Direct economic burden and influencing factors of pneumoconiosis patients in Nanjing

Objective To describe the direct economic burden of pneumoconiosis patients in Nanjing in 2019 and analyze the influencing factors to provide a basis for formulating relevant prevention and treatment strategies.

Methods Based on the baseline data of pneumoconiosis patients followed up in Nanjing in 2019, the direct economic burden (hospitalization costs, outpatient costs, total costs) of 1 290 pneumoconiosis patients in that year was investigated, and the factors influencing medical costs were analyzed.

Results The median and 25th, 75th percentiles (P₂₅, P₇₅) of age at initial diagnosis of 1 290 pneumoconiosis patients was 50 (45, 56) years, and the median time of occupational dust exposure was 24 (18, 29) years. The median per capita hospitalization cost was ￥14 400 (￥8 100, ￥33 000), the median per capita outpatient cost was ￥15 400 (￥6 000, ￥54 900), and the median per capita total cost was ￥ 21 300 (￥8 700, ￥62 700). Multivariate analysis showed that outpatient costs and total costs were associated with the patients' age at initial diagnosis, the time of occupational dust exposure, and the stage of pneumoconiosis. Compared with cement pneumoconiosis patients, the outpatient costs of silicosis, coal workers' pneumoconiosis, the other types of pneumoconiosis, electric welders' pneumoconiosis, and casting workers' pneumoconiosis patients increased by ￥8 540, ￥12 580, ￥8 050, ￥6 330, and ￥8 570 (in terms of logarithmically transformed values). Outpatient costs of patients at stage Ⅱ and stage Ⅲ were ￥3 800 higher than patients at stage Ⅰ (P < 0.01); for each additional year of age at initial diagnosis, outpatient costs increased by ￥110 (P < 0.05), and for each additional year of occupational dust exposure time, outpatient costs increased by ￥140 (P < 0.01). In terms of total costs, compared with cement pneumoconiosis patients, the total costs of silicosis, coal workers' pneumoconiosis, other types of pneumoconiosis, and casting workers' pneumoconiosis patients increased by ￥6 300, ￥9 400, ￥5 530, and ￥6 280 (in terms of logarithmically transformed values). Total costs of patients at stage Ⅱ and stage Ⅲ were ￥4 320 higher than patients at stage Ⅰ (P < 0.01); for each additional year of age at initial diagnosis, total costs increased by ￥180 (P < 0.01), and for each additional year of occupational dust exposure time, total costs increased by ￥100 (P < 0.05).

Conclusions The per capita outpatient, hospitalization, and total costs were at relatively high levels, with the economic loss issue being more prominent among coal workers' pneumoconiosis patients. Higher age at initial diagnosis, the time of occupational dust exposure, and stage of pneumoconiosis resulted in higher direct economic burdens. Relevant departments should intensify efforts to provide treatment for pneumoconiosis patients, protect their rights, and minimize the medical burden on them as much as possible.