Health-care utilization for primary headache disorders in China: a population-based door-to-door survey

The Journal of Headache and Pain

Research Article

Xiutang Cao¹  Xiangyang Qiao²  Mianwang He³  Ruozhuo Liu³  Shengyuan Yu⁴  Yannan Fang⁵  Jiachun Feng⁶  Gang Zhao⁷  Xiaosu Yang⁸  Timothy J Steiner⁹ 

[1] Department of Health and Economics, Chinese PLA General Hospital, Beijing, China;Department of Neurology, Affiliated Huashan Hospital of Fudan University, Shanghai, China;Department of Neurology, Chinese PLA General Hospital, 100853, Beijing, China;Department of Neurology, Chinese PLA General Hospital, 100853, Beijing, China;Department of Neurology, Chinese PLA General Hospital, Fuxing Road 28, 100853, Haidian District, Beijing, China;Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China;Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, China;Department of Neurology, The Fourth Military Medical University, Xian, Shaanxi Province, China;Department of Neurology, Xiangya Hospital of Centre-south University, Changsha, Hunan Province, China;Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway;

关键词: China;    Headache disorders;    Migraine;    Tension-type headache;    Health-care utilization;    Global campaign against headache;   

DOI  :  10.1186/1129-2377-14-47

 received in 2013-04-09, accepted in 2013-05-27,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundIn order to know the status quo of health care for primary headache disorders in China, questions about headache consultation and diagnosis were included in a nationwide population-based survey initiated by Lifting The Burden: the Global Campaign against Headache.MethodsThroughout China, 5,041 unrelated respondents aged 18–65 years were randomly sampled from the general population and visited unannounced at their homes. After basic sociodemographic and headache diagnostic questions, respondents with headache answered further questions about health-care utilization in the previous year.ResultsSignificantly higher proportions of respondents with migraine (239/452; 52.9%) or headache on ≥15 days per month (23/48; 47.9%) had consulted a physician for headache than of those with tension-type headache (TTH) (218/531; 41.1%; P < 0.05). Multivariate analysis showed associations between disability and probability of consultation in those with migraine (mild vs. minimal: AOR 3.4, 95% CI: 1.6–7.4; moderate vs. minimal: 2.5, 1.2–5.4; severe vs. minimal: 3.9, 1.9–8.1) and between rural habitation and probability of consulting in those with TTH (AOR: 3.5; 95% CI: 1.9–6.3, P < 0.001). Married respondents with TTH were less likely than unmarried to have consulted (AOR: 0.26; 95% CI: 0.07–0.93; P = 0.038). About half of consultations (47.8–56.5%) for each of the headache disorders were at clinic level in the health system. Consultations in level-3 hospitals were relatively few for migraine (5.9%) but more likely for headache on ≥15 days/month (8.7%) and, surprisingly, for TTH (13.3%). Under-diagnosis and misdiagnosis were common in consulters. More than half with migraine (52.7%) or headache on ≥15 days/month (51.2%), and almost two thirds (63.7%) with TTH, reported no previous diagnosis. Consulters with migraine were as likely (13.8%) to have been diagnosed with “nervous headache” as with migraine. “Nervous headache” (9.8%) and “vascular headache” (7.6%) were the most likely diagnoses in those with TTH, of whom only 5.6% had previously been correctly diagnosed. These were also the most likely diagnoses (14.0% each) in consulters with headache on ≥15 days/month.ConclusionsThis picture of the status quo shows limited reach of headache services in China, and high rates of under-diagnosis and misdiagnosis in those who achieve access to them. This is not a picture of an efficient or cost-effective response to major causes of public ill-health and disability.

【 授权许可】

Unknown   
© Liu et al.; licensee Springer. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.