Background: An increase in healthcare utilization in response to universal health coverage may leave massive economic burden on individuals and households. Identifying catastrophic health expenditure helps us understand such burden. This study aims to examine the incidence of catastrophic health expenditure at various thresholds, explore its trend over years, and investigate whether it varies across socioeconomic status (SES). Methods: Data used in this study were from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015, and 2018. SES was measured by annual per-capita household expenditure, which was then divided into quintiles (Quintile 1 (Q1): the poorest - Quintile 5 (Q5): the wealthiest). Catastrophic health expenditure was measured at both a fixed threshold (40%) and a set of variable thresholds, where the thresholds for other quintiles were estimated by multiplying 40% by the ratio of average food expenditure in certain quintile to that in the index quintile. Multilevel mixed-effects logistic regression models were used to analyze the determinants of catastrophic health expenditure at various thresholds. Results: A total of 6,953 households were included in our study. The incidence of catastrophic health expenditure varied across the thresholds set. At a fixed threshold, 10.90%, 9.46%, 13.23%, or 24.75% of households incurred catastrophic health expenditure in 2011, 2013, 2015, and 2018, respectively, which were generally lower than those at variable thresholds. Catastrophic health expenditure often decreased from 2011 to 2013, and an increasing trend occurred afterwards. Compared to households in Q5, those in lower quintiles were more likely to suffer catastrophic health expenditure, irrespective of the thresholds set. Similarly, having chronic diseases and healthcare utilization increased the odds of catastrophic health expenditure. Conclusions: The financial protection against catastrophic health expenditure shocks remains a challenge in China, especially for the low-SES and those with chronic diseases. Concerted efforts are needed to further expand health insurance coverage across breadth, depth, and height, optimize health financing mechanism, redesign cost-sharing arrangements and provider payment methods, and develop more efficient expenditure control strategies.

To understand the future trajectory of health expenditure in China if current trends continue and the estimated impact of reforms, this study projected health expenditure by disease and function fr...

Background: With the rapid ageing of the population, injuries are increasingly threatening the health of elderly individuals. A comprehensive evaluation of the injury burden is important for selecting and formulating strategies for injury prevention. Objective: To evaluate the temporal trends of injury burden among elderly Chinese individuals aged 60 years and older. Methods: Based on the results of the Global Burden of Disease Study 2019, the injury mortality, morbidity, and disability-adjusted life years (DALYs) of elderly individuals from 1990 to 2019 were estimated by age and sex. The autoregressive integrated moving average model was used to predict the injury burden in the next decade. Results: In 2019, there were an estimated 304 373 deaths due to injuries in China, accounting for 3.55 % of all deaths. The main cause of injury-related death was unintentional injuries (67.28 deaths per 100 000), followed by transport injuries (30.44 deaths per 100 000). The standardized DALYs rate due to injuries among elderly individuals was 3488.54 DALYs per 100 000. In the past 30 years, the morbidity of injuries among elderly individuals in China has increased by 52.18 %. In 2030, we estimated that there will be 398 200 deaths of elderly individuals due to injury. Conclusions: Over 21% of injury-related deaths among elderly individuals occurred in China. The injury burden among elderly individuals is high, and efforts are needed to inform injury prevention policies and adopt injury prevention strategies to reduce the injury burden and promote the health and well-being of elderly individuals.

Given the recent update of SF-6Dv2, detailed data on utility scores for cancer patients by cancer type remain scarce in China and other regions, which limits the precision of cost-utility analyses (CUA) in cancer interventions. The aim of the study was to systematically evaluate utility scores of six common cancers in China measured using SF-6Dv2, and identify the potential factors associated with utility scores. A hospital-based cross-sectional survey was conducted from August 2022 to December 2023. It recruited 896 cancer patients from three tertiary hospitals in China, including 270 with lung cancer, 96 with stomach cancer, 88 with liver cancer, 71 with oesophagus cancer, 142 with colorectum cancer, and 160 with breast cancer. The validated Simplified Chinese version of the SF-6Dv2 was used to calculate utilities based on the Chinese value set, and the utility values were described using the mean and standard deviation (SD). Participants’ socio-demographic, behavioral and clinical characteristics were also obtained from the survey. Univariate and multivariate linear regression models were performed to explore the impact of these three categories of characteristics on utility scores derived from SF-6Dv2 for the total cancer patients and each cancer group. The mean utility score was 0.66 (SD = 0.26) for the total cancer sample, 0.66 (SD = 0.25) for lung cancer, 0.75 (SD = 0.23) for stomach cancer, 0.69 (SD = 0.24) for liver cancer, 0.69 (SD = 0.24) for oesophagus cancer, 0.65 (SD = 0.31) for colorectum cancer, and 0.57 (SD = 0.24) for breast cancer. Multivariate linear regression analysis indicated that patients who were older, from larger families, under greater economic pressures, undergoing fewer health examinations, smoking, and in advanced cancer stages had lower utility scores in the total cancer sample (p<0.05), with variations observed across different cancer types. This study is one of the first to apply the SF-6Dv2 to a heterogeneous group of cancer patients, providing evidence for conducting CUA with SF-6Dv2 across six common cancers in China. In addition, the study provides a basis for improving interventions for different cancer types.