The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
Collaborating Centre on Implementation Research for Prevention & Control of NCDs, WHO, Melbourne, Victoria, Australia.
BMJ Glob Health. 2021 Feb;6(2). doi: 10.1136/bmjgh-2020-004042.
Multimorbidity is a growing challenge in low-income and middle-income countries. This study investigates the effects of multimorbidity on annual medical costs and the out-of-pocket expenditures (OOPEs) along the cost distribution.
Data from the nationally representative China Health and Retirement Longitudinal Study (CHARLS 2015), including 10 592 participants aged ≥45 years and 15 physical and mental chronic diseases, were used for this nationally representative cross-sectional study. Quantile multivariable regressions were employed to understand variations in the association of chronic disease multimorbidity with medical cost and OOPE.
Overall, 69.5% of middle-aged and elderly Chinese had multimorbidity in 2015. Increased number of chronic diseases was significantly associated with greater health expenditures across every cost quantile groups. The effect of chronic diseases on total medical cost was found to be larger among the upper tail than those in the lower tail of the cost distributions (coefficients 12, 95% CI 6 to 17 for 10th percentile; coefficients 296, 95% CI 71 to 522 for 90th percentile). Annual OOPE also increased with chronic diseases from the 10th percentile to the 90th percentile. Multimorbidity had larger effects on OOPE and was more pronounced at the upper tail of the health expenditure distribution (regression coefficients of 8 and 84 at the 10th percentile and 75th percentile, respectively).
Multimorbidity is associated with escalating healthcare costs in China. Further research is required to understand the impact of multimorbidity across different population groups.
多病共存是低收入和中等收入国家面临的一个日益严峻的挑战。本研究旨在探讨多病共存对年度医疗费用以及费用分布中自付支出（out-of-pocket expenditures，OOPEs）的影响。
本研究采用全国代表性的中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）2015 年的数据，纳入了 10592 名年龄≥45 岁的参与者和 15 种身心慢性疾病，进行了这项全国代表性的横断面研究。采用分位数多变量回归来了解慢性病多病共存与医疗费用和 OOPE 之间关联的变化。
2015 年，中国中老年人群总体多病共存率为 69.5%。随着慢性病数量的增加，各费用分位数组的健康支出均显著增加。与较低费用分位组相比，慢性病对总医疗费用的影响在费用分布的较高尾部更大（第 10 分位数的系数为 12，95%置信区间为 6 至 17；第 90 分位数的系数为 296，95%置信区间为 71 至 522）。自付支出也随着慢性病从第 10 分位到第 90 分位而增加。多病共存对 OOPE 的影响更大，且在医疗支出分布的较高尾部更为明显（第 10 分位和第 75 分位的回归系数分别为 8 和 84）。
多病共存与中国医疗费用的不断增加有关。需要进一步研究以了解多病共存对不同人群的影响。
