Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Zhejiang, 310058, Hangzhou, China.
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
BMC Geriatr. 2022 Aug 4;22(1):640. doi: 10.1186/s12877-022-03341-8.
The catastrophic health expenditure of older adults results in serious consequences; however, the issue of whether cognitive status and living situations contribute to such financial burdens is uncertain. Our aim was to compare the differences in catastrophic health expenditure between adults living alone with cognitive impairment and those adults living with others and with normal cognition.
We identified 909 observations of participants living alone with cognitive impairment (cases) and 37,432 observations of participants living with others and with normal cognition (comparators) from the 2011/2012, 2013, 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We used propensity score matching (1:2) to create matched cases and comparators in a covariate-adjusted logistic regression analysis. Catastrophic health expenditure was defined as an out-of-pocket cost for health care ≥40% of a household's capacity to pay.
In comparison with participants living with others and with normal cognition, those adults living alone with cognitive impairment reported a higher percentage of catastrophic health expenditure (19.5% vs. 11.8%, respectively, P < 0.001). When controlling for age, sex, education, marital status, residence areas, alcohol consumption, smoking status and disease counts, we found that this subpopulation had significantly higher odds of having catastrophic health expenditure (odds ratio [OR] = 1.89, 95% confidence interval [CI]: 1.40, 2.56). Additional analyses confirmed the robustness of the results.
This study demonstrated that adults living alone with cognitive impairment in the CHARLS experienced a high burden of catastrophic health expenditure. Health care policies on social health insurance and medical assistance should consider these vulnerable adults.
老年人灾难性卫生支出会产生严重后果；然而，认知状态和生活状况是否会导致这种经济负担尚不确定。我们的目的是比较认知障碍的独居成年人与认知正常且与他人一起生活的成年人之间灾难性卫生支出的差异。
我们从中国健康与养老追踪调查（CHARLS）2011/2012 年、2013 年、2015 年和 2018 年的四个波次中，共确定了 909 例认知障碍独居成年人（病例）和 37432 例与他人一起生活且认知正常的成年人（对照组）的观察值。我们使用倾向评分匹配（1:2）在协变量调整的逻辑回归分析中创建匹配的病例和对照组。灾难性卫生支出被定义为医疗保健自付费用超过家庭支付能力的 40%。
与认知正常且与他人一起生活的成年人相比，认知障碍的独居成年人报告灾难性卫生支出的比例更高（分别为 19.5%和 11.8%，P<0.001）。在控制年龄、性别、教育程度、婚姻状况、居住地区、饮酒、吸烟状况和疾病数量后，我们发现该人群发生灾难性卫生支出的可能性显著更高（比值比 [OR] = 1.89，95%置信区间 [CI]：1.40，2.56）。进一步的分析证实了结果的稳健性。
本研究表明，CHARLS 中的认知障碍独居成年人经历了灾难性卫生支出的高负担。社会医疗保险和医疗救助的卫生保健政策应考虑这些弱势群体。
