中国山东农村地区患有多种疾病的单身空巢老年人的灾难性卫生支出：虚弱共病的影响
Catastrophic health expenditure among single empty-nest elderly with multimorbidity in rural Shandong, China: the effect of co-occurrence of frailty.
作者信息
Jing Zhengyue, Li Jie, Fu Pei Pei, Wang Yi, Yuan Yemin, Zhao Dan, Hao Wenting, Yu Caiting, Zhou Chengchao
机构信息
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
出版信息
Int J Equity Health. 2021 Jan 7;20(1):23. doi: 10.1186/s12939-020-01362-6.
BACKGROUND
Previous studies have indicated that older adults with multimorbidity had higher risk of incurring catastrophic health expenditure (CHE). However, the effect of co-occurrence of frailty on CHE among single empty-nest elderly with multimorbidity remains unclear. This study aims to explore the effect of co-occurrence of frailty on CHE among single empty-nest elderly with multimorbidity, and whether this effect is moderated by economic status.
METHODS
A cross-sectional household survey of the older adults in 2019 in Shandong province, China. A total of 606 single empty-nest elderly aged 60 years or older were included in this study. CHE was defined as the out-of-pocket payments for health care that equals or exceeds 40% of the household' s capacity to pay. Logistic regression models are employed to examine the effect of co-occurrence of frailty on CHE among single empty-nest elderly with multimorbidity. The interaction term is introduced to explore the economic status difference in this effect.
RESULTS
The CHE incidence for single empty-nest elderly with multimorbidity alone is 64.2%, and the co-occurrence of frailty results in an increase by almost 1.3 times (84.0%) in CHE incidence among single empty-nest elderly with multimorbidity. The co-occurrence of frailty increases the risk of incurring CHE among the single empty-nest elderly with multimorbidity, with the odds of incurring CHE increased by 3.19 times (OR = 3.19; P = 0.005). Furthermore, the interaction analysis shows that the effect of co-occurrence of frailty on CHE among single empty-nest elderly with multimorbidity still exist in lower economic status groups (OR = 4.64; P = 0.027), but not in higher economic status (OR = 2.76; P = 0.062).
CONCLUSIONS
This study demonstrates that there is a positive effect of co-occurrence of frailty on the CHE among the single empty-nest elderly with multimorbidity, and this effect varies by economic status. The health policy-makers should reorganize the healthcare system to make it pro-poor, so as to meet the multiple medical demand and reduce the potential economic burden and inequalities of older adults.
背景
以往研究表明，患有多种疾病的老年人发生灾难性卫生支出（CHE）的风险更高。然而，虚弱与多种疾病并存对单一空巢老年患者CHE的影响尚不清楚。本研究旨在探讨虚弱与多种疾病并存对单一空巢老年患者CHE的影响，以及这种影响是否受经济状况的调节。
方法
2019年在中国山东省对老年人进行的一项横断面家庭调查。本研究共纳入606名年龄在60岁及以上的单一空巢老年人。CHE定义为自付医疗费用等于或超过家庭支付能力的40%。采用逻辑回归模型检验虚弱与多种疾病并存对单一空巢老年患者CHE的影响。引入交互项以探讨这种影响在经济状况方面的差异。
结果
仅患有多种疾病的单一空巢老年人CHE发生率为64.2%，虚弱与多种疾病并存使单一空巢老年患者CHE发生率增加近1.3倍（84.0%）。虚弱与多种疾病并存增加了单一空巢老年患者发生CHE的风险，发生CHE的几率增加了3.19倍（OR = 3.19；P = 0.005）。此外，交互分析表明，虚弱与多种疾病并存对单一空巢老年患者CHE的影响在经济状况较低的群体中仍然存在（OR = 4.64；P = 0.027），但在经济状况较高的群体中不存在（OR = 2.76；P = 0.062）。
结论
本研究表明，虚弱与多种疾病并存对单一空巢老年患者的CHE有正向影响，且这种影响因经济状况而异。卫生政策制定者应重新组织医疗体系，使其有利于贫困人口，以满足老年人的多重医疗需求，减轻其潜在的经济负担和不平等状况。
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