Abstract
BackgroundThe coexistence of chronic diseases among people with stroke is common. However, little is known about the extent of incremental healthcare expenditures associated with having physically and psychologically chronic conditions among stroke survivors.MethodsWe used the nationally representative data from the China Health and Nutrition Survey, including 36,076 participants enrolled as our analytic cohort of ten years of follow-up visits (2006, 2009, 2011, 2015). Chronic conditions include hypertension, diabetes, obesity, and impaired cognitive function. Two-part models were used to estimate the effect of comorbid chronic conditions on total annual healthcare expenditure, out-of-pocket (OOP) healthcare expenditure, and incidence of catastrophic healthcare expenditure (CHE).ResultsAmong survivors of stroke during 2006 to 2015, the prevalence rates of hypertension, diabetes, obesity and impaired cognitive function were 75.5, 9.8, 12.7 and 65.1%, significantly higher than those among adults without stroke history (27.9, 2.7, 10.0 and 41.2%). Having hypertension ($794.5, p = 0.004), diabetes ($3978.5, p < 0.001) were associated with the largest incremental total healthcare expenditures. Stroke survivors with diagnosed hypertension and diabetes had additional 5.7 (p < 0.001) and 10.4 (p < 0.001) percentage point of CHE rate, respectively. Total healthcare expenditures were $2413.0 (P < 0.001) and $5151.7 (P < 0.001) higher among patients with 2, and ≥ 3 chronic conditions, respectively, than those individuals with no chronic conditions.ConclusionsExcess expenditures associated with chronic diseases were substantial among stroke survivors. These results highlight the needs for both prevention and better management of multimorbidity among stroke survivors, which in turn may lower the financial burden of treating these concurrent comorbidities.
Highlights
Stroke is the leading cause of death in China, which accounted for about one-third of worldwide stroke mortality [1]
This study aimed to examine the prevalence of comorbid chronic conditions among stroke survivors and those without a history of stroke, and to estimate the effect of comorbidities on medical care costs and incidence of catastrophic health expenditures among survivors of stroke in China
Prevalence of comorbid chronic conditions Compared with individuals without a history of stroke, survivors of stroke had higher proportion of individuals aged≥55 years (88.6% vs 39.8%), higher percentage of lower household income per capita (42.4% vs 34.9%), higher percentage of having primary/illiterate education (61.1% vs 40.8%), and lower rate of being employed (17.7% vs 57.4%)
Summary
Stroke is the leading cause of death in China, which accounted for about one-third of worldwide stroke mortality [1]. A notable trend among the stroke survivors is the rising coexistence with chronic conditions, including cardiovascular and psychological conditions [3] Such coexistence imposes a considerable financial burden on individuals and families, as a result of increased healthcare use and costs, work productivity loss, and reduced income. Understanding the prevalence and burden of comorbidities in stroke survivors is an important consideration for national efforts to improve care and cost containment in this population. This information can help optimize health and quality of life among the growing population of people with multiple (two or more) chronic conditions. Little is known about the extent of incremental healthcare expenditures associated with having physically and psychologically chronic conditions among stroke survivors
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