The Assessment Of The Medical Cost Of Attributable To Hypertension Among Chinese Middle And Old Aged Residents

Background With the rapid economic development of society,the changes in life styles,the improvement of living standards,as well as the acceleration of the ageing society,the prevalence rate of hypertension and patients number are rising.Hypertension is a chronic non-infectious disease that seriously affects residents 'physical and mental health,and causes extra medical costs for the family and economic burden on society.The rapid increase of the number of patients with high blood pressure brings new challenges to the national health planning and allocation of health resources,it is required the government to invest more resources for health.So scientific assessment and forecasting of medical burden of hypertension is an important policy problem that worth exploring deeply.Economic burden for high blood pressure study started late in China,which gradually increased by the 21st century.However the studies were relatively fragmented,and the results were not consistent.Besides,some studies were conducted only in a single community,and the study sample was relatively small.The health information system is gradually improving in country,but the basis data of high blood pressure is not completed,so we used the "China Health and Nutrition Survey"data to assess the medical cost of hypertension in middle and old aged residents,explore the main factors influencing the medical cost and provide scientific evidence for health resource allocation and service planning in China.Objective This research aimed to describe the hypertension trend analyse the probability people that go to see a doctor and the medical cost in middle and old aged residents(45 years and above),and compare the difference of results between cross-sectional data and panel data.To analyse and forecast the direct medical burden of hypertension,and explore the influence factors,which provide the theoretical basis for policy resource allocation and health planning in future.Methods This research was based on the data from the ongoing longitudinal cooperative project--"China Health and Nutrition Survey"(CHNS)conducted by the University of North Carolina and the China Center for Disease Control and Prevention.According to the different dietary structure and economic development,there were 9 provinces including Heilongjiang,Liaoning,Shandong,Henan,Jiangsu,Hunan,Hubei,Guangxi,and Guizhou.Beijing,Shanghai and Chongqing were added in 2011.In each of the surveyed provinces,a multistage,random-cluster process was used to select the sample.The survey was conducted every 2-4 years.The study subjects included those adults aged 45 and older who participated in the surveysfroml993 to2011.This study used two-parts model and random-effect model to assess the extra medical cost related to high blood pressure and influence factors.Results From 1993 to 2011,the prevalence rate of hypertension showed a gradual rising trend in 9 provinces(cities,districts)of China,the prevalence of hypertension among middle and old aged residents increased from 29.9%in 1993 to 38.0%in 2011.The prevalence of hypertension in Beijing,Shanghai and Chongqing was 40.2%.The hypertension prevalence rate in men residents was higher than that in women.Middle and old aged in rural areas hypertension prevalence rate is rising.The hypertension prevalence rate among overweight and obesity residents were higher than normal person.The hypertension prevalence rate of abdominal obesity residents was higher.Residents at a lower level of physical activity has a higher rate of hypertension prevalence.About the medical service,residents in medical service hypertension increases the probability(OR=1.51;95%CI=1.38,1.65)of the acception of the medical service;People go to the hospital present a tendency of increasing probability over the year,at the same time,residents in the course of medical treatment,medical costs are increasing;Residents of the higher age groups with high medical acception probability;Women relative to men will increase the probability(OR=1.29;95%CI=1.17,1.42)on the selection of medical service,and women have high medical expenditure;As for the education degree,residents with high education degree have a lower probability on the selection of medical service,and those residents have high medical expenditure;About the health insurance form,residents who have medical insurance,will increased the probability on the acception of medical service;Residents lived in the rural area have higher probability on the acception of medical care compared to residents lived in town;residents in north have lower probability on the acception of medical service relative to the residents in the South,but health care costs are relatively high.Residents with high per capita annual incomes have less probability on the acception of medical service but have high medical cost;The probability(OR=1.11;95%CI=0.94,1.31)on the acception of medical service will increase if the residents are fat;The increase of residents' physical activities can reduce the medical cost.The improvement of residents' dietary quality also can reduce the medical cost.The right amount of sodium consumption will reduce the probability of middle-aged and old residents of medical and health care cost.From 1993 to 2011,the medical cost attributedto hypertension among residents aged 45 and above has increased.Residents' the medical costs in one medical process gradually increased from 63.50 Yuan in 1993 to 271.45 Yuan in 2011.Medical cost attributed to hypertension by extra increase from 1.69%to 3.06%.The medical cost caused by hypertension among middle and old aged residents constantly aggravated.Medical cost attributed to hypertension in men(2.86 Yuan)slightly lower than women(5.29 Yuan);Residents lived in rural areas have higher medical cost attributed to hypertension(13.28 yuan vs 4.59 yuan)than those lived in urban areas.Conclusions From 1993 to 2011,the prevalence of hypertension among middle and old aged residents showed a rising trend in China,and it increased rapidly over the past decade.The medical costs of middle and old aged residents also showed a rising trend.Hypertension can increases the probability on the selection of medical service,and also the medical cost.Residents have different probability on the selection of medical care services and medical cost based on gender,occupations,educations andhealthcondition.Medical costs attributedto high blood pressure among middle and old aged residents showed a rising trend,the economic burden of the middle and old aged residents in China attributed to hypertension is becoming heavier.So we should pay more attention to the trend of hypertension in middle and old aged residents,reduce the social and economic burden by preventing and controlling the development of chronic non-communicable diseases through community health care.