Abstract
Objective: Metabolic diseases have been a clinical challenge worldwide and a major public health issue. Very few studies from China investigated the impact of metabolic multimorbidity on healthcare and health outcomes at the national level. This study aims to examine the association of metabolic multimorbidity with health service utilization, spending, functional and mental health.Materials and Methods: This is a nationally representative cross-sectional study, utilizing the data from the China Health and Retirement Longitudinal Study in 2015, including 11,377 participants aged 45 years and older. Multivariable regression models were used to assess the association of metabolic multimorbidity with healthcare, out-of-pocket expenditure (OOPE), the activities of daily living (ADL) limitation, the instrumental activities of daily living (IADL) limitation, and depression.Results: Overall, 30.50% of total participants had metabolic multimorbidity in 2015 in China. Compared with single disease, metabolic multimorbidity were associated with the number of outpatient visits [incident rate ratio (IRR) = 1.30, 95% CI = 1.05, 1.62] and days of inpatient care (IRR = 1.52, 95% CI = 1.28, 1.81). Metabolic multimorbidity was positively associated with the OOPE on outpatient care (coefficient = 82.99, 95% CI = 17.70, 148.27) and physical functional difficulties, including ADL limitation (odds ratio = 1.36, 95% CI = 1.18, 1.57).Conclusions: Metabolic multimorbidity is associated with higher levels of health-care service use, greater expenditure for outpatient care, and more difficulties in ADL among Chinese adults. China's health-care systems need to shift from single-disease models to new financing and service delivery models to effectively manage metabolic multimorbidity.
Highlights
Metabolic diseases have been a major public health issue and a clinical challenge worldwide, which is linked with the increased risk of cardiovascular diseases [1, 2] and all-cause mortality [3, 4]
While there have been many studies conducted in high-income countries (HICs) on the impacts of chronic disease multimorbidity [10,11,12], this topic is still an emerging area of research inquiry in low-and middle income countries (LMICs)
52.62% were women, 43.10% of the participants were illiterate, 63.18% were residing in rural areas and 82.23% were enrolled in social health insurance schemes
Summary
Metabolic diseases have been a major public health issue and a clinical challenge worldwide, which is linked with the increased risk of cardiovascular diseases [1, 2] and all-cause mortality [3, 4]. While there have been many studies conducted in high-income countries (HICs) on the impacts of chronic disease multimorbidity [10,11,12], this topic is still an emerging area of research inquiry in LMICs. Currently, only a couple of small studies in certain parts of China have examined this issue [13, 14], such as a study focused on Guangdong which looked at the health service utilization arising from multimorbidity of 162,464 subjects [15]. No current study from China has estimated the impact of metabolic multimorbidity on functional limitation and mental health at the national level [16, 17]. This study aims to systemically examine the association of metabolic multimorbidity with healthcare utilization, out-of-pocket expenditure (OOPE), functional health and depression, using nationally representative population-based data
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