Economic Burden of Major Diseases in China in 2013 - Frontiers

The majority of studies focus on the economic burden of a single or regional disease; however, holistic or national research is rare in China. DownloadArticle DownloadPDF ReadCube EPUB XML(NLM) Supplementary Material Supplementaldata totalviews ViewArticleImpact SHAREON YonghongPeng ManchesterMetropolitanUniversity,UnitedKingdom JiangboPu InstituteofBiomedicalEngineering,ChineseAcademyofMedicalSciencesandPekingUnionMedicalCollege,China YUEHUANG JinanUniversity,China Theeditorandreviewer'saffiliationsarethelatestprovidedontheirLoopresearchprofilesandmaynotreflecttheirsituationatthetimeofreview. Abstract Introduction Methods Results Discussion Conclusion DataAvailabilityStatement AuthorContributions ConflictofInterest Acknowledgments References Opensupplementaldata Exportcitation EndNote ReferenceManager SimpleTEXTfile BibTex Checkforupdates Peoplealsolookedat ORIGINALRESEARCHarticle Front.PublicHealth,19May2021Sec.DigitalPublicHealth https://doi.org/10.3389/fpubh.2021.649624 EconomicBurdenofMajorDiseasesinChinain2013 XianyanSong1,LanLan2*,TingZhou3,JinYin2andQiongMeng4* 1InstituteofHospitalManagement,WestChinaHospital,SichuanUniversity,Chengdu,China 2WestChinaBiomedicalBigDataCenter,WestChinaHospital,SichuanUniversity,Chengdu,China 3DepartmentofEpidemiologyandBiostatistics,WestChinaSchoolofPublicHealthandWestChinaFourthHospital,SichuanUniversity,Chengdu,China 4DepartmentofEpidemiologyandHealthStatistics,SchoolofPublicHealth,KunmingMedicalUniversity,Kunming,China Studiesontheeconomicburdenofdisease(EBD)canestimatethesocialbenefitsofpreventingorcuringdisease.Themajorityofstudiesfocusontheeconomicburdenofasingleorregionaldisease;however,holisticornationalresearchisrareinChina.EstimatingthenationalEBDcanprovideevidenceforpolicymakers.Weusedthetop-downmethodtoassesstheeconomicburdenof30typesofdiseasesbetweenurbanandruralareasinChina.Thetwo-stepmodelwasusedtoevaluatethedirecteconomicburdenofdisease(DEBD),whilethehumancapitalmethodwasusedtoassesstheindirecteconomicburdenofdisease(IEBD).Thetotaleconomicburdenof30typesofdiseasesinChinawasbetween$13.39and803.00billionin2013.Theaveragetotaleconomicburdenofdisease(TEBD)incitieswas$81.39billion,whilediseasesinvillagesaccountedfor$50.26billion.TherangeofdirectandindirectEBDwas$5.77–494.52billion,andtherangeinurbanareaswas$0.61–20.34billion.ThedirectandindirectEBDinruralareasaccountedfor$5.88–277.76billionand$0.59–11.39billion,respectively.Therewasalargedifferencebetweentheeconomicburdenofdifferentdiseases.Theeconomicburdenofurbandiseaseswasmoresignificantthantheburdenfortherural.Thetopfivemosteconomicallyburdensomediseasesweremyocardialinfarctioncoronaryarterybypass,acutemyocardialinfarction,cerebralhemorrhage,acuteuppergastrointestinalbleedingandacuteappendicitis. Introduction Therapiddevelopmentoftheeconomyhasimprovedlivingandnutritionalstandards.Simultaneously,ithashadalargeeffectonchangingthespectrumofdiseasesinChina(1,2).Chronicnon-communicablediseasesarecurrentlytheprevailingdiseases,increasingnumberofpeoplepayingmoreattentiontotheirhealth.Furthermore,thestudyoftheeconomicburdenofdisease(EBD)canhelpestimatethesocialbenefits,resultinginthepreventionorcureofdisease,andcanprovideinformationrelatedtotheeconomicevaluationofdisease(3–6).Moreimportantly,thistypeofresearchoffersascientificbasisforlimitedmedicalinsuranceandarationalallocationofhealthresources. ChinaintroducedanewmedicalsystemreformpolicyonMarch17,2009.Themainpurposeofthenewpolicywastosolvetheproblemsthatmadeitdifficultandexpensiveforpatientstovisitadoctor.Thenewpolicyhasdecreasedthedamageonpatients'bodiesandthelosstosocietycausedbyillnesses.However,ifthemaindiseasecanbepreventedbyimplementingcertaininterveningmeasureswithlimitedhealthresources,injuriesandlossesforindividuals,familiesandsocietiesthatarecausedbythediseasecanbeavoided.DuetoChina'suniqueeconomicdevelopment,thereisgreateconomicdisparitybetweenurbanandruralareasinChina,whichhasgreatlyaffectedtheconstituentofthediseaseandthetreatmentoptionsthatareavailabletoresidentslivingbetweenurbanandruralareas.Themajorityofresearchesoneconomicburdenhasmostlyfocusedonasinglediseaseorlocalizeddiseases(7–11),butanintegratedstudyofmultiplediseasesisrareinChina.Recentstudiesonlyestimatedtheeconomicburdenoflungcancer(12),seasonalinfluenza(13),chronicdiseases(14),childrenwithasthma(15)andAlzheimer'sdisease(16)inChina,andtheeconomicburdenofAlzheimer'sdiseaseinZhejiangProvince(17),hepatitisE-infectedpatientsinJiangsuProvince(18)andrarediseasesinShanghai(19)etc.Therefore,weintendtoestimatetheoverallEBDandthen,toseparatelymeasuretheEBDbetweenurbanandruralareasinChinainordertoprovideevidenceforrelevantpolicymakers. Methods Weusedatop-downapproachtoestimateEBDinChina.Thetop-downapproach(6)findsnationalorregionaltotalhealthexpendituresinadvance,relyingontheexistingsystemforinformationonhealthexpenditures.Then,thevariousexpensesareclassified,suchashospitalizationcosts,outpatientandemergencycosts,drugcosts,etc.,basedonacertainpercentagecorrespondingtotheallocationofitemsusedtotargetdisease.Lastly,theaveragecostofindividualorvariousdiseasesiscalculated. DataCollection TheAnalysisReportofNotionalHealthServicesSurveyinChina2013(ARNHSS)providedconsultationratesdatafor2weeks,categorizedbythediseasesandhospitalizationratesandconstituentratioofoutpatientandinpatientinstitutionsin2013.TheChinaHealthandFamilyPlanningStatisticalYearbook2014(CHFPSY)providedthedatafortheaverageoutpatientcosts,hospitalizationcostsandthelengthofstaybydiseasesatdifferenthospitallevelsandthetotalnationalhealthexpenditurein2013.TheChinaStatisticalYearbook2014(CSY)providedtheurbanandruralpopulationnumbersandtheGrossDomesticProduct(GDP)datain2013. Every5years,theChinesegovernmentconductsthenationalhealthservicessurvey,whichisaspecialsamplesurvey,inordertounderstandtheurbanandruralresidents'healthstatus,healthcareutilization,healthcarecostsandburdenonthecountry.In2013,thefifthnationalhealthservicessurveyadoptedmulti-stagestratifiedclusterrandomsampling.Thesamplecovered31provinces,156counties,780townsand1,560villages.Itcollecteddatafromatotalof93,600families,whichis~30millionpeopleandisagoodrepresentativesampleofChina.ThedatafromCHFPSYandCSYwerereportedbytheadministrativeagencythatishighlycredibleandknownforhighqualitywork.Furthermore,inordertoobtainaconsistentstatisticalcaliber,eachanalyticalindexinCHFPSYwasascloselymatchedaspossiblewithARNHSSinChina. ResearchDisease Weselected30typesofdiseasesfromCHFPSYforthisstudytoestimatetheirdirectandindirecteconomicburdenbecausetheclassificationofdiseasesdidnotpreciselymatchbetweenCHFPSYandARNHSSinChina.Additionally,theCHFPSYclassificationofdiseaseswascodedaccordingtoICD-10.Therefore,itcanbededucedthatdataintegrationwasinprocess.Firstly,welistedthe30typesofdiseasesfromCHFPSY2014,andthenwematchedthenameofthediseasewithARNHSSinChina2013.Ifwecouldnotfindtheexactsamenameofthedisease,weclassifiedthediseasesintorelatedsystemsaccordingtothesystemsofdiseasesormainsymptoms.Iftheystilldidnotmatchusingthismethod,thediseasewasclassifiedasmissing. DirectEconomicBurdenofDisease(DEBD) DEBDreferstothetotaldirectcostsforthepreventionandtreatmentofdiseases,includingvariouscostsincurredbytheindividual,familyandsocietyforpreventing,diagnosing,treatingandrehabilitatingthediseasesandinjuries(20).Ontheonehand,itincludesthecostsofhealthservicesprovidedbythehealthinstitutions,suchasthepreventionofcapitalcosts,emergencyexpenses,outpatientdiagnosisandtreatmentcosts,hospitalexpenses,medicalexpenses,healthtechnologylabor,familybedtreatmentandcarecosts,etc.Ontheotherhand,otherchargespaidbythepatientswhilereceivinghealthservicesareincluded,suchasnutritionfees,transportationfees,travelexpenses,non-prescriptioncostsforpurchasingrehabilitationequipment,etc.Weestimatedthedirecteconomicburdenof30typesofdiseases,includingoutpatientmedicalexpensesandinpatientmedicalexpensesonlybecausewedon'thavenon-medicalexpenses.Theformulaisasfollows: DEBDi=N×[2-weekconsultationrate×26×(Σoutpatientfacilitiesconstituentratio×averageoutpatientmedicalcostinoutpatientinstitutionsatdifferentlevels)+hospitalizationrate×(Σinpatientfacilitiesconstituentratio×averagehospitalizationmedicalexpenseininpatientinstitutionsatdifferentlevels)](1) Intheaboveformula,DEBDiisthedirecteconomicburdenfortheclassidisease,andNisthenumberofpeopleintheresearchpopulation. IndirectEconomicBurdenofDisease(IEBD) IEBDreferstoasocietyandfamily'slossbetweenthecurrentvalueandfuturepotentialvalueduetoillnessthatmayresultinthereductionofeffectiveworkingtimeandtheabilitytowork(21).Thisisalsoknownasindirectcosts.Indirectcostsrepresentthevaluegivenbysocietytohealthandlife.Whileitbroadlyincludessocialproductivitylosses,lossesofincome,lossesofhousework,employmentcosts,trainingcosts,insurancecosts,managementcosts,etc.,indirectcostsindicatethelossofproductivityinthisnarrowsense.Weusedthehumancapitalapproach(22)toestimatetheindirecteconomicburdenof30typesofdiseasesandcalculatetheeconomiclossofmissedworkingtimeduetohospitalization.Theformulaisasfollows: IEBDi=N×hospitalizationrate×(Σinpatientfacilitiesconstituentratio×averagehospitalizationdaysininpatientinstitutionsatdifferentlevels)×GDP/365(2) Intheaboveformula,IEBDiistheindirecteconomicburdenfortheclassidisease,andNisthenumberofpeopleintheresearchpopulation. Results DEBD Weweightedtheaverageoutpatientmedicalcoststhatwerenotcausedbydiseaseaccordingtotheconstituentratiooffirstdiagnosismechanismforurbanoutpatientsover2weeks.Theproportionsofaverageoutpatientmedicalcostsintertiary,secondaryandprimaryhospitalswere14.46,18.18,and67.36%,respectively.In2013forurbanpatients,therewere16.04%distributedintertiaryhospitals,69.28%distributedinsecondaryhospitals,and14.68%distributedinprimaryhospitals.Thisdistributionwasusedtoweightheaveragemedicalcostsofhospitalization.Chinahadapopulationof731.11millionurbanresidentsin2013.Theresultoftheoutpatientcosts,hospitalizationcostsandDEBDinurbanChinaareshowninTable1,whichisbasedonFormula(1).ThelargestDEBDinurbanareaswasmyocardialinfarctioncoronaryarterybypass(MICAB),andthesecondlargestwasacutemyocardialinfarction(AMI),whilethesmallestDEBDwasprimarynephroticsyndrome(PNS). TABLE1 Table1.Directeconomicburdenof30typesofdiseasesinurbanareasinChinain2013. Similartothemethodusedtoprocessurbanmedicalcosts,weweightedtheaverageruraloutpatientmedicalcosts.Asaresult,theproportionsofaverageruraloutpatientmedicalcostsintertiary,secondaryandprimaryhospitalsforruraloutpatientswere2.53,16.31,and81.16%in2013,respectively.In2013,therewere13.11%ofruralinpatientsdistributedintertiaryhospitals,56.61%distributedinsecondaryhospitals,and30.28%distributedinprimaryhospitals.Chinahadaruralpopulationof629.61millionresidentsin2013.Theresultoftheoutpatientcosts,hospitalizationcostsandDEBDinruralChinaareshowninTable2,whichisbasedonFormula(1).ThelargestDEBDinruralareaswasMICAB,andthesecondlargestwasacuteuppergastrointestinalbleeding(AUGIB),whilethesmallestDEBDwasPNS. TABLE2 Table2.Directeconomicburdenof30typesofdiseasesinruralareasinChinain2013. IEBD WeweightedaveragehospitalizationdaysbydiseasebasedontheconstituentratioforChina'surbaninpatientsin2013.TheGDPpercapitawas$6,807inChinain2013.TheindirecteconomiclossesofurbanpatientscausedbyhospitalizationareshowninTable3,whichisbasedonFormula(2).ThelargestIEBDinurbanareaswasMICAB,whichwasfollowedbycerebralhemorrhage(CH),andthesmallestIEBDwasaplasticanemia(AA). TABLE3 Table3.Indirecteconomicburdenof30typesofdiseasesinurbanareasinChinain2013. Similartothemethodusedfordealingwithurbanpatients'data,weweightedaveragehospitalizationdaysbydiseasetoobtainruralpatients'hospitalizationdaysbydisease.TheindirecteconomiclossesofruralpatientsduetohospitalizationaredemonstratedinTable4,whichisbasedonFormula(2).ThelargestIEBDinruralareaswasCH,whichwasfollowedbyMICAB,andthesmallestIEBDwasAA. TABLE4 Table4.Indirecteconomicburdenof30typesofdiseasesofruralareainChina,2013. TotalEconomicBurdenofDisease(TEBD) ThetotalhealthexpenditureofChinain2013was$517.64billion.Thetopfivediseasesamong30typesofdiseasesthathadtheheaviestTEBDbasedontheproportionintotalhealthexpenditurewereMICAB(15.51%),AMI(5.67%),CH(5.11%),AUGIB(5.01%)andacuteappendicitis(AAs)(4.45%).ThelastfivediseasesthathadthesmallestTEBDwereAA(0.26%),PNS(0.26%),acuteleukemia(AL)(0.41%),infiltrativepulmonarytuberculosis(IPT)(0.43%)andviralhepatitis(VH)(0.46%).TheaverageTEBDforcitieswas$81.39billionandforthevillageswas$50.26billion,respectively.Thetotaleconomicburdenof30typesofdiseasesinurbanandruralareasinChinaisshowninTable5. TABLE5 Table5.Totaleconomicburdenof30typesofdiseasesinChinain2013. Discussion ThisstudyintegrallyestimatedtheEBDofChina.TheTEBDwasbetween$13.39and803.00billion,whichincluded30typesofcommondiseasesinChina.Thisaccountedfor2.54%oftheaverageproportionofthenationaltotalhealthexpenses;although,thehighestproportionwas15.51%.Thisproportionisenoughtocaptureourgovernment'sattention.TheDEBDofcitieswas$5.77–494.52billion,whiletheDEBDofvillageswas$5.88–277.76billion.TheIEBDforcitizenswas$0.61–20.34billion,andtheIEBDfortheruralpopulationwas$0.59–11.39billion.Whetherincitiesorcountryside,theDEBDwasmuchhigherthantheIEBD. TheDEBD,IEBD,andTEBDofVH,IPT,andPNSinurbanareaswereslightlylowerthanthoseinruralareas;however,theresidualEBDof27typesofdiseasesforthecitieswerehigherthanthoseforthecountryside.Interestingly,thelargestdifferencefortheEBDofMICABbetweenurbanandruralareas,whichexceeded$226.72billionforTEBD,wasarelativelylargedifferenceforDEBDbutaslightdifferenceforIEBD.Thereisapossibleexplanationforthisdifference.OnepossiblereasoncouldbethatthereweremoreMICABpatientsincitiesthaninthecountrysidebecauseruralpatientsfailedtovisitadoctorbecausetheywereworriedaboutincurringexpensivemedicalbills. TheEBDhadalargedifferenceamongdifferentdiseases.Theaveragetotaleconomicburdenof30typesofdiseaseswas$131.65billioninChina.ThelargestfivediseasesforTEBDwereMICAB,AMI,CH,AUGIB,andAAs.ThesmallestfivediseasesforTEBDwereAA,PNS,AL,IPT,andVH.ThemiddlepositionforTEBDwasheldbymalignanttumors. Itisimportanttonotethatthisstudyhassomelimitations.Thefollowingcostsorintangibleeconomicburdenswerenottakenintoconsiderationbecauseoflimiteddata:selfpurchasedmedicalfees,thecostoftimeinbed,andcostofrecoverytimeathome.Additionally,wecouldnotmeasuretheproductionvalueofthelossoflifeduetoprematuredeathandthelossofproductionvalueduetolong-termdisabilitycausedbyillnessordisability,whichwilllikelyresultinunderestimatingtheEBD.Themisclassificationofthediseasesmayalsoresultinerrors. Conclusion TheEBDreflectstheburdencausedbyillnessforasociety.IfwecanreduceoreliminateEBD,socioeconomiclosseswilldecrease,andoursocietywillbenefit.However,policymakersmustmakeallocationswithlimitedresources.Therefore,thispaperprovidessoliddataandresearchforpolicymakerstomakeinformeddecisions.Overall,therewasalargedifferenceintheeconomicburdenofdifferentdiseases,andthetotaleconomicburdenofurbanpatients'diseasewaslargerthanthatofruralpatients.Thetoptendiseasesweremyocardialinfarctioncoronaryarterybypass,acutemyocardialinfarction,cerebralhemorrhage,acuteuppergastrointestinalbleeding,acuteappendicitis,prolapseoflumbarintervertebraldisc,chronicpulmonaryheartdisease,cerebralinfarction,benignprostatichyperplasiaandcongestiveheartfailure. DataAvailabilityStatement Publiclyavailabledatasetswereanalyzedinthisstudy.Thisdatacanbefoundhere:http://www.stats.gov.cn/,http://www.nhc.gov.cn/. AuthorContributions LLandQMcontributedtothedesignofthestudyandprojectmanagementandcontributedtothefinalinterpretationofdata.XSwastheleadqualitativeresearcheranddesignedtheprocessevaluation.QMdevelopedthecodingframeworkwithLLandTZ.CodingandinitialdatainterpretationwasperformedbyLL,TZ,andJY.ThefirstdraftofthemanuscriptwasproducedbyXSandLL.Allauthorscriticallyreviewedandeditedthedraftpaper,readandapprovedthefinalmanuscript. ConflictofInterest Theauthorsdeclarethattheresearchwasconductedintheabsenceofanycommercialorfinancialrelationshipsthatcouldbeconstruedasapotentialconflictofinterest. Acknowledgments WethankNationalNaturalScienceFoundationofChina(No.81960617). 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Editedby:YonghongPeng,ManchesterMetropolitanUniversity,UnitedKingdom Reviewedby:YueHuang,JinanUniversity,ChinaJiangboPu,ChineseAcademyofMedicalSciencesandPekingUnionMedicalCollege,China Copyright©2021Song,Lan,Zhou,YinandMeng.Thisisanopen-accessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense(CCBY).Theuse,distributionorreproductioninotherforumsispermitted,providedtheoriginalauthor(s)andthecopyrightowner(s)arecreditedandthattheoriginalpublicationinthisjournaliscited,inaccordancewithacceptedacademicpractice.Nouse,distributionorreproductionispermittedwhichdoesnotcomplywiththeseterms. *Correspondence:QiongMeng,[email protected];LanLan,[email protected] ThisarticleispartoftheResearchTopic Data-EnabledIntelligenceforMedicalTechnologyInnovation,VolumeI Viewall 17Articles Peoplealsolookedat Download