Economic burden of comorbid chronic conditions among survivors of stroke in China: 10-year longitudinal study

Abstract

Background The 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. Methods We 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). Results Among 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. Conclusions Excess 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.

The Differences of Metabolites in Different Parts of the Brain Induced by Shuxuetong Injection against Cerebral Ischemia-Reperfusion and Its Corresponding Mechanism

“…It is an acute cerebrovascular disease that can seriously harm human health. IS is characterized by poor prognosis and easy coexistence with other chronic diseases, bringing severe psychological and economic burden to patients around the world [ 1 ]. The core treatment of IS is to unclog blocked blood vessels, but even after the unclog is completed, there are still risks like cerebral ischemic-reperfusion (CIR) injury [ 2 ].…”

Comparative efficacy of 5 non-pharmacological therapies for adults with post-stroke cognitive impairment: A Bayesian network analysis based on 55 randomized controlled trials

“…According to the “Global Stroke Fact Sheet 2022” ( 10 ) published by the World Stroke Organization (WSO), reporting that stroke remains the second leading cause of death and the third leading cause of death and disability combined in the world. Although the development of effective acute treatments has resulted in global trends showing improvement in stroke outcomes ( 24 ), PSCI remains highly prevalent ( 25 , 26 ) and associated closely with disability, dependency, and morbidity ( 6 , 27 ), posing a major burden to patients, caregivers, and health care systems ( 8 , 9 ). Thus, viable treatments are needed critically to help slow or stop the progression of PSCI.…”

“…Disruptions in advanced brain functions such as attention, language, memory, executive, and visuospatial function are the most common symptoms of PSCI, which not only have a negative impact on patients' activities of daily living and overall rehabilitation ( 4 – 6 ) but also linked closely to a higher risk of recurrent ischemic stroke ( 7 ) and a lower 5-year survival rate ( 2 ). In addition, the ongoing care and support needs required by PSCI patients are closely related to the increased physical and psychological burden of family caregivers ( 8 ) and the medical and economic burden on society ( 9 ). To sum up, PSCI has become a major public health concern that has to be addressed promptly as the great burden of stroke continues to climb ( 10 , 11 ).…”

Trends and Comparisons of Blood Pressure and Fasting Plasma Glucose in Patients with Hypertension, Diabetes, and Comorbidity: 4-Year Follow-Up Data

“…Our findings highlight the significant improvement in the FPG control rate in diabetic patients but also point out the unsatisfactory BP control rate in comorbid patients, which can provide a reference for the long-term development of FPG and BP under this program and further explore the deeper reasons for poor control, such as self-management ability and economic burden of patients. 41 , 42 …”

“…Our findings highlight the significant improvement in the FPG control rate in diabetic patients but also point out the unsatisfactory BP control rate in comorbid patients, which can provide a reference for the longterm development of FPG and BP under this program and further explore the deeper reasons for poor control, such as self-management ability and economic burden of patients. 41,42 No significant decrease in FPG levels was observed during the follow-up regardless of whether diabetic patients had comorbid hypertension, which might be explained by fluctuations in FPG that make it difficult to control at a stable low level and the large rise in FPG in the non-compliant records. Similar problems were reported in previous studies.…”