Catastrophic Health Expenditure Associated With Frailty in Community-Dwelling Chinese Older Adults: A Prospective Cohort Analysis

Abstract

Background: Catastrophic health expenditure (CHE) represents a key indicator for excessive financial burden due to out-of-pocket (OOP) healthcare costs, which could push the household into poverty and is highly pronounced in households with members at an advanced age. Previous studies have been devoted to understanding the determinants for CHE, yet little evidence exists on its association with frailty, an important geriatric syndrome attracting growing recognition. We thus aim to examine the relationship between frailty and CHE and to explore whether this effect is moderated by socioeconomic-related factors.Methods: A total of 3,277 older adults were drawn from two waves (2011 and 2013) of the China Health and Retirement Longitudinal Study (CHARLS). CHE was defined when OOP healthcare expenditure exceeded a specific proportion of the capacity of the household to pay. Frailty was measured following the Fried Phenotype (FP) scale. Mixed-effects logistic regression models were employed to assess the longitudinal relationship between frailty and CHE, and stratification analyses were conducted to explore the moderation effect.Results: The incidence of CHE among Chinese community-dwelling older adults was 21.76% in 2011 and increased to 26.46% in 2013. Compared with non-frail individuals, prefrail or frail adults were associated with higher odds for CHE after controlling for age, gender, residence, education, marriage, income, health insurance, smoking, drinking, and comorbidity (prefrail: odds ratio (OR) = 1.32, 95%CI = 1.14–1.52; frail: OR = 1.67, 95%CI = 1.13–2.47). Three frailty components including weakness, exhaustion, and shrinking contributed to a significantly increased likelihood of CHE (all p < 0.05), while the other two components including slowness and inactivity showed a non-significant effect (all p > 0.05). Similar effects from frailty on CHE were observed across socioeconomic-related subgroups differentiated by gender, residence, education, household income, and social health insurance.Conclusions: Frailty is a significant predictor for CHE in China. Developing and implementing cost-effective strategies for the prevention and management of frailty is imperative to protect households from financial catastrophe.

Is Co-Occurrence of Frailty and Multimorbidity Associated with Increased Risk of Catastrophic Health Expenditure? A Prospective Cohort Analysis in China

“…Noticeably, frailty is characterised as systemic, dynamic, and reversible. 4,12 Thus, certain intervention measures can be taken to prevent early occurrence of frailty, control its progress, or promote recovery to potentially lead to cost savings. This can provide policy makers with clear evidence of the 364 requirement for certain interventions to prevent and control frailty.…”

“…[8][9][10] Jin et al examined the association between frailty and healthcare expenditure among Chinese older adults, and found that frailty was associated with higher odds of incurring outpatient, inpatient, and self-treatment expenditure. 11 Fan et al found that prefrail or frail adults were associated with higher odds for CHE through a prospective cohort analysis 12 in one of the first studies to explore the association between frailty and CHE in China. However, the study period was relatively short (2011)(2012)(2013).…”

Publicly Funded Health Insurance & the Extent of Out-of-pocket Expenditure among the Elderly in India

“…Increased healthcare needs coupled with nancial dependency pushes the families of the elderly into catastrophe [16,17,18]. Fan et al [19] estimated that the incidence of catastrophic health expenditure (CHE) increased to 27 per cent in 2013 from 22 per cent in 2011 for the elderly in China. It is also found that elderly people suffering from non-communicable diseases are more exposed to CHE even with advanced risk pooling mechanism [17].…”

Groningen Frailty Indicator–Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy

“…Using validated tools to identify pre-frail/frail older people is an essential step in estimating the community need and hence the formulation of preventative services [16][17][18]. Various frailty screening tools are available, but no tool has been developed for the Asia-Pacific region [12,14].…”