Association of Body Mass Index with Risk of Household Catastrophic Health Expenditure in China: A Population-Based Cohort Study

Abstract

Catastrophic health expenditure (CHE) is a major obstacle to achieving universal health coverage, and body mass index (BMI) is linked to both health and economy. We aimed to explore the association of BMI with the risk of CHE to provide advice for reducing CHE. We used national cohort data from the China Family Panel Studies, which comprised 33,598 individuals (14,607 households) from 25 provinces between 2010 to 2018. We used multivariate Cox proportional hazard models to estimate adjusted hazard ratios (aHRs) and 95% confident interval (CI) for CHE in participants at underweight, overweight, and obesity, compared with those at normal weight. Restricted cubic splines were employed to model the association of continuous BMI scale with risk of CHE. We found that families with female household heads at underweight had a 42% higher risk of CHE (aHR = 1.42, 95%CI: 1.16–1.75), and those at overweight had a 26% increased risk of CHE (aHR = 1.26, 95%CI: 1.09–1.47), compared with those at normal weight. A weak U-shaped curve for the association of continuous BMI with risk of CHE in female-headed households (p for non-linear = 0.0008) was observed, which was not significant in male-headed households (p for non-linear = 0.8725). In female-headed households, underweight and overweight BMI are connected with a higher risk of CHE. Concerted efforts should be made to keep a normal BMI to prevent CHE.

The usage and costs of national drug price-negotiated anticancer medicines in a first-tier city in Northeast China: a study based on health insurance data

“…Thus, it is recommended that policies be implemented in favour of these cancer types, which impose heavier burdens on patients compared with others. In addition, it is necessary to integrate medical assistance policies that focus on helping low-income impoverished groups and improving the expenditure target identification mechanism to prevent patients from falling into poverty or returning to poverty due to their illness [44].…”

Understanding variation in catastrophic health expenditure from socio-ecological aspect: a systematic review

“…A study from Bangladesh also concluded that people from lower income quintiles have lower CHE as the utilization of formal care is low [31]. Conversely, poverty consistently predicts CHE, indicating that poor people have higher CHE [13,18,21,27,28,37,46,48,54,58]. To safeguard poor people from financial catastrophe, several studies from China, Kenya, and Malaysia emphasized on health insurance [19,20,36,54].…”

“…Conversely, poverty consistently predicts CHE, indicating that poor people have higher CHE [13,18,21,27,28,37,46,48,54,58]. To safeguard poor people from financial catastrophe, several studies from China, Kenya, and Malaysia emphasized on health insurance [19,20,36,54]. However, countries where health insurance is available reported that due to insufficient coverage and the delay in reimbursement, health insurance could not save people from CHE [43].…”

“…However, a study from Nigeria identified having the elderly as a weak predictor of CHE [22]. Studies from China, Nepal, Korea, and Kenya concluded that families having members with chronic disease face higher CHE [20,34,42,53,54]. Again, the study from Kenya, Pakistan, and South Africa found that families with children have higher CHE incidence [3,20,52].…”

“…Again, accessed care is another influential predictor of CHE. Studies from Iran, China, and Vietnam concluded that those who are taking inpatient care very likely face CHE [4,36,47,48,54]. Moreover, diseases for which the treatment cost is higher have higher CHE.…”