Yang Zhao|Rifat Atun|Brian Oldenburg|Barbara McPake|Shenglan Tang|Stewart W Mercer|Thomas E Cowling|Grace Sum|Vicky Mengqi Qin|John Tayu Lee
Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data
George Institute for Global Health|Peking University|The George Institute for Global Health|University of Melbourne|Harvard Global Health Institute|Harvard University|The George Institute for Global Health|University of Melbourne|The George Institute for Global Health|University of Melbourne|Duke Institute for Health Innovation|Duke University|University of Edinburgh|London School of Hygiene & Tropical Medicine|National University Health System|National University of Singapore|National University Health System|National University of Singapore|Imperial College London|The George Institute for Global Health|University of Melbourne
h3backgroundh3 multimorbidity presence two mental physical chronic noncommunicable diseases major challenge health system china faces unprecedented ageing population examined distribution physical multimorbidity relation socioeconomic status association physical multimorbidity healthcare service use catastrophic health expenditures whether associations varied socioeconomic group social health insurance schemes h3methodsh3 populationbased panel data analysis used data three waves nationally representative china health retirement longitudinal study charls 2011 2013 2015 included participants aged 50 years older 2015 complete followup three waves used 11 physical noncommunicable diseases measure physical multimorbidity annual percapita household consumption spending proxy socioeconomic status h3findingsh3 17 708 participants charls 11 817 eligible inclusion analysis median age participants 62 years iqr 5669 2015 5766 488 participants male 7320 619 eligible participants physical multimorbidity china 2015 prevalence physical multimorbidity increased older age odds ratio 293 95 ci 271315 among women 270 204357 within higher socioeconomic group quartile 4 highest group 150 124182 higher educational level 517 302883 however physical multimorbidity common poorer regions affluent regions additional chronic noncommunicable disease associated increase number outpatient visits incidence rate ratio 129 95 ci 127131 number days spent hospital inpatient 138 135141 saw similar effects health service use additional chronic noncommunicable disease different socioeconomic groups among covered different social health insurance programmes overall physical multimorbidity associated significantly increased likelihood catastrophic health expenditure overall population odds ratio 129 95 ci 126132 adjusted sociodemographic variables effect physical multimorbidity catastrophic health expenditures persisted even among higher socioeconomic groups across health insurance programmes h3interpretationh3 concerted efforts needed reduce health inequalities due physical multimorbidity adverse economic effect population groups china social health insurance reforms must place emphasis reducing outofpocket spending patients multimorbidity provide greater financial risk protection h3fundingh3 none