Abstract
AimsThe aim of this study was to determine the association between social determinants of health and direct economic burden on Chinese middle-aged and elderly individuals living with diabetes in China.MethodsThis study used data from the baseline wave of The China Health and Retirement Longitudinal Study (CHARLS) database, covering 17,708 middle-aged and elderly residents in China. The population with diabetes was grouped into those diagnosed with diabetes mellitus (DDM) and those undiagnosed with diabetes mellitus (UDM). Direct economic cost data, including total direct medical costs (TC) and out-of-pocket (OOP) payments, were extracted as outcome variables. A two-part model was applied to analyze the association between social determinants of health and direct economic burden.ResultsIn our analysis, we included 958 patients with DDM and 1,285 patients with UDM. The mean TC and OOP payments were 11,193 CNY (US $1,733; 6.46 CNY = 1 USD) and 7,266 CNY (US $1,125) in DDM patients, and 3,700 CNY (US $573) and 3,060 CNY (US $474) in UDM patients. Rural-urban status (p<0.05), regional status (p<0.05), household personal consumption expenditures (p<0.05), and comorbidities(p<0.05) were crucial factors associated with medical costs in people with diabetes.ConclusionAlthough progress has been made in the development of current health policies intended to contain the direct economic burden of diabetes, the gaps in that burden in populations with different social characteristics remains a burning issue. More policy breakthroughs are needed to achieve health equity.
Highlights
Diabetes mellitus, with a prevalence of 8.5% in the world population, is the eighth leading cause of deaths in the world [1]
Rural-urban status (p
Progress has been made in the development of current health policies intended to contain the direct economic burden of diabetes, the gaps in that burden in populations with
Summary
With a prevalence of 8.5% in the world population, is the eighth leading cause of deaths in the world [1]. China ranks second world-wide in diabetes prevalence, with one quarter of the world’s more than one hundred million patients [2, 3]. The occurrence of diabetes in China is positively related to aging, with a prevalence lower than 3.0% in people younger than 45 years, 11.5% in the middle-age group (ages 45–59 years), and more than 20% in the elderly (ages 60 years) [4, 5]. Half of the individuals with diabetes have at least one comorbid condition, while the situation is more severe in middleaged and elderly patients [7]. Since China had over 280 million people aged 60 years in 2020, research on factors influencing diabetes-related costs is crucial for the development of mechanisms to help the country cope with the booming economic burden faced by individuals with diabetes
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