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

Article


Fan, Lijun, Hou, Xiang-Yu, Liu, Yingyan, Chen, Sunan, 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, pp. 1-10. https://doi.org/10.3389/fpubh.2021.718910
Article Title

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

ERA Journal ID200526
Article CategoryArticle
AuthorsFan, Lijun (Author), Hou, Xiang-Yu (Author), Liu, Yingyan (Author), Chen, Sunan (Author), Wang, Qian (Author) and Du, Wei (Author)
Journal TitleFrontiers in Public Health
Journal Citation9, pp. 1-10
Article Number718910
Number of Pages10
Year2021
PublisherFrontiers Media SA
Place of PublicationSwitzerland
ISSN2296-2565
Digital Object Identifier (DOI)https://doi.org/10.3389/fpubh.2021.718910
Web Address (URL)https://www.frontiersin.org/articles/10.3389/fpubh.2021.718910/full
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.

Keywordshealth expenditure, frailty, older adults, China
ANZSRC Field of Research 2020420311. Health systems
420210. Social epidemiology
420305. Health and community services
Public Notes

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.

Institution of OriginUniversity of Southern Queensland
Byline AffiliationsSoutheast University, China
School of Health and Wellbeing
Guangdong Academy of Medical Sciences, China
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