West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, Sichuan, China.
Front Public Health. 2023 Jan 4;10:997694. doi: 10.3389/fpubh.2022.997694. eCollection 2022.
To evaluate the incidence and trend of catastrophic health expenditures (CHE) in China over the past 20 years and explore the socioeconomic factors affecting China's CHE rate.
The systematic review was conducted according to the Cochrane Handbook and reported according to PRISMA. We searched English and Chinese literature databases, including PubMed, EMbase, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang, China Science and Technology Journal Database (CQVIP), and CBM (Sino Med), for empirical studies on the CHE rate in China and its associated socioeconomic factors from January 2000 to June 2020. Two reviewers conducted the study selection, data extraction, and quality appraisal. The secular trend of the CHE rate was examined, and factors associated with CHE were explored using subgroup analysis and meta-regression.
A total of 118 eligible studies with 1,771,726 participants were included. From 2000 to 2020, the overall CHE rate was 25.2% (95% CI: 23.4%-26.9%) in China. The CHE rate continued to rise from 13.0% in 2000 to 32.2% in 2020 in the general population. The CHE rate was higher in urban areas than in rural areas, higher in the western than the northeast, eastern, and central region, in the elderly than non-elderly, in low-income groups than non-low-income groups, in people with cancer, chronic infectious disease, and cardio-cerebrovascular diseases (CCVD) than those with non-chronic disease group, and in people with NCMS than those with URBMI and UEBMI. Multiple meta-regression analyses found that low-income, cancer, CCVD, unspecified medical insurance type, definition 1 and definition 2 were correlated with the CHE rate, while other factors were all non-significantly correlated.
In the past two decades, the CHE rate in China has been rising. The continuous rise of health expenditures may be an important reason for the increasing CHE rate. Age, income level, and health status affect the CHE rate. Therefore, it is necessary to find ways to meet the medical needs of residents and, at the same time, control the unreasonable rapid increase in health expenditures in China.
评估过去 20 年中国灾难性卫生支出（CHE）的发生率和趋势，并探讨影响中国 CHE 率的社会经济因素。
本系统评价按照 Cochrane 手册进行，并根据 PRISMA 进行报告。我们检索了英文和中文文献数据库，包括 PubMed、EMbase、Web of Science、中国国家知识基础设施（CNKI）、万方、中国科技期刊数据库（CQVIP）和中国生物医学文献数据库（Sino Med），以获取 2000 年 1 月至 2020 年 6 月期间中国 CHE 率及其相关社会经济因素的实证研究。两名评审员进行了研究选择、数据提取和质量评估。我们还检验了 CHE 率的时间趋势，并通过亚组分析和荟萃回归探讨了与 CHE 相关的因素。
共有 118 项符合条件的研究，涉及 1771726 名参与者。2000 年至 2020 年，中国的总体 CHE 率为 25.2%（95%CI：23.4%-26.9%）。普通人群的 CHE 率从 2000 年的 13.0%持续上升至 2020 年的 32.2%。城市地区的 CHE 率高于农村地区，西部地区高于东北地区、东部地区和中部地区，老年人高于非老年人，低收入群体高于非低收入群体，患有癌症、慢性传染病和心血管疾病（CCVD）的人群高于非慢性疾病组，以及参加新型农村合作医疗的人群高于参加城镇职工基本医疗保险和城镇居民基本医疗保险的人群。多项荟萃回归分析发现，低收入、癌症、CCVD、未特指医疗保险类型、定义 1 和定义 2 与 CHE 率相关，而其他因素均与 CHE 率无显著相关性。
在过去的 20 年中，中国的 CHE 率一直在上升。卫生支出的持续增长可能是 CHE 率上升的一个重要原因。年龄、收入水平和健康状况影响 CHE 率。因此，有必要寻找满足居民医疗需求的方法，同时控制中国卫生支出不合理的快速增长。
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