中国公共卫生

目的 了解我国苯丙酮尿症患者家庭灾难性卫生支出的发生率、强度，分析其影响因素及各因素对不公平性的贡献程度。方法 基于2025年中国24个省（自治区、直辖市）263户苯丙酮尿症患者家庭的横断面调查数据，依据WHO推荐的40%阈值界定灾难性卫生支出，测算发生率、平均差距和相对差距；运用集中指数及其分解法评估公平性，并用logistic回归分析影响因素。结果 苯丙酮尿症患者家庭灾难性卫生支出发生率为52.09%(137/263)，农村家庭发生率[69.57%(112/161)]显著高于城镇[24.51%(25/102)]。城乡差距（OR=11.18,95%CI=5.367～23.295）及患者并发症（OR=2.35,95%CI=1.122～4.941）为主要风险因素。灾难性卫生支出的发生呈现亲贫特征，集中指数为–0.43(95%CI=–0.52～–0.33)，其中城乡差异对总体不公平的贡献率达65.53%。结论 我国苯丙酮尿症患者家庭灾难性卫生支出发生风险高、强度大，存在明显的亲贫不公平，城乡差异是主要驱动因素。

Objective To investigate the incidence, intensity, and influencing factors of catastrophic health expenditure(CHE) among families of patients with phenylketonuria(PKU) in China and to assess the contributions of various factors to the inequity in CHE. Methods A cross-sectional survey was conducted among 263 PKU families from24 provinces(autonomous regions, municipalities directly under the Central Government) in China, 2025. CHE was defined according to WHO recommended threshold of 40% of household capacity-to-pay. The incidence, mean gap(MG), and mean positive gap(MPG) of CHE were calculated. The concentration index and its decomposition were employed to evaluate equity, and logistic regression was adopted to identify influencing factors. Results The overall incidence of CHE among PKU families was 52.09%(137/263). The incidence in rural families [69.57%(112/161)] was significantly higher than that in urban families [24.51%(25/102)]. Major risk factors for CHE included urban-rural disparity(OR = 11.18, 95%CI: 5.367–23.295) and the presence of complications(OR = 2.35, 95%CI: 1.122–4.941). The distribution of CHE demonstrated a pro-poor pattern, with a concentration index of –0.43(95%CI: –0.52 to –0.33). The urban-rural disparity accounted for 65.53% of the total inequality. Conclusions Families of PKU patients in China face a high risk of CHE with substantial intensity and significant pro-poor inequality. The urban-rural disparity serves as the primary driver of this inequity.