TY - JOUR
T1 - Catastrophic health expenditure among Chinese adults living alone with cognitive impairment
T2 - findings from the CHARLS
AU - Li, Chenxi
AU - Jin, Shuyi
AU - Cao, Xingqi
AU - Han, Ling
AU - Sun, Ning
AU - Allore, Heather
AU - Hoogendijk, Emiel O.
AU - Xu, Xin
AU - Feng, Qiushi
AU - Liu, Xiaoting
AU - Liu, Zuyun
N1 - Funding Information: This research was supported by two grants from the National Natural Science Foundation of China (82171584 and 72004201), the 2020 Milstein Medical Asian American Partnership Foundation Irma and Paul Milstein Program for Senior Health project award (ZL), fundings from Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province (2020E10004), and Zhejiang University Global Partnership Fund (188170–11103). The data used in this study are from the China Health and Retirement Longitudinal Study (CHARLS). We thank the National Institute on Aging (NIA) in the United States (1-R21-AG031372–01, 1-R21-AG033675–01-A1, 1-R01-AG037031–01 and 1-R01-AG037031-03S1, HGA and LH who contributed from the Yale Claude D. Pepper Older Americans Independence Center P30AG021342, R33AG045050, P30AG066508), the National Natural Science Foundation of China (70773002, 70910107022 and 71130002), and the World Bank (7159234) for their support for the CHARLS. The funders had no role in the study design; data collection, analysis, or interpretation; in the writing of the report; or in the decision to submit the article for publication. Publisher Copyright: © 2022, The Author(s).
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
KW - Aged
KW - Catastrophic Illness/epidemiology
KW - China/epidemiology
KW - Cognitive Dysfunction/diagnosis
KW - Health Expenditures
KW - Home Environment
KW - Humans
KW - Longitudinal Studies
KW - Retirement
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85135501884&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/35922775
U2 - https://doi.org/10.1186/s12877-022-03341-8
DO - https://doi.org/10.1186/s12877-022-03341-8
M3 - Article
C2 - 35922775
SN - 1471-2318
VL - 22
JO - BMC geriatrics
JF - BMC geriatrics
IS - 1
M1 - 640
ER -