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. 2025 May 1;25(1):302.
doi: 10.1186/s12877-025-05985-8.

Disease trajectories and medical expenditures of older adults with disabilities: insights from China's long-term care insurance program

Lijun Zeng #  1 , Huaicheng Tan #  2 , Shujuan Yang  3   4 , Lisha Hou  5 , Jinhui Wu  5 , Birong Dong  5 , Adam Gordon  6 , Qingyu Dou  7
Affiliations

Disease trajectories and medical expenditures of older adults with disabilities: insights from China's long-term care insurance program

Lijun Zeng et al. BMC Geriatr. .

Abstract

Background: In China, long-term care (LTC) system has been implemented in recent years to improve the quality of care for older adults. To address healthcare needs of older adults with disabilities, this study investigated the disease trajectory and medical expenditures.

Methods: This study included older adults aged 65 and above with disabilities, using data from China's Long-Term Care Insurance (LTCI) program since July 2017. The participants were followed until June 2021. Diagnoses and hospitalization costs were extracted from electronic medical records and the medical insurance system. Disease trajectory networks were constructed by identifying and linking disease pairs with overlapping conditions. Medical expenditures associated with specific diseases were then calculated.

Results: The study included 30,003 participants with a mean age of 79.6 ± 11.1 years, 57.0% of whom were female. After a mean follow-up of 21 ± 16 months, 17,428 (58.1%) deaths occurred. The diseases with the highest hazard ratios (HRs) included septic shock (HR 3.59, 95% CI, 3.36-3.84), respiratory failure (HR 3.19, 95% CI, 3.05-3.34), sepsis (HR 2.98, 95% CI, 2.80-3.18), malnutrition (HR 2.38, 95% CI, 2.27-2.48), and decubitus ulcer (HR 2.27, 95% CI, 2.14-2.41). Disease trajectories indicated that mortality was closely associated with malnutrition related diseases (anemia, hypoproteinemia, and malnutrition), pneumonia, and organ failure (respiratory failure and heart failure). Among the top 30 diseases leading to frequent hospitalization, intracerebral hemorrhage (47,882.4 CNY), sepsis (37,978.2 CNY), and respiratory failure (25,921.1 CNY) accounted for the highest total medical costs.

Conclusions: The study revealed that malnutrition and infection-related diseases contributed significantly to mortality among older adults with disabilities, with the latter also driving higher medical costs. These findings could inform updates to LTCI policies by emphasizing adequate nutritional support and strengthened infection prevention measures.

Trial registration: chictr.org.cn, ChiCTR2100049973, retrospectively registered.

Keywords: Disability; Disease trajectory; Long-term care; Medical expenditures; Nutrition.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Written informed consent was obtained from all participants. Ethical approval was granted by the institutional ethics review committee of West China Hospital (2021 − 687). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Protocol of study design. LTCI: long-term care insurance
Fig. 2
Fig. 2
Hazard ratio of high-risk medical conditions related to mortality. The X-axis shows the disease categories according to ICD-10 codes A-N and S-Y. The Y-axis shows the hazard ratio
Fig. 3
Fig. 3
Disease trajectories leading to mortality among older disabled individuals. The color of the circle represents the hazard ratios of this medical condition when comparing decedents to survivors. The size of the circle represents the frequency of this medical condition. The color of the arrows indicates the odds ratios of the sequential association between the two medical conditions
Fig. 4
Fig. 4
Median medical expenditures by age group before death or at the end of follow-up. a (survivors), b (decedents)
See this image and copyright information in PMC

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