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Prevalence of preference of mother for non-national immunization program vaccines in Chongqing

Introduction

Topics

mother of newborns，non-Immunization Program Vaccine, Preference

Project Description

1) To track maternal changes in awareness, attitudes, and knowledge of non-NIP vaccines, and the perceived threat of related diseases and vaccines, as well as to investigate the longitudinal interplay among perceived threat, attitudes towards vaccines, and vaccination behavior.

2) To explore the relationship between maternal preferences for non-NIP vaccines and the financing, organization, and delivery of non-NIP vaccine services.

3) To investigate social determinants associated with child vaccination patterns, particularly among socially vulnerable or marginalized groups.

* To understand the effects of social networks on vaccine information dissemination and the relationships between the characteristics of networks and maternal beliefs.

* Is there a resource dilution in vaccination in families with more than one child? How does the gender of children interact with the size of the family and influence parental beliefs and vaccination behaviors?

Research Area

Chongqing, China

Project Goal

This study aims to investigate and track the preferences of mothers of 2-month-old newborns in Chongqing, China, for several non-NIP vaccines, and the actual vaccination practices. It also explores health systems and social determinants that impact accessibility, availability, acceptability, and affordability of non-NIP vaccines, to provide evidence-based policy suggestions to enhance the coverage and administration of non-immunization schedule vaccines.

Period

Start: 2023-11-10
End: 2025-02-28

Progress

December 2023 – January 2024: Organize on-site training and conduct a first-round questionnaire survey and qualitative research on mothers of 2-month-old infants.

Project Team(s)

Duke Kunshan University Long Qian and Wang Yu Research Team

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Contact

QUICK LINKS

2024 © Innovation Lab for Vaccine Delivery Research
苏ICP备16021093号
Duke Kunshan University Long Qian and Wang Yu Research Team

团队所在单位介绍

The Global Health Research Center (GHRC) was established in 2013 and co-founded by Duke Kunshan University and the Duke Global Health Institute. Our mission is to improve health and promote health equity in China and globally.

GHRC is built on the principles of scientific excellence and focuses on establishing interdisciplinary, mutually beneficial collaborations with researchers from China. We aim to conduct high-quality research that leads to informed policy-making and innovative approaches to health challenges at local and global levels. Ultimately, we strive to make contributions to achieve the national goals identified in Healthy China 2030 and other Chinese policies, and the health-related Sustainable Development Goals such as universal health coverage, health system strengthening, and infectious and NCD risk reduction globally.

团队成员

龙倩
Qian Long

Qian Long, Associate Professor of Global Health, Duke Kunshan University. Her research interest and experience center on health equity in health systems development (with a focus on health financing and health services organization and delivery), including maternal and child health, tuberculosis control, and non-communicable disease management in poor areas and among vulnerable groups in China and other low- and middle-income countries. Before joining Duke Kunshan University, she worked in the Department of Reproductive Health and Research, at the World Health Organization, based in Geneva, for over two years. She also actively participates in various academic association exchanges and is currently a member of the International Exchange and Cooperation Sub-Committee of the Chinese Antituberculosis Association. She has provided technical advice to the Jiangsu Provincial Health Commission, the Center for Health and Information Statistics of the National Health Commission, and the World Health Organization. Dr. Long Qian received her Master of Public Health degree from the Royal Tropical Institute in the Netherlands and her Doctor of Medical Science degree from the University of Helsinki, Finland. In the past 15 years, she has participated in and managed more than 20 international collaborative projects, mainly funded by the World Health Organization (WHO), the European Commission INCO programme, the Academy of Finland, the Gates Foundation, etc. Dr. Qian Long has published 70 peer-reviewed academic papers in international journals, mainly in first-class journals in her research area, including Lancet Public Health, Bulletin of the World Health Organization, PLoS Medicine, etc.

王宇
Yu Wang

Dr. Yu Wang is an Assistant Professor of Sociology at Duke Kunshan University. She received her BS and MS in Sociology from Renmin University and her MS and PhD in Sociology from the University of Wisconsin-Madison (2017). Her research focuses on the role of intermarriage and individual achievement as pathways to social mobility and work and family conflicts in China. A second line of her research focuses on social determinants of health. Her current projects are about the interaction between demographic changes and assortative mating in contemporary China and the relationship between family and child vaccinations in China. Her articles have appeared in journals, such as Research in Social Stratification and Mobility, Social Science Research, the American Journal of Public Health, and Contraception.

团队近5年具有代表性的成果​

Long Q, Jia YF, Li JL, Lou ZX, Liu YG. National Basic Public Health Services Programme in China: Case study (ISBN (WHO) 978-92-4-007781-2 (electronic version); ISBN (WHO) 978-92-4-007782-9 (print version)). 2023; World Health Organization and the Organisation for Economic Co-operation and Development (in English).

Jia YF, Jiang WX, Yang BL, Tang S, Long Q. Cost drivers and financial burden for cancer-affected families in China: a systematic review. Current Oncology 2023;30:7654-7671.

Li Z, Jia Y, Parshley I, Zhang Y*, Wang J*, Long Q. Current prevalence, changes, and determinants of breastfeeding practice in China: data from cross-sectional national household health services surveys in 2013 and 2018. Int Breastfeed J. 2023 Aug 11;18(1):40. doi: 10.1186/s13006-023-00572-2. PMID: 37568207; PMCID: PMC10416475.

Jiang W, Trimawartinah, Rahman FM, Wibowo A, Sanjaya A, Silitonga PII, Tang S*, Long Q*. The co-management of tuberculosis-diabetes co-morbidities in Indonesia under the National Tuberculosis Control Program: results from a cross-sectional study from 2017 to 2019. BMC Public Health. 2022 Apr 8;22(1):689. doi: 10.1186/s12889-022-13017-y. PMID: 35395745; PMCID: PMC8990273.

Long Q*, Zhang Y*, Zhang J, Tang X, Kingdon C. Changes in caesarean section rates in China during the period of transition from the one-child to two-child policy era: cross-sectional National Household Health Services Surveys. BMJ Open. 2022 Apr 13;12(4): e059208. doi: 10.1136/bmjopen-2021-059208. PMID: 35418438; PMCID: PMC9014066.

Wyatt S, Ostbye T, De Silva V, Long Q*. Antenatal depression in Sri Lanka: a qualitative study of public health midwives’ views and practices. Reprod Health. 2022 Jan 28;19(1):23. doi: 10.1186/s12978-022-01330-z. PMID: 35090509; PMCID: PMC8796187.

Long Q*, Guo L, Jiang W, Huan S, Tang S. Ending tuberculosis in China: health system challenges. Lancet Public Health. 2021 Dec;6(12): e948-e953. doi: 10.1016/S2468-2667(21)00203-6. PMID: 34838198.

Wyatt S, Ostbye T, De Silva V, Lakmali P, Long Q*. Predictors and occurrence of antenatal depressive symptoms in Galle, Sri Lanka: a mixed-methods cross-sectional study. BMC Pregnancy Childbirth. 2021 Nov 10;21(1):758. doi: 10.1186/s12884-021-04239-w. PMID: 34758774; PMCID: PMC8578523.

Wyatt S, Silitonga PII, Febriani E, Long Q*. Socioeconomic, geographic and health system factors associated with rising C-section rate in Indonesia: a cross-sectional study using the Indonesian demographic and health surveys from 1998 to 2017. BMJ Open. 2021 May 21;11(5): e045592. doi: 10.1136/bmjopen-2020-045592. PMID: 34020977; PMCID: PMC8144035.

*Corresponding Author

Xu, X.,Wang, Yu.,and Zhang, Z. (2023). Family, community, and the society work together to promote non-NIP vaccines among children in China. Innovation Lab for Vaccine Delivery Research. https://vaxlab.dukekunshan.edu.cn/paper/non-epi-vax/.

Jin, Chuyao., Dai, Xiaochen., Mishra, Gita., Wang, Yu., and Xu, Xiaolin. 2023. “Childhood socioeconomic disadvantage and risks of depression and physical multimorbidity in later life: Results from the China Health and Retirement Longitudinal Study.” Maturitas 167 (1):17-23.

团队所在单位介绍

团队成员

No data was found

团队近5年具有代表性的成果​

团队所在单位介绍

团队成员

No data was found

团队近5年具有代表性的成果​

Duke Kunshan University Long Qian and Wang Yu Research Team

Introduction of team's institution

The Global Health Research Center (GHRC) was established in 2013 and co-founded by Duke Kunshan University and the Duke Global Health Institute. Our mission is to improve health and promote health equity in China and globally.

GHRC is built on the principles of scientific excellence and focuses on establishing interdisciplinary, mutually beneficial collaborations with researchers from China. We aim to conduct high-quality research that leads to informed policy-making and innovative approaches to health challenges at local and global levels. Ultimately, we strive to make contributions to achieve the national goals identified in Healthy China 2030 and other Chinese policies, and the health-related Sustainable Development Goals such as universal health coverage, health system strengthening, and infectious and NCD risk reduction globally.

Team members

龙倩
Qian Long

Qian Long, Associate Professor of Global Health, Duke Kunshan University. Her research interest and experience center on health equity in health systems development (with a focus on health financing and health services organization and delivery), including maternal and child health, tuberculosis control, and non-communicable disease management in poor areas and among vulnerable groups in China and other low- and middle-income countries. Before joining Duke Kunshan University, she worked in the Department of Reproductive Health and Research, at the World Health Organization, based in Geneva, for over two years. She also actively participates in various academic association exchanges and is currently a member of the International Exchange and Cooperation Sub-Committee of the Chinese Antituberculosis Association. She has provided technical advice to the Jiangsu Provincial Health Commission, the Center for Health and Information Statistics of the National Health Commission, and the World Health Organization. Dr. Long Qian received her Master of Public Health degree from the Royal Tropical Institute in the Netherlands and her Doctor of Medical Science degree from the University of Helsinki, Finland. In the past 15 years, she has participated in and managed more than 20 international collaborative projects, mainly funded by the World Health Organization (WHO), the European Commission INCO programme, the Academy of Finland, the Gates Foundation, etc. Dr. Qian Long has published 70 peer-reviewed academic papers in international journals, mainly in first-class journals in her research area, including Lancet Public Health, Bulletin of the World Health Organization, PLoS Medicine, etc.

王宇
Yu Wang

Dr. Yu Wang is an Assistant Professor of Sociology at Duke Kunshan University. She received her BS and MS in Sociology from Renmin University and her MS and PhD in Sociology from the University of Wisconsin-Madison (2017). Her research focuses on the role of intermarriage and individual achievement as pathways to social mobility and work and family conflicts in China. A second line of her research focuses on social determinants of health. Her current projects are about the interaction between demographic changes and assortative mating in contemporary China and the relationship between family and child vaccinations in China. Her articles have appeared in journals, such as Research in Social Stratification and Mobility, Social Science Research, the American Journal of Public Health, and Contraception.

Representative achievements of the team in the past five years

Long Q, Jia YF, Li JL, Lou ZX, Liu YG. National Basic Public Health Services Programme in China: Case study (ISBN (WHO) 978-92-4-007781-2 (electronic version); ISBN (WHO) 978-92-4-007782-9 (print version)). 2023; World Health Organization and the Organisation for Economic Co-operation and Development (in English).

Jia YF, Jiang WX, Yang BL, Tang S, Long Q. Cost drivers and financial burden for cancer-affected families in China: a systematic review. Current Oncology 2023;30:7654-7671.

Li Z, Jia Y, Parshley I, Zhang Y*, Wang J*, Long Q. Current prevalence, changes, and determinants of breastfeeding practice in China: data from cross-sectional national household health services surveys in 2013 and 2018. Int Breastfeed J. 2023 Aug 11;18(1):40. doi: 10.1186/s13006-023-00572-2. PMID: 37568207; PMCID: PMC10416475.

Jiang W, Trimawartinah, Rahman FM, Wibowo A, Sanjaya A, Silitonga PII, Tang S*, Long Q*. The co-management of tuberculosis-diabetes co-morbidities in Indonesia under the National Tuberculosis Control Program: results from a cross-sectional study from 2017 to 2019. BMC Public Health. 2022 Apr 8;22(1):689. doi: 10.1186/s12889-022-13017-y. PMID: 35395745; PMCID: PMC8990273.

Long Q*, Zhang Y*, Zhang J, Tang X, Kingdon C. Changes in caesarean section rates in China during the period of transition from the one-child to two-child policy era: cross-sectional National Household Health Services Surveys. BMJ Open. 2022 Apr 13;12(4): e059208. doi: 10.1136/bmjopen-2021-059208. PMID: 35418438; PMCID: PMC9014066.

Wyatt S, Ostbye T, De Silva V, Long Q*. Antenatal depression in Sri Lanka: a qualitative study of public health midwives’ views and practices. Reprod Health. 2022 Jan 28;19(1):23. doi: 10.1186/s12978-022-01330-z. PMID: 35090509; PMCID: PMC8796187.

Long Q*, Guo L, Jiang W, Huan S, Tang S. Ending tuberculosis in China: health system challenges. Lancet Public Health. 2021 Dec;6(12): e948-e953. doi: 10.1016/S2468-2667(21)00203-6. PMID: 34838198.

Wyatt S, Ostbye T, De Silva V, Lakmali P, Long Q*. Predictors and occurrence of antenatal depressive symptoms in Galle, Sri Lanka: a mixed-methods cross-sectional study. BMC Pregnancy Childbirth. 2021 Nov 10;21(1):758. doi: 10.1186/s12884-021-04239-w. PMID: 34758774; PMCID: PMC8578523.

Wyatt S, Silitonga PII, Febriani E, Long Q*. Socioeconomic, geographic and health system factors associated with rising C-section rate in Indonesia: a cross-sectional study using the Indonesian demographic and health surveys from 1998 to 2017. BMJ Open. 2021 May 21;11(5): e045592. doi: 10.1136/bmjopen-2020-045592. PMID: 34020977; PMCID: PMC8144035.

*Corresponding Author

Xu, X.,Wang, Yu.,and Zhang, Z. (2023). Family, community, and the society work together to promote non-NIP vaccines among children in China. Innovation Lab for Vaccine Delivery Research. https://vaxlab.dukekunshan.edu.cn/paper/non-epi-vax/.

Jin, Chuyao., Dai, Xiaochen., Mishra, Gita., Wang, Yu., and Xu, Xiaolin. 2023. “Childhood socioeconomic disadvantage and risks of depression and physical multimorbidity in later life: Results from the China Health and Retirement Longitudinal Study.” Maturitas 167 (1):17-23.

Introduction of team's institution

Team members

No data was found

Representative achievements of the team in the past five years

Introduction of team's institution

Team members

No data was found

Representative achievements of the team in the past five years

代表性地区的基本情况、接种政策及效果、宣传推动情况

(1) 成都市

 

基本情况

成都市2022年度GDP为20817.5亿元，排名全国城市第七。成都市出台了《健康城市建设推动健康中国行动创新模式成都市宫颈癌综合防控试点工作方案》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

目标人群为13-14岁在校且无HPV疫苗接种史女生。免疫程序为国产二价0-6二剂次、进口二价0-1-6三剂次、进口四价0-2-6三剂次。资助政策为国产二价疫苗（沃泽惠）免费，其它疫苗补贴600元/人，并自付20元/剂接种费。疫苗接种按照属地化管理原则，由学校所在地预防接种单位负责。截至2022年1月，目标人群首针接种率达90.04%[14]。

宣传推动

成都市开展多形式、多载体的健康教育宣传。形式包括讲座、知晓日、义诊咨询、专题课程、专题活动等，载体包括宣传册、宣传栏、展板、电视、微信、视频号、抖音平台等，覆盖相关医疗机构300余、社区300余个、和公众场所90余个。面向适龄女孩及监护人、适龄女性及全体市民开展广泛宣教，宣传材料发放至近9万名群众，讲座活动覆盖近2万名群众。宣教内容包括HPV疫苗接种、两癌防控、其它女性常见疾病防控等。

(2) 济南市

 

基本情况

济南市2022年度GDP为12027.5亿元，位列全国城市排名20。2021年，济南市出台《健康城市建设推动健康中国行动创新模式试点一济南市宫颈癌综合防治工作方案（2021—2025年）》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

目标人群为≤14周岁且无HPV疫苗接种史的在校七年级女生。免疫程序为国产二价0-6二剂次。资助政策免费接种。疫苗接种按照属地化管理原则，安排分班级分时段前往学校所在地的预防接种单位进行接种。截至2022年11月，目标人群首针接种率达
94.4%[15].

宣传推动

济南市开展多形式、多载体的健康教育宣传。形式包括采访、线上线下专题活动，载体包括网络媒体、纸媒、科普展板、宣传手册、子宫颈癌与HPV疫苗知识读本、济南HPV疫苗接种手册，宣教人群广泛涵盖全体市民，宣教内容包括HPV疫苗接种、两癌防控等知识。

(3) 鄂尔多斯市

 

基本情况

鄂尔多斯市2022年度GDP为5613.44亿元，全国地级市第45位。2021年，鄂尔多斯市出台了《健康城市建设推动健康鄂尔多斯行动创新模式工作方案》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

2020年8月，鄂尔多斯市在准格尔旗率先开展HPV疫苗免费接种项目。目标人群为全市当年13-18岁在校且无HPV疫苗接种史女生。免疫程序为进口二价0-1-6三剂次，

2023年起调整为13-14岁女孩0-6二剂次。资助政策为疫苗免费，自付20元/剂接种费。组织方式为疫苗接种服务中心根据任务安排联系学校，有规划的通知适龄女孩前来完成HPV疫苗接种。截至2022年11月，目标人群首针接种率接近70%［16］。

2022年8月，启动准格尔旗和达拉特旗高三女生接种四价和九价HPV疫苗的试点工作，利用暑假时间展开接种，力争在2023年年底达成90%的接种目标［17］。自鄂尔多斯之后，由政府主导的HPV疫苗惠民行动在多地等涌现。值得注意的是，近年来多主体参与到HPV疫苗支持项目，如慈善总会、医院、妇联等为主体单位牵头组织开展了一些公益活动。

宣传推动

鄂尔多斯市开展多形式、多载体的健康教育宣传。形式包括讲座、知晓日、义诊咨询、专题课程、专题活动等，载体包括宣传册、宣传栏、展板、电视、微信、视频号、抖音平台等，宣教人群广泛涵盖在校女孩及监护人，适龄女性及全体市民。宣教内容包括HPV疫苗接种、两癌防控、其它女性常见疾病防控等。

(4) 西安市

 

基本情况

西安市2022年度GDP为11486.51亿元，排名全国第22位。2021年，西安市出台了《西安市健康城市建设推动健康中国行动创新模式试点宫颈癌综合防治工作方案》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

目标人群为全市年龄满13周岁（初中）在校女生。免疫程序为国产二价0-6二剂次，进口二价0-1-6三剂次，进口四价和进口九价0-2-6三剂次。接种政策为自愿自费。各区（县）合理设立HPV疫苗专项疫苗接种门诊承担接种任务，并及时将接种信息统一录入儿童免疫规划信息平台。

宣传推动

西安市出台了《西安市宫颈癌综合防治宣传方案》（市健办发〔2022〕12号）。通过媒体宣传、社区活动、义诊等形式，宣传册、宣传栏、展板、电视、微信公众号、报纸等载体普及宫颈癌防治相关知识。

(5) 西藏自治区

 

基本情况

西藏自治区2022年度GDP为2132.64亿元，经济总量整体规模相对其他省份较小，人均GDP处于全国中等偏下水平。2022年出台《西藏自治区妇女“两癌”综合防治工作实施方案》等系列政策推动适龄女孩HPV疫苗接种。

接种政策及效果

目标人群为13-14岁在校女生。免疫程序为国产二价0-6二剂次。资助政策为免费。由学校组织，接种者在商定接种时间携带个人身份证明材料与法定监护人一同前往定点接种单位接种。

宣传推动

充分利用网络、电视、广播、报刊等媒介，以群众喜闻乐见的宣传方式，对适龄在校女生HPV疫苗接种工作的意义及内容进行广泛宣传。

近年来各地HPV疫苗惠民项目信息

“疾病负担”指标解读

疾病负担（burden of disease, BOD）是指疾病造成的失能（伤残）、生活质量下降和过早死亡对健康和社会造成的总损失，包括疾病的流行病学负担和经济负担两个方面。

 

在疾病的流行病学方面，衡量疾病负担的常用指标包括传统指标和综合指标。

 

传统指标

传统疾病负担的衡量指标包括：用于描述和反映健康状况与水平的常规指标，如死亡人数、伤残人数和患病人数等绝对数指标；以及用来比较不同特征人群疾病分布差异的指标，如发病率、伤残率、患病率、死亡率、门诊和住院率等相对数指标。

 

上述传统疾病负担的衡量指标基本上只考虑了人口的生存数量，而忽略了生存质量，不够全面；但优势在于资料相对计算方便，结果直观，可用于各种疾病的一般性描述。

 

综合指标

疾病负担不等同于死亡人数，综合指标弥补了传统指标的单一性，且可以让各种不同疾病造成的负担之间相互比较。

 

潜在寿命损失年（YPLL）：通过疾病造成的寿命损失来估计疾病负担的大小。但忽略了疾病造成的失能对生存质量的影响。

 

伤残调整寿命年(DALYs)：将死亡和失能相结合，用一个指标来描述疾病的这两方面的负担。它包括因早死造成健康生命年的损失（YLL）和因伤残造成健康生命年的损失（YLD），即DALY=YLL+YLD。目前，DALY是国内外一致公认的最具代表性、运用最多的疾病负担评价指标。

 

健康期望寿命（HALE）：指具有良好健康状态的生命年以及个体在比较舒适的状态下生活的平均预期时间，综合考虑生命的质量和数量两方面。

 

 

随着疾病负担研究的深入，其测量范围从流行病学负担扩大到经济负担。

 

疾病经济负担是由于发病、伤残（失能）和过早死亡给患者本人、家庭以及社会带来的经济损失，和由于预防治疗疾病所消耗的经济资源。

详细见：疾病的“经济负担”怎么计算？

 

参考资料：

陈文. 卫生经济学 [M]. 人民卫生出版社. 2017.

李茜瑶,周莹,黄辉等.疾病负担研究进展[J].中国公共卫生,2018,34(05):777-780.

什么是“年龄标化”？

在流行病学研究中，年龄是多种疾病的危险因素。以发病率为例，该指标反映了一定时期内，特定人群中癌症新发病例的情况。由于年龄是癌症发生的一个重要影响因素，年龄越大，发病率就越高。

 

如果两个国家的人群年龄结构相差很大，例如A市老年人口比例更大，B市年轻人口占比更高，直接比较两地癌症发病率的高低，我们不能确定发病率较高的市，是因为年龄构成不同还是因为其他影响因素（如饮食习惯、环境等）所导致。因此，需要用“年龄标化”的统计学方法，进一步处理数据，排除年龄影响因素的干扰，再来比较两地的发病率数据。

 

以发病率为例，即把原始数据套到一个“标准年龄结构人群里”，计算出”年龄标化发病率“，这样人群结构不同的A市和B市，就能在同一个指标尺度下进行“发病率”比较。年龄标化通常有“中标率”，即我国各地基于某一年份的中国人口年龄结构构成作为标准计算，国内不同地区的疾病数据比较采用的是“中标率”；另一种是“世标率”，即用世界标准人口构成机型标化计算，适用于国与国之间的指标比较。

 

同样地，以死亡率为例，应特别注意各之间地人口构成的差异。用标准化死亡率进行比较才能得出正确结论。如甲、乙两地在未标化前的肺癌死亡率相同，但实际上乙地人群的肺癌死亡率要明显地高于甲地，其原因在于甲地男性老年人口居多，而肺癌的死亡率又与年龄和性别有关，所以用未标化率进行比较时，就会得出甲乙两地肺癌死亡率相同的错误结论。

 

参考资料：

 

张科宏教授：年龄标化的患病率 – 丁香公开课 (dxy.cn)

科学网—癌症（粗）发病率与标化发病率的区别 – 杨雷的博文 (sciencenet.cn)

WHO年龄标化死亡率定义及计算方法

沈洪兵，齐秀英. 流行病学 [M]. 人民卫生出版社. 2015.

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疾病的“经济负担”怎么计算？

疾病经济负担是由于发病、伤残（失能）和过早死亡给患者本人、家庭以及社会带来的经济损失，和由于预防治疗疾病的费用。通过计算疾病的经济负担，可以从经济层面上研究或比较不同疾病对人群健康的影响。

总疾病经济负担包括直接疾病经济负担、间接疾病经济负担和无形疾病经济负担。

直接经济负担：指直接用于预防和治疗疾病的总费用，包括直接医疗经济负担和直接非医疗经济负担两部分。直接医疗经济负担是指在医药保健部门购买卫生服务的花费，主要包括门诊费（如挂号费、检查费、处置费、诊断费、急救费等）、住院费（如手术费、治疗费等）和药费等。直接非医疗经济负担包括和疾病有关的营养费、交通费、住宿费、膳食费、陪护费和财产损失等。

间接经济负担：指由于发病、伤残（失能）和过早死亡给患者本人和社会带来的有效劳动力损失而导致的经济损失。具体包括：劳动工作时间损失、个人工作能力和效率降低造成的损失、陪护病人时损失的劳动工作时间、精神损失等。

无形经济负担：指患者及亲友因疾病在心理、精神和生活上遭受的痛苦、悲哀、不便等生活质量下降而产生的无形损失。

 

参考资料：

陈文. 卫生经济学 [M]. 人民卫生出版社. 2017.

李茜瑶,周莹,黄辉等.疾病负担研究进展[J].中国公共卫生,2018,34(05):777-780.