死亡人数居40种法定传染病首位 。 以及随着年龄增长而出现的慢性病等，患者长期护理的
我国自 2004 年开始实行“四免一关怀”政策，给予 费用仍然较高，家庭经济负担较重 ［3-6］ 。目前，我国
HIV/AIDS 患者免费的抗艾滋病病毒治疗（antiretroviral 有关 HIV/AIDS 患者家庭经济负担及其影响因素的研究
therapy，ART）。此后，我国相继出台有关的减免或救 较少，现存研究多为地方性研究且存在时间滞后性，无
助政策，减轻了 HIV/AIDS 患者的经济负担 ［2］ 。但由 法展现患者家庭经济负担的现状 ［7-8］ 。因此，为了解