Analysis of the difference of urban and rural catastrophic health expenditure between middle-aged and elderly co-patients in China—study based from a cross-sectional analysis of CHARLS 2020 (Preprint)

BACKGROUND The aim of this study is to investigate the factors influencing the disparity in catastrophic health expenditure (CHE) among middle-aged and elderly individuals with multiple chronic conditions in urban and rural areas of China, as well as to measure the contributions of these influencing factors. OBJECTIVE Elderly individuals with multiple chronic conditions represent a high-risk population burdened with significant healthcare expenses. This study focused on exploring this population and identifying the independent factors contributing to catastrophic health expenditure among them. This study aimed to identify the factors and contribution levels of the dual urban-rural disparities in catastrophic health expenditure among elderly individuals with multiple chronic conditions in China through decomposition analysis. This study presented strategies to reduce the risk of catastrophic health expenditure among this population and mitigate urban-rural disparities, aiming to alleviate the burden of healthcare expenses. METHODS This study aims to construct a binary logistic regression model to examine the primary factors influencing catastrophic health expenditure (CHE), and to utilize the Fairlie model to analyze the factors and contributions affecting the disparities in catastrophic health expenditure (CHE) among middle-aged and elderly individuals with multiple chronic conditions in urban and rural areas. RESULTS In Chinese, the prevalence of catastrophic health expenditure (CHE) in households with middle-aged and elderly individuals with multiple chronic conditions is 54.8%. The proportion of households experiencing catastrophic health expenditure (CHE) in rural areas (57.7%) is higher than in urban areas (49.5%). The established Fairlie model has an explanatory power of 90.21%. The main factors contributing to the disparities in catastrophic health expenditure (CHE) among middle-aged and elderly individuals with multiple chronic conditions in urban and rural areas are primarily related to household economic status (-64.16%), self-rated health (-15.71%), hospitalization in the past year (-8.23%), activities of daily living (-2.98%), marital status (-2.18%), physical activity (-1.90%), outpatient visits in the past month (-1.84%), household size (-1.83%), age (-1.74%), alcohol consumption (-1.63%), number of chronic conditions (1.20%), and geographic location (0.73%). CONCLUSIONS The study found that the prevalence of catastrophic health expenditure (CHE) among middle-aged and elderly individuals with multiple chronic conditions is higher in rural areas of China compared to urban areas. This difference is mainly attributed to disparities in household economic status, household size, health condition, lifestyle, and hospitalization between urban and rural residents. The Chinese government should pay close attention to households with middle-aged and elderly individuals with multiple chronic conditions in both urban and rural areas, and take measures to improve fairness in catastrophic health expenditure (CHE) for this population.