Longitudinal associations of multimorbidity, disability and out-of-pocket health expenditures in households with older adults in Mexico: The study on global AGEing and adult health (SAGE)
Longitudinal associations of multimorbidity, disability and out-of-pocket health expenditures in households with older adults in Mexico: The study on global AGEing and adult health (SAGE)
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DOI：
10.1016/j.dhjo.2019.03.004
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发表时间：
2019-10-01
影响因子：
4.5
通讯作者：
Salinas-Rodriguez, Aaron
中科院分区：
文献类型：
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作者：
Rivera-Almaraz, Ana;Manrique-Espinoza, Betty;Salinas-Rodriguez, Aaron
背景：经验证据表明，多病和残疾均与自费卫生支出显著相关；然而，很少有人努力探讨它们与项目事务处保健支出的联合关系。目的：评估多重疾病和残疾与墨西哥老年人家庭整体健康支出的关系，以及多重疾病和残疾对整体健康支出的潜在相互作用。方法：纵向研究基于全球老龄化和成人健康研究第1波（2009年）和第2波（2014年）收集的数据，这是一项在墨西哥进行的具有全国代表性的研究，样本为50岁及以上的老年人。因变量为OOP卫生支出，主要暴露变量为多发病和残疾。采用两部分回归模型分析多发病、残疾与面向对象卫生支出之间的关系。结果：多发病与发生OOP卫生支出的概率相关（OR=1.28, CI95% 1.11 ~ 1.48），与残疾的三分位数相关（OR= 1.45, CI95% 1.23 ~ 0.70； OR= 2.19, CI95% 1.81 ~ 0.66）。多重疾病的存在与平均OOP健康成本增加13% （beta=0.13, CI95% 0.01- 0.25）和第三个残疾分位数增加16% （beta=0.16, CI95% 0.01- 0.31）相关。我们没有发现多病和残疾之间有显著的相互作用。结论：多病和残疾似乎是OOP卫生支出的重要决定因素。应强调对家庭和保健系统的经济影响，特别是在低收入和中等收入国家，因为这些国家的老龄人口迅速增长。(c) 2019爱思唯尔公司版权所有。
Background: Empirical evidence suggests that multimorbidity and disability are each significantly associated with out-of-pocket (OOP) health expenditures; however few efforts have been made to explore their joint association with OOP health expenditures.Objectives: To estimate the association of multimorbidity and disability with OOP health expenditures in households with older adults in Mexico, as well as the potential interaction effects of multimorbidity and disability on OOP health expenditures.Methods: Longitudinal study based on data collected as part of the Study on global AGEing and adult health Wave 1 (2009) and Wave 2 (2014), a nationally representative study in Mexico with a sample of older adults aged 50 and older. The dependent variable was OOP health expenditures, and main exposure variables were multimorbidity and disability. Two-Part regression models were used to analyze the relation between multimorbidity, disability and OOP health expenditures.Results: Multimorbidity was associated with the probability of incurring OOP health expenditures (OR=1.28, CI95% 1.11-1.48), and also the tertiles of disability (2nd tertile: OR= 1.45, CI95% 1.23-.70; 3rd tertile: OR= 2.19, CI95%% 1.81-.66). The presence of multimorbidity was associated with an increase of 13% in average OOP health costs (beta=0.13, CI95% 0.01-.25), and 16% for the 3rd tertile of disability (beta=0.16, CI95% 0.01-.31). We did not find significant interaction effects of multimorbidity and disability.Conclusions: Multimorbidity and disability appear to be important determinants of OOP health expenditures. The economic implications for the households and the health system should be highlighted, particularly in low- and middle-income countries because of the rapid growth of their aging populations. (c) 2019 Elsevier Inc. All rights reserved.