基于分位数回归模型的2型糖尿病足患者住院费用影响因素分析OA
Influencing factors of hospitalization costs in patients with type 2 diabetic foot based on a quantile regression model
目的 从卫生经济学视角,探究2型糖尿病足患者住院费用的异质性分布特征及关键影响因素,为优化糖尿病足分级诊疗策略和医疗资源合理配置提供循证依据.方法 收集山西省人民医院2022-2024年收治的237例2型糖尿病足住院患者资料.采用分位数回归方法在住院费用的10%,50%和90%三个分位数点上对影响因素进行分析,并使用随机森林模型对不同影响因素重要程度进行排序.结果 237例患者平均住院总费用为23 376.43元,平均住院15 d.单因素分析结果显示,年龄、职业、住院天数、治疗效果、Wagner分级、截肢(趾)6个因素各层间的2型糖尿病足住院费用差异有统计学意义(P<0.05);手术次数、换药次数与住院费用呈显著正相关(P<0.001).分位数回归结果显示,住院时间为主要核心驱动因素,Wagner 4～5级是导致中等费用医疗负担加重的关键因素,年龄段40～59岁是驱动极高费用的风险因素,在低至中等费用患者(10%,50%分位点)中,手术次数增加会显著加重其医疗费用(均P<0.05).随机森林模型变量重要性排序依次为:住院时间、手术次数、换药次数、治疗效果、截肢(趾)、职业状态、Wagner分级、年龄.结论 基于分位数回归分析,本研究揭示T2DF患者住院费用呈异质性分布,年龄、住院时间、手术次数、Wagner分级在住院费用的不同分位数点产生影响.
Objective To analyze the influencing factors of hospitalization cost in patients with type 2 diabetic foot based on health economics,thus providing evidence-based support for optimizing hierarchical diagnosis and treatment strategies for diabetic foot and the rational allocation of medical resources.Methods The data of 237 patients with type 2 diabetic foot hospitalized in Shanxi Provincial People's Hospital from 2022 to 2024 were collected.A quantile regression analysis was conducted to examine the determi-nants of hospitalization costs at the 10 th,50 th,and 90 th percentiles of its conditional distribution,and the importance of different influencing factors were ranked using a random forest model.Results The average total hospitalization cost for the 237 patients was 23 376.43 yuan,and the average hospital stay was 15 d.Univariate analysis revealed that age,occupation,length of hospital stay,treatment outcome,Wagner grade,and amputation(toe)status showed statistically significant differences in hospitalization costs for type 2 diabetic foot patients across subgroups(P<0.05).The number of surgery and the frequency of dressing changes were signifi-cantly positively correlated with hospitalization costs(P<0.001).Quantile regression analysis revealed that the length of hospital stay was the primary driver of costs,Wagner grade 4-5 was a key factor in increasing the financial burden for patients with median-level expenses,while the age of 40-59 years was a risk factor for extremely high costs.An increased number of surgical procedures signifi-cantly raised medical expenses in patients with low to median costs(10 th,50 th percentiles)(all P<0.05).The variable importance was ranked by random forest model as follows:hospitalization duration,number of operations,dressing change frequency,treatment efficacy,amputation(toe),employment status,Wagner grade,and age.Conclusion Based on quantile regression analysis,this study reveals that the hospitalization costs of patients with T2DF exhibit a heterogeneous distribution.Age,length of hospital stay,number of surgical procedures,and Wagner grade exert varying influences at different quantiles of hospitalization costs.
罗茜;张慧芳;郭钊;张祥祥;任超;武嘉乐;贾中伟
山西医科大学公共卫生学院劳动卫生教研室,太原 030001山西医科大学公共卫生学院劳动卫生教研室,太原 030001山西医科大学第五临床医学院山西医科大学第五临床医学院山西医科大学第五临床医学院山西医科大学第五临床医学院山西医科大学第五临床医学院||山西省人民医院骨科
医药卫生
2型糖尿病足卫生经济学住院费用分位数回归随机森林影响因素
type 2 diabetic foothealth economicshospitalization costsquantile regressionrandom forestinfluencing factors
《山西医科大学学报》 2026 (2)
193-200,8
山西省基础研究计划项目(202103021224367)山西省医学重点科研项目(2023XM049)山西省卫生健康委科研课题计划项目(2023034)
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