Cardiometabolic diseases, frailty, and healthcare utilization and expenditure in community-dwelling Chinese older adults

Abstract

This study investigated associations between cardiometabolic diseases, frailty, and healthcare utilization and expenditure among Chinese older adults. The participants were 5204 community-dwelling adults aged at least 60 years from the China Health and Retirement Longitudinal Study. Five cardiometabolic diseases were assessed including hypertension, dyslipidemia, diabetes, cardiac diseases and stroke. Frailty status was based on five criteria: slowness, weakness, exhaustion, inactivity, and shrinking. Participants were deemed frailty if they met at least three criteria. As the number of cardiometabolic diseases increased, so did the prevalence of frailty, and the proportion of healthcare utilization, including outpatient visit and inpatient visit. Moreover, the total healthcare expenditure and the odds of catastrophic health expenditure were increased with the number of cardiometabolic disorders. After adjusting for covariates, cardiometabolic diseases were positively associated with higher odds of frailty, incurring outpatient and inpatient visit. And individuals with 2 or more cardiometabolic diseases had a higher odds of catastrophic health expenditure than persons with non-cardiometabolic disease. Participants who were frailty were more likely to report higher odds of healthcare utilization. These findings suggest that both cardiometabolic diseases and frailty assessment may improve identification of older adults likely to require costly, extensive healthcare.

Figure 1

Prevalence of frailty, and healthcare utilization and expenditure by counts of cardiometabolic diseases. Column graph describing the prevalence of (A) frailty, (B) outpatient visit, (C) inpatient visit, and (D) catastrophic health expenditure, stratified by counts of cardiometabolic diseases.

Figure 2

The association between cardiometabolic diseases, healthcare utilization and catastrophic health expenditure. Forest plots describing the associations of cardiometabolic diseases with (A) outpatient visit, (B) inpatient visit, and (C) catastrophic health expenditure.