Catastrophic health expenditure associated with frailty in community-dwelling Chinese older adults: a prospective cohort analysis

Fan, Lijun and Hou, Xiang-Yu and Liu, Yingyan and Chen, Sunan and Wang, Qian and Du, Wei (2021) Catastrophic health expenditure associated with frailty in community-dwelling Chinese older adults: a prospective cohort analysis. Frontiers in Public Health, 9:718910. pp. 1-10.

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Abstract

Background: Catastrophic health expenditure (CHE) represents a key indicator for excessive financial burden due to out-of-pocket (OOP) healthcare costs, which could push the household into poverty and is highly pronounced in households with members at an advanced age. Previous studies have been devoted to understanding the determinants for CHE, yet little evidence exists on its association with frailty, an important geriatric syndrome attracting growing recognition. We thus aim to examine the relationship between frailty and CHE and to explore whether this effect is moderated by socioeconomic-related factors.

Methods: A total of 3,277 older adults were drawn from two waves (2011 and 2013) of the China Health and Retirement Longitudinal Study (CHARLS). CHE was defined when OOP healthcare expenditure exceeded a specific proportion of the capacity of the household to pay. Frailty was measured following the Fried Phenotype (FP) scale. Mixed-effects logistic regression models were employed to assess the longitudinal relationship between frailty and CHE, and stratification analyses were conducted to explore the moderation effect.

Results: The incidence of CHE among Chinese community-dwelling older adults was 21.76% in 2011 and increased to 26.46% in 2013. Compared with non-frail individuals, prefrail or frail adults were associated with higher odds for CHE after controlling for age, gender, residence, education, marriage, income, health insurance, smoking, drinking, and comorbidity (prefrail: odds ratio (OR) = 1.32, 95%CI = 1.14–1.52; frail: OR = 1.67, 95%CI = 1.13–2.47). Three frailty components including weakness, exhaustion, and shrinking contributed to a significantly increased likelihood of CHE (all p < 0.05), while the other two components including slowness and inactivity showed a non-significant effect (all p > 0.05). Similar effects from frailty on CHE were observed across socioeconomic-related subgroups differentiated by gender, residence, education, household income, and social health insurance.

Conclusions: Frailty is a significant predictor for CHE in China. Developing and implementing cost-effective strategies for the prevention and management of frailty is imperative to protect households from financial catastrophe.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Specialty section: This article was submitted to Aging and Public Health, a section of the journal Frontiers in Public Health. Copyright © 2021 Fan, Hou, Liu, Chen, Wang and Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Health and Wellbeing (1 Jan 2015 -)
Faculty/School / Institute/Centre: Current - Institute for Resilient Regions - Centre for Health Research (1 Apr 2020 -)
Date Deposited: 09 Sep 2021 05:37
Last Modified: 09 Sep 2021 05:37
Uncontrolled Keywords: health expenditure, frailty, older adults, China
Fields of Research (2008): 11 Medical and Health Sciences > 1117 Public Health and Health Services > 111706 Epidemiology
11 Medical and Health Sciences > 1117 Public Health and Health Services > 111708 Health and Community Services
11 Medical and Health Sciences > 1117 Public Health and Health Services > 111709 Health Care Administration
Fields of Research (2020): 42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems
42 HEALTH SCIENCES > 4202 Epidemiology > 420210 Social epidemiology
42 HEALTH SCIENCES > 4203 Health services and systems > 420305 Health and community services
Socio-Economic Objectives (2008): C Society > 94 Law, Politics and Community Services > 9401 Community Service (excl. Work) > 940103 Ageing and Older People
C Society > 92 Health > 9204 Public Health (excl. Specific Population Health) > 920412 Preventive Medicine
C Society > 94 Law, Politics and Community Services > 9401 Community Service (excl. Work) > 940101 Ability and Disability
Socio-Economic Objectives (2020): 20 HEALTH > 2002 Evaluation of health and support services > 200201 Determinants of health
23 LAW, POLITICS AND COMMUNITY SERVICES > 2301 Community services > 230102 Ageing and older people
20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200502 Health related to ageing
Identification Number or DOI: https://doi.org/10.3389/fpubh.2021.718910
URI: http://eprints.usq.edu.au/id/eprint/43530

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