Abstract
BackgroundSome previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. The purpose of this study is to compare the incidence and determinants of CHE between hypertensive patients with and without complications.MethodsData of this study were from a cross-sectional study in Shandong Province in China in 2016. Of the recruited 3457 hypertensive patients registered in the NCDs management system in the sampling villages, 3113 completed the survey, with a response rate of 90.05%.CHE was defined as out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay (non-food expenditure). Hypertension complications (e.g., stroke, coronary heart disease, hypertensive kidney disease, etc.) were collected in this study, which was categorized into 0 (no), 1(single), and 2 and more according to the types of hypertensive complications. We employed Chi-square test to explore associated factors and logistic regression model to identify the determinants of CHE.ResultsThe incidence of CHE and impoverishment is 13.6 and 10.8% among hypertensive patients. The incidence of CHE with one complication is 25.3% (Ρ = 0.000, OR = 2.29) and 47.3% (P = 0.000, OR = 3.60) in patients with two or more complications, which are both statistically higher than that in patients without complication (6.1%). Across all types of patients, income levels are inversely related to the incidence of CHE. Patients who use outpatient or inpatient service are more likely to experience CHE (Ρ = 0.000). Factors including living arrangements, family size, educational attainment are found to be significantly associated with CHE in some subgroups (Ρ <0.05).ConclusionsCHE and impoverishment incidence among hypertensive patients are both high in rural China. Patients with hypertensive complication are at higher catastrophic risk than those without complication. More attention needs to be paid to households with hypertension patients, especially for those with hypertension complications.
Highlights
Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications
The number of deaths worldwide due to hypertensive complication is 9.4 million, of which 45% die from heart disease, and 51% die from stroke [6]
Incidence of CHE and impoverishment among patients with different numbers of complications Figure 1 presents the incidence of CHE and impoverishment effect for different types of patients, of which the overall incidence of CHE and impoverishment are 13.6 and 10.8% respectively
Summary
Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. Cardiovascular disease is the world’s leading cause of deaths, accounting for one third of the total [1]. Hypertension is one of the major risk factors for cardiovascular disease, which plays a major role in the development of cerebrovascular disease, cardiac and renal failure [2]. About 50% of coronary heart disease and 75% of the burden of cerebrovascular disease are caused by hypertension [3]. Hypertension and its complications are the leading causes of death and disability [5]. The number of deaths worldwide due to hypertensive complication is 9.4 million, of which 45% die from heart disease, and 51% die from stroke [6]. The World Health Organization (WHO) ranks hypertension as one of the top five health risk factors [5]
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