Measurement of catastrophic health expenditures in households with essential hypertension and type 2 diabetes mellitus in cold regions of China.

IF 3.3 3区经济学 Q1 ECONOMICS

Health Economics Review Pub Date : 2025-10-14 DOI:10.1186/s13561-025-00678-9

Haofei Li, Xiangjin Cui, Yiyin Cao, Xu Jin, Jiaxuan Shi, Lei Leng, Lijun Xu, Tiemin Zhai, Weidong Huang

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Abstract

Objective: This study examines the incidence, intensity, and inequality of catastrophic health expenditure (CHE) among households with hypertension and type 2 diabetes mellitus (T2DM) in cold regions of China. It also explores key drivers of CHE and compares across diseases.

Methods: Using data from the 2023 Seventh Health Services Survey in Heilongjiang Province, this study applies the World Health Organization's (WHO) normative algorithm for basic food needs to analyze CHE incidence, average gap (G_cat), and mean positive gap (MPG) in 1,051 hypertension households and 294 T2DM households. The concentration curve and concentration index (CI) are used to quantify CHE inequality. Key drivers of CHE are analyzed through univariate analysis, Logistic regression, and Tobit regression models.

Results: The CHE incidence for hypertension and T2DM households were 31.11% and 34.69%, respectively. The G_cat was 6.38% for hypertension households and 7.02% for T2DM households, while the MPG was 20.51% and 20.24%, respectively. The CI for hypertension and T2DM households were - 0.2541 and - 0.2762. CHE decreased as economic status improved but increased with the number of chronic conditions. Under different CHE thresholds, the incidence and G_cat of CHE in T2DM households are generally higher than in hypertension households, but the MPG in hypertension households is slightly higher than in T2DM households. Determinant analysis revealed that low household economic status, multiple chronic conditions, and utilization of outpatient and inpatient services are significant drivers of CHE in chronic disease households, while being employed and having a larger household size are important protective factors.

Conclusion: Households with hypertension and T2DM in cold regions of China face a high risk of CHE, particularly among those with lower economic status. There is a pressing need for a more equitable healthcare financing system and improved management of chronic diseases in these populations.

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中国寒区原发性高血压和2型糖尿病家庭灾难性医疗支出的测量

目的：研究中国寒区高血压合并2型糖尿病（T2DM）家庭灾难性医疗支出（CHE）的发生率、强度和不公平性。它还探讨了CHE的关键驱动因素，并对不同疾病进行了比较。方法：利用黑龙江省2023年第七次卫生服务调查数据，应用世界卫生组织（WHO）基本食物需求规范算法，对1051户高血压家庭和294户T2DM家庭的CHE发生率、平均缺口（Gcat）和平均阳性缺口（MPG）进行分析。使用浓度曲线和浓度指数（CI）来量化CHE不平等。通过单变量分析、Logistic回归和Tobit回归模型，分析了中国经济发展的主要驱动因素。结果：高血压和T2DM家庭CHE发病率分别为31.11%和34.69%。高血压家庭Gcat为6.38%，T2DM家庭Gcat为7.02%，MPG分别为20.51%和20.24%。高血压和T2DM家庭的CI分别为- 0.2541和- 0.2762。CHE随着经济状况的改善而下降，但随着慢性病数量的增加而增加。在不同CHE阈值下，T2DM家庭CHE的发生率和Gcat均高于高血压家庭，但高血压家庭的MPG略高于T2DM家庭。决定因素分析显示，低家庭经济状况、多种慢性病以及门诊和住院服务的利用是慢性病家庭CHE的重要驱动因素，而就业和家庭规模较大是重要的保护因素。结论：在中国的寒冷地区，患有高血压和2型糖尿病的家庭面临较高的CHE风险，特别是在经济地位较低的家庭中。迫切需要建立一个更加公平的卫生保健筹资系统，并改善这些人群的慢性病管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Economics Review Multiple-

CiteScore

3.90

自引率

4.20%

发文量

审稿时长

13 weeks

期刊介绍： Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.