Catastrophic health expenditure, incidence, trend and socioeconomic risk factors in China: A systematic review and meta-analysis

Fangkai Zhang; Jianjun Jiang; Min Yang; Kun Zou; Dandi Chen

doi:10.3389/fpubh.2022.997694

Catastrophic health expenditure, incidence, trend and socioeconomic risk factors in China: A systematic review and meta-analysis

Front Public Health. 2023 Jan 4:10:997694. doi: 10.3389/fpubh.2022.997694. eCollection 2022.

Authors

Fangkai Zhang^{1

2}, Jianjun Jiang^{1

2}, Min Yang^{1

3

4}, Kun Zou^{5

6

7

8}, Dandi Chen^{1

2}

Affiliations

¹ West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
² Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, Sichuan, China.
³ West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan, China.
⁴ Faculty of Health, Art and Design, Swinbune Technology University, Melbourne, VIC, Australia.
⁵ Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
⁶ Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
⁷ NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China.
⁸ Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.

Abstract

Objective: To evaluate the incidence and trend of catastrophic health expenditures (CHE) in China over the past 20 years and explore the socioeconomic factors affecting China's CHE rate.

Methods: The systematic review was conducted according to the Cochrane Handbook and reported according to PRISMA. We searched English and Chinese literature databases, including PubMed, EMbase, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang, China Science and Technology Journal Database (CQVIP), and CBM (Sino Med), for empirical studies on the CHE rate in China and its associated socioeconomic factors from January 2000 to June 2020. Two reviewers conducted the study selection, data extraction, and quality appraisal. The secular trend of the CHE rate was examined, and factors associated with CHE were explored using subgroup analysis and meta-regression.

Results: A total of 118 eligible studies with 1,771,726 participants were included. From 2000 to 2020, the overall CHE rate was 25.2% (95% CI: 23.4%-26.9%) in China. The CHE rate continued to rise from 13.0% in 2000 to 32.2% in 2020 in the general population. The CHE rate was higher in urban areas than in rural areas, higher in the western than the northeast, eastern, and central region, in the elderly than non-elderly, in low-income groups than non-low-income groups, in people with cancer, chronic infectious disease, and cardio-cerebrovascular diseases (CCVD) than those with non-chronic disease group, and in people with NCMS than those with URBMI and UEBMI. Multiple meta-regression analyses found that low-income, cancer, CCVD, unspecified medical insurance type, definition 1 and definition 2 were correlated with the CHE rate, while other factors were all non-significantly correlated.

Conclusion: In the past two decades, the CHE rate in China has been rising. The continuous rise of health expenditures may be an important reason for the increasing CHE rate. Age, income level, and health status affect the CHE rate. Therefore, it is necessary to find ways to meet the medical needs of residents and, at the same time, control the unreasonable rapid increase in health expenditures in China.

Keywords: catastrophic health expenditure; influencing factors; meta-analysis; social-economic risk factors; systematic review.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

China / epidemiology
Family Characteristics
Health Expenditures*
Humans
Incidence
Income*
Insurance, Health
Middle Aged
Risk Factors
Rural Population
Socioeconomic Factors