Fundação Oswaldo Cruz. Instituto René Rachou. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, Minas Gerais, Brasil.
Universidade de Brasília. Departamento de Estatística. Brasília, Distrito Federal, Brasil.
Rev Saude Publica. 2020 Dec 14;54:125. doi: 10.11606/s1518-8787.2020054002285. eCollection 2020.
To estimate the relation between catastrophic health expenditure (CHE) and multimorbidity in a national representative sample of the Brazilian population aged 50 year or older.
This study used data from 8,347 participants of the Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI - Brazilian Longitudinal Study of Aging) conducted in 2015-2016. The dependent variable was CHE, defined by the ratio between the health expenses of the adult aged 50 years or older and the household income. The variable of interest was multimorbidity (two or more chronic diseases) and the variable used for stratification was the wealth score. The main analyses were based on multivariate logistic regression.
The prevalence of CHE was 17.9% and 7.5%, for expenditures corresponding to 10 and 25% of the household income, respectively. The prevalence of multimorbidity was 63.2%. Multimorbidity showed positive and independent associations with CHE (OR = 1.95, 95%CI 1.67-2.28, and OR = 1.40, 95%CI 1.11-1.76 for expenditures corresponding to 10% and 25%, respectively). Expenditures associated with multimorbidity were higher among those with lower wealth scores.
The results draw attention to the need for an integrated approach of multimorbidity in health services, in order to avoid CHE, particularly among older adults with worse socioeconomic conditions.
在巴西 50 岁及以上人群的全国代表性样本中，估计灾难性卫生支出（CHE）与多种疾病之间的关系。
本研究使用了 2015-2016 年巴西老龄化纵向研究（ELSI-Brazilian Longitudinal Study of Aging）中 8347 名参与者的数据。因变量为 CHE，由 50 岁及以上成年人的卫生支出与家庭收入的比率定义。感兴趣的变量为多种疾病（两种或多种慢性疾病），分层变量为财富评分。主要分析基于多变量逻辑回归。
CHE 的患病率为 17.9%和 7.5%，分别对应于家庭收入的 10%和 25%的支出。多种疾病的患病率为 63.2%。多种疾病与 CHE 呈正相关且独立相关（支出对应于 10%和 25%时的比值比[OR]分别为 1.95[95%置信区间（CI）1.67-2.28]和 1.40[95%CI 1.11-1.76]）。与多种疾病相关的支出在财富评分较低的人群中较高。
研究结果提请注意，在卫生服务中需要采取综合方法来解决多种疾病问题，以避免 CHE，特别是在社会经济条件较差的老年人群中。
