Catastrophic health expenditure: A comparative study between hypertensive patients with and without complication in rural Shandong, China

Abstract

Background: Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. The purpose of this study is to compare the incidence and determinants of CHE between hypertensive patients with and without complications. Methods: Data of this study were from a cross-sectional study in Shandong Province in China in 2016. Of the recruited 3,457 hypertensive patients registered in the NCDs management system in the sampling villages, 3,113 completed the survey, with a response rate of 90.05%.CHE was defined as out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay (non-food expenditure). Hypertension complications (e.g., stroke, coronary heart disease, hypertensive kidney disease, etc.) were collected in this study, which was categorized into 0 (no), 1(single), and 2 and more according to the types of hypertensive complications. We employed Chi-square test to explore associated factors and logistic regression model to identify the determinants of CHE. Results: The incidence of CHE and impoverishment is 13.6% and 10.8% among hypertensive patients. The incidence of CHE with one complication is 25.3% ( R =0.000, OR=2.29 ) and 47.3% ( P =0.000, OR=3.60 ) in patients with two or more complications, which are both statistically higher than that in patients without complication (6.1%). Across all types of patients, income levels are inversely related to the incidence of CHE. Patients who use outpatient or inpatient service are more likely to experience CHE ( R =0.000 ). Factors including living arrangements, family size, educational attainment are found to be significantly associated with CHE in some subgroups ( P ＜ 0.05 ). Conclusions: CHE and impoverishment incidence among hypertensive patients are both high in rural China. Patients with hypertensive complication are at higher catastrophic risk than those without complication.More attention needs to be paid to households with hypertension patients, especially for those with hypertension complications.

Urban-rural differences in catastrophic health expenditure among households with chronic non-communicable disease patients : evidence from China Family Panel Studies

“…among individuals or households suffering from NCDs around the world. Three existing studies emphasized that households with NCD patients were in the high risk to incur CHE in China, Korea and Iran [9,14,15]. Gwatidzo (2017) found that adults aged 50 or above in India were less likely to incur CHE due to diabetes mellitus medication use compared to China [16].…”

Assessing progress towards Sustainable Development Goal 3.8.2 and determinants of catastrophic health expenditures in Malaysia

“…A systematic review of 38 studies discovered that the economic status of the household, the frequency of hospitalisation, and the presence of an elderly, disabled, or chronically ill family member were all significant factors associated with household CHE [10]. Other factors include age, marital status, education, and a higher level of dependence [11], geographic location, household size [12], the absence of local basic medical insurance coverage [13], the types of family structure [14], living arrangements [15], health facility types [16], physical multimorbidity [17], gender of the household head and the quality of life of sick household member [18]. Despite the numerous CHE determinants mentioned in the literature, none have previously been investigated in Malaysia, owing to the low prevalence of CHE and a general lack of interest in the subject.…”

Prevalence and predictive risk factors of hypertension in patients hospitalized in Kamenge Military hospital and Kamenge University teaching hospital in 2019: A fixed effect modelling study in Burundi

“…Hypertension is responsible for 45% deaths due to heart disease and 51% stroke related deaths [ 11 , 12 ]. Premature death and health care expenditure for treatments due the hypertension puts an economic toll on families and pushes many into poverty [ 13 , 14 ]. At the macro level, these high expenses and human losses significantly impacts on economic growth and reduces productivity [ 15 , 16 ].…”