중고령자 가계의 사망 전 본인부담 의료비 지출에 관한 연구 (Out-of-Pocket Medical Expenditures in the Last Three Years of Life in Middle Aged and Elderly Households)

2018 ◽  
Author(s):  
Serah Shin ◽  
Jung Eun Kim
Author(s):  
Donglan Zhang ◽  
Shukai Li

Background: Hypertension is a prevalent and costly health condition in China. We sought to estimate the inpatient and outpatient expenditures attributable to hypertension among China’s middle-aged and elderly population. Methods: Data for this study was from the China Health and Retirement Longitudinal Survey (CHARLS) 2011 and 2013, a comprehensive and nationally representative survey of Chinese residents aged 45 and older. We selected our study sample among respondents who had complete information on biomarker blood pressure measures and had not developed hypertension in 2011. Hypertension in 2013 was identified in the following steps: (a) He/she had an average systolic blood pressure of ≥ 140 mmHg, and/or an average diastolic blood pressure of ≥ 90 mmHg and/or (b) He/she was currently taking anti-hypertensive medications. The outcome measures were total inpatient expenditures in the past year and outpatient expenditures in the last month. We used a difference-in-difference approach, by classifying those with hypertension as treatment group, and those without hypertension as control group. A propensity score weighting approach was applied to balance out the population characteristics between the treatment and control groups. Linear regression was used to examine the incremental medical expenditures attributable to hypertension. Results: The final sample contained 7827 observations. For those who developed hypertension between 2011 and 2013, their inpatient expenditure increased faster and on average, the hypertension-attributable inpatient expenditures were¥129.5 ($20.9) per person in a year. When we restricted the sample to those with only positive inpatient expenditures, the incremental expenditure reached ¥1526.2 ($246.2) a year. On average, the hypertension-attributable outpatient expenditures were ¥31.0 ($5) per person each month. When we only considered the sample with positive outpatient expenditures, the incremental outpatient expenditures reached ¥276.1 ($44.5) in a month. Conclusions: Having hypertension was associated with substantially higher medical expenditures for both inpatient and outpatient care services. Given that the prevalence of hypertension among adults aged 45 and older was 33% (180 million) in China), the estimated national medical expenditures attributable to hypertension would be as high as ¥90.3 billion ($14.6 billion) per year.


Author(s):  
Hossein Shahinfar ◽  
Farhang Djafari ◽  
Nadia Babaei ◽  
Samira Davarzani ◽  
Mojdeh Ebaditabar ◽  
...  

Abstract. Background: The association between dietary patterns and cardiorespiratory fitness (CRF) is not well established. Objective: We sought to investigate association between a posteriori dietary pattern and CRF in middle-aged adults. Design: Adults (n = 276), aged 20–74 years, who were residents of Tehran, Iran were recruited. Diet was assessed by using a validated 168-item semi-quantitative food frequency questionnaire. Principal component analysis was used to derive dietary patterns. Socio-economic status, anthropometric measures, body composition, and blood pressure were recorded. CRF was assessed by using a graded exercise treadmill test. Analysis of variance and linear regression models were used to discern the association between dietary patterns and CRF. Results: Higher scores of the healthy dietary pattern had no association with VO2max (p = 0.13 ). After controlling for potential confounders, VO2max was positively associated across tertiles of healthy dietary patterns (p < 0.001). Higher adherence to the “mixed” dietary pattern was inversely related to VO2max (p < 0.01). After adjusting for confounders, the significant association disappeared (p = 0.14). Higher scores of the “Western” dietary pattern was not associated with VO2max (p = 0.06). However, after controlling for potential confounders, VO2max was positively associated with the “Western” dietary pattern (p = 0.01). A positive linear association between the “healthy” dietary pattern and CRF for the total sample (R2 = 0.02; p < 0.01) were presented. Conclusions: Overall, our findings suggest that higher adherence to a “healthy” and “Western” dietary pattern was positively associated with CRF. However, further studies are required to examine and clarify the causal relationship between dietary patterns and CRF.


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