Catastrophic healthcare expenditure and its inequality for households with hypertension: evidence from the rural areas of Shaanxi Province in China.
Catastrophic healthcare expenditure and its inequality for households with hypertension: evidence from the rural areas of Shaanxi Province in China.
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DOI：
10.1186/s12939-016-0506-6
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发表时间：
2017-07-01
影响因子：
4.8
通讯作者：
Heitner J
中科院分区：
文献类型：
--
作者：
Si Y;Zhou Z;Su M;Ma M;Xu Y;Heitner J
在过去三十年中，中国经历了巨大的人口和流行病转变，非传染性疾病和人口老龄化造成的负担日益加重，给中国的保健带来了巨大挑战。许多研究考察了全球范围内整个人群而不是特定弱势群体的灾难性医疗支出（CHE）。随着高血压和其他慢性病在中国疾病负担中所占的份额越来越大，它们将成为CHE的一个越来越重要的组成部分。本研究旨在估计陕西省农村地区高血压家庭的CHE发病率及其收入不平等。数据来源于2013年陕西省开展的全国家庭卫生服务调查，共确定13104户家庭进行分析。这些住户被分为三种类型：非慢性病住户、仅患有高血压的住户和患有高血压合并其他慢性病的住户。CHE是根据自付医疗费用占非食品家庭支出的比例来衡量的，集中指数被用来衡量CHE中与收入相关的不平等程度。采用基于概率单位模型的分解方法，将浓度指标分解为决定性组分。与非慢性疾病家庭相比，高血压家庭的CHE发病率处于令人不安的水平。单纯高血压和高血压合并其他慢性病的家庭发生CHE的比例分别为23.48%和34.01%，而非慢性病家庭发生CHE的比例仅为13.33%。非慢性病家庭集中度指数为-0.4871。而仅患高血压和高血压合并其他慢性病家庭的集中指数分别为-0.4645和-0.3410。观察到的CHE中的大多数不平等现象是由家庭经济状况和有老年成员来解释的。陕西省农村居民家庭发生CHE的比例在三类家庭中均较高，高血压家庭发生CHE的风险较高。此外，在所有三种类型的家庭中都存在着强烈的有利于穷人的CHE不平等，结果表明，与其他两组相比，非慢性病家庭的不平等程度更高。我们的研究表明，更多的关注需要针对高血压加其他慢性病和家庭有老年成员的家庭。
China has been undergoing tremendous demographic and epidemiological transitions during the past three decades and increasing burden from non-communicable diseases and an ageing population have presented great health-care challenges for the country. Numerous studies examine catastrophic healthcare expenditures (CHE) worldwide on whole populations rather than specific vulnerable groups. As hypertension and other chronic conditions impose a growing share of the disease burden in China, they will become an increasingly important component of CHE. This study aims to estimate households with hypertension incurring CHE and its income-related inequality in the rural areas of Shaanxi Province. Data were obtained from the National Household Health Service Surveys of Shaanxi Province conducted in 2013 and 13104 households were identified for analysis. The households were classified into three types: households with non-chronic diseases, households with hypertension only and households with hypertension plus other chronic diseases. CHE was measured according to the proportion of out-of-pocket health payments to non-food household expenditures and the concentration index was employed to measure the extent of income-related inequality in CHE. A decomposition method based on a probit model was used to decompose the concentration index into its determining components. The incurring of CHE of households with hypertension is at a disconcerting level compared to households with non-chronic diseases. Households with hypertension only and households with hypertension plus other chronic diseases incurred CHE in 23.48% and 34.01% of cases respectively whereas households with non-chronic diseases incurred CHE in only 13.33%. The concentration index of households with non-chronic diseases is -0.4871. However, the concentration index of households with hypertension only and households with hypertension plus other chronic diseases is -0.4645 and -0.3410 respectively. The majority of observed inequalities in CHE were explained by household economic status and having elder members. The proportion of households incurring CHE in the rural areas of Shaanxi Province was considerably high in all three types of households and households with hypertension were at a higher risk of incurring CHE. Furthermore, there existed a strong pro-poor inequality of CHE in all three types of households and the results implied more inequality in households with non-chronic diseases compared with two other groups. Our study suggests that more concern needs to be directed toward households with hypertension plus other chronic diseases and households having elder members.