Multimorbidity and catastrophic health expenditure: Evidence from the China Health and Retirement Longitudinal Study.
Multimorbidity and catastrophic health expenditure: Evidence from the China Health and Retirement Longitudinal Study.
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DOI：
10.3389/fpubh.2022.1043189
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发表时间：
2022
影响因子：
5.2
通讯作者：
Huang, Weidong
中科院分区：
文献类型：
--
作者：
Li, Haofei;Chang, Enxue;Zheng, Wanji;Liu, Bo;Xu, Juan;Gu, Wen;Zhou, Lan;Li, Jinmei;Liu, Chaojie;Yu, Hongjuan;Huang, Weidong
人口老龄化伴随的多重疾病给家庭和医疗保健系统带来了巨大的负担。本研究旨在了解中国多病老年人家庭灾难性医疗支出（CHE）的发生率及其决定因素。数据来自2018年进行的中国健康与退休纵向研究（CHARLS），共有3511名患有多种疾病的老年人（≥60岁）代表其家庭接受了调查。使用两个阈值确定CHE：自费卫生支出占家庭总支出（THE）的≥10%，自费卫生支出占家庭支付能力（CTP）的≥40%，以非食品家庭支出衡量。建立了Logistic回归模型，以确定与CHE发病率相关的个人和家庭特征。整体卫生支出中位数为1.99万元，整体卫生支出中位数为1500元，整体卫生支出中位数为10520元。使用≥40% CTP阈值时，CHE发生率达到31.5%，使用≥10% The阈值时，CHE发生率达到45.6%。随着家庭经济状况的增加，家庭慢性疾病的发生率增加（aOR = 1.293 ~ 1.855, p < 0.05）；随着家庭经济状况的增加，家庭慢性疾病的发生率降低（aOR = 1.622 ~ 4.595，最高四分位数，p < 0.001）。调查对象过去一年的住院次数（aOR = 6.707, 95% CI: 5.186 ~ 8.674）和过去一个月的门诊次数（aOR = 4.891, 95% CI: 3.822 ~ 6.259）是CHE发病率的最强预测因子。调查对象为男性（aOR = 1.266, 95% CI: 1.054 ~ 1.521）、已婚（OR = 1.502, 95% CI: 1.211 ~ 1.862）、年龄大于70岁（相对于60 ~ 69岁，aOR = 1.288 ~ 1.458, p < 0.05）、完成小学教育（相对于文盲，aOR = 1.328, 95% CI: 1.079 ~ 1.635）或中学教育（相对于文盲，aOR = 1.305, 95% CI: 1.002 ~ 1.701）、生活在小家庭（≤2人）(aOR = 2.207, 95% CI：1.825 ~ 2.669)，居住在东北地区（相对于东部aOR = 1.935, 95% CI: 1.396 ~ 2.682）更容易发生CHE。多重发病是CHE的重要风险。家庭CHE发病率随着报告的慢性病数量的增加而增加。在中国，CHE发病率的社会经济和地区差异仍然存在。
Population aging accompanied by multimorbidity imposes a great burden on households and the healthcare system. This study aimed to determine the incidence and determinants of catastrophic health expenditure (CHE) in the households of old people with multimorbidity in China. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, with 3,511 old people (≥60 years) with multimorbidity responding to the survey on behalf of their households. CHE was identified using two thresholds: ≥10% of out-of-pocket (OOP) health spending in total household expenditure (THE) and ≥40% of OOP health spending in household capacity to pay (CTP) measured by non-food household expenditure. Logistic regression models were established to identify the individual and household characteristics associated with CHE incidence. The median values of THE, OOP health spending, and CTP reached 19,900, 1,500, and 10,520 Yuan, respectively. The CHE incidence reached 31.5% using the ≥40% CTP threshold and 45.6% using the ≥10% THE threshold. It increased by the number of chronic conditions reported by the respondents (aOR = 1.293–1.855, p < 0.05) and decreased with increasing household economic status (aOR = 1.622–4.595 relative the highest quartile, p < 0.001). Hospital admissions over the past year (aOR = 6.707, 95% CI: 5.186 to 8.674) and outpatient visits over the past month (aOR = 4.891, 95% CI: 3.822 to 6.259) of the respondents were the strongest predictors of CHE incidence. The respondents who were male (aOR = 1.266, 95% CI: 1.054 to 1.521), married (OR = 1.502, 95% CI: 1.211 to 1.862), older than 70 years (aOR = 1.288–1.458 relative to 60–69 years, p < 0.05), completed primary (aOR = 1.328 relative to illiterate, 95% CI: 1.079 to 1.635) or secondary school education (aOR = 1.305 relative to illiterate, 95% CI: 1.002 to 1.701), lived in a small (≤2 members) household (aOR = 2.207, 95% CI: 1.825 to 2.669), and resided in the northeast region (aOR = 1.935 relative to eastern, 95% CI: 1.396 to 2.682) were more likely to incur CHE. Multimorbidity is a significant risk of CHE. Household CHE incidence increases with the number of reported chronic conditions. Socioeconomic and regional disparities in CHE incidence persist in China.
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