Multimorbidity, Health Service Use and Catastrophic Health Expenditure by Socio-Economic Groups in China: A Panel Data Analysis

Background: Multimorbidity, which is the presence of two or more chronic non-communicable diseases (NCDs), is a growing challenge for the health system in China, which faces unprecedented ageing of its population. This study examined: (1) the distribution of multimorbidity in relation to economic status; (2) the relationships between multimorbidity, healthcare service use, and catastrophic health expenditures (CHE); and (3), whether these relationships varied by economic groups and social health insurance schemes in China. Methods: We used data from the three waves of the nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011-15), including 11 718 participants aged ≥50 years, and applied random-effects logistic regression to examine the socio-demographic correlates of multimorbidity. Random-effects negative binomial models were used to assess the relationship between the number of NCDs and health service use. Random-effects logistic regression models were used to estimate the impact of multimorbidity on CHE. Findings: Overall, 62% of participants had multimorbidity in China in 2015. The onset of multimorbidity occurred 5 to 10 years earlier in people belonging to the wealthiest socio-economic quartile group compared with the lowest. A higher number of chronic diseases was associated with more frequent health service use for both outpatient visits (Coefficient=0·25, 95% CI=0·24, 0·27) and days of hospitalisation (Coefficient=0·32, 95% CI=0·30, 0·34). There were similar effects from different socioeconomic groups and among those covered by different social health insurance programmes. Overall, multimorbidity was associated with a substantially higher likelihood of experiencing CHE (Adjusted OR=1·29 for the overall population, 95% CI=1·26, 1·32). The effect of multimorbidity on CHE persisted even among the most affluent population and those with the more generous health insurance coverage. Interpretation: Concerted efforts are needed to reduce health inequalities due to multimorbidity, and its adverse economic impact in population groups in China. Multimorbidity is associated with higher levels of health service use and a greater financial burden in China. Social health insurance reforms must place greater emphasis on reducing out-of-pocket spending for patients with multiple chronic conditions to provide greater financial risk protection to those at risk of high out-of-pocket spending due to multimorbidity. Funding: None. Declaration of Interests: We declare no competing interests. Ethical Approval Statement: The Biomedical Ethics Review Committee of Peking University approved the CHARLS study, and all interviewees were required to provide informed consent. The ethical approval number was IR1052–11015.