Healthcare utilisation and catastrophic health expenditure among middle-aged and older adults with psychiatric disorders: a nationwide cross-sectional study using CHARLS (2011–2020)

Psychiatric disorders impose substantial economic burdens on affected individuals and healthcare systems, yet the healthcare utilisation patterns and catastrophic health expenditure (CHE) risk among older adults with psychiatric disorders in low- and middle-income countries remain poorly characterised. We aimed to quantify the independent association between psychiatric disorders and healthcare utilisation outcomes, CHE incidence, and unmet healthcare needs among Chinese adults aged 45 years and older. We used data from five waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020), comprising 93,953 individuals aged ≥ 45 years. Healthcare utilisation outcomes included hospitalisation (past year), outpatient visits (past month), CHE (> 40% and > 10% of household consumption as out-of-pocket [OOP] spending), and unmet healthcare need. Multivariable logistic regression with robust standard errors was used to estimate adjusted odds ratios (aORs). Stratified analysis by insurance type was conducted. Compared with non-psychiatric participants, those with psychiatric disorders had higher hospitalisation rates (27.7% vs. 14.6%, aOR = 1.29, 95% CI 1.12–1.48), higher CHE incidence at the 40% threshold (11.9% vs. 5.8%, aOR = 1.33, 95% CI 1.02–1.73), and lower unmet healthcare need (44.7% vs. 47.4%, aOR = 0.63, 95% CI 0.55–0.71). Compared with the rural insurance (aOR = 1.22, P = 0.503) or the uninsured subgroups (aOR = 2.09, P = 0.205), the association between psychiatric disorders and CHE was marginally significant in the urban insurance holders (aOR = 1.52, P = 0.069). The hospitalisation gap between groups widened from 7.7% points in 2011 to 17.2 in 2020. Psychiatric disorders independently increased the risk of hospitalisation and CHE among Chinese older adults, even after accounting for chronic disease multimorbidity. Urban insurance may have a potentially strong association with CHE. Not applicable.