Multimorbidity and catastrophic health expenditure among patients with diabetes in China: a nationwide population-based study

Abstract

IntroductionMultimorbidity is common among patients with diabetes and can lead to catastrophic health expenditure (CHE) for their families. This study aims to investigate the prevalence of multimorbidity and CHE among people with diabetes in China, and the association between multimorbidity and CHE and whether this is influenced by socioeconomic status and health insurance type.MethodsA national survey was conducted in China in 2013 that included 8471 people aged ≥18 years who were living with diabetes. The concentration curve and concentration index were used to measure socioeconomic-related inequalities. Factors influencing CHE and the impact of multimorbidity on CHE according to socioeconomic status and health insurance type were examined by logistic regression.ResultsThere were 5524 (65.2%) diabetes patients with multimorbidity. The prevalence of CHE was 56.6%, with a concentration index of −0.030 (95% CI −0.035 to –0.026). For each additional chronic disease, the probability of CHE increased by 39% (OR=1.39, 95% CI 1.31 to 1.47). Factors that were positively associated (p<0.05) with CHE included older age; male sex; lower educational level; being retired, unemployed or jobless; being a non-smoker and non-drinker; having had no physical examination; lower socioeconomic status; being in an impoverished family; and residing in the central or western regions. Among participants with Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical Scheme, the probability of CHE increased by 32% (OR=1.32, 95% CI 1.23 to 1.43), 43% (OR=1.43, 95% CI 1.24 to 1.65) and 47% (OR=1.47, 95% CI 1.33 to 1.63), respectively, with each additional chronic disease. The association between multimorbidity and CHE was observed across all health insurance types irrespective of socioeconomic status.ConclusionsMultimorbidity affects about two-thirds of Chinese patients with diabetes. Current health insurance schemes offer limited protection against CHE to patients’ families.

Multimorbidity and catastrophic health expenditure: Evidence from the China Health and Retirement Longitudinal Study

“…In this study, we found that 31.5% (≥40% OOP in CTP) to 45.6% (≥10% OOP in THE) households of old people (≥60 years) living with multimorbidity incurred CHE. This is lower than the CHE incidence (56.6%) revealed in another national representative study for households with diabetic patients with multimorbidity (23), even when our study participants were restricted to those with diabetes. The different results are a reflection of varied thresholds adopted: a more relaxed threshold (≥20% OOP in CTP) was adopted in the above-cited study.…”

“…Catastrophic health expenditure (CHE) threatens the ability of the household to purchase other goods and services, potentially driving the household into poverty ( 21 , 22 ). Previous studies have shown that even in the wealthy households with health insurance coverage, multimorbidity is significantly associated with the occurrence of CHE ( 12 , 23 ). According to the WHO, global health spending is rising rapidly, and this trend is particularly profound in the low- and middle-income countries (LMICs) ( 24 ).…”

“…Zhou et al estimated that the incidence of CHE in the single elderly with multimorbidity in rural Shandong can be as high as 64.2% ( 29 ). Fu et al identified a CHE incidence of 56.6% in the households with diabetic patients with multimorbidity in China ( 23 ). This study aimed to address the gap in the literature by determining the CHE incidence and its determinants in the households of old people in China with multimorbidity using a national representative dataset.…”

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

“…Similarly, Razak et al [ 32 ] revealed that the prevalence of BMI lower than 16 kg/m 2 was associated with poverty and low education levels, and this prevalence did not increase over time in most countries studied. Since lower BMI is relevant to poverty and, furthermore, linked to poverty-related diseases [ 33 ], the association of poverty and health, as well as lower socioeconomic level with risk of CHE is widely verified [ 7 , 8 , 9 ], and it cannot be difficult to understand that underweight BMI is related to higher incidence of CHE.…”

“…Zhao et al [ 5 ] found that after adjusting for sociodemographic confounders, physical multimorbidity was significantly associated with an increased number of outpatient visits (odds ratio = 1.29, 95% confident interval (CI): 1.27–1.31), inpatient days spent (odds ratio = 1.38, 95%CI: 1.35–1.41), and likelihood of CHE (odds ratio = 1.29, 95%CI: 1.26–1.32). As for economic factors, a series of studies revealed that families with lower socioeconomic status, such as lower family income, lower education level, and higher unemployment, were more likely to incur CHE [ 7 , 8 , 9 ]. Therefore, in order to eliminate CHE and move to UHC, one of the key points is finding ways to light the heavy health-economic burden.…”