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Association of Depressive Symptoms With Health Service Use and Catastrophic Health Expenditure Among Middle-Aged and Older Chinese Adults: Analysis of Population-Based Panel Data

  • Rui Yan
    Affiliations
    Big Data Center for Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
    Search for articles by this author
  • Lifeng Li
    Affiliations
    Internet Medical and System Applications of National Engineering Laboratory, Zhengzhou, Henan, P. R. China

    Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
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  • Xiaoran Duan
    Affiliations
    Internet Medical and System Applications of National Engineering Laboratory, Zhengzhou, Henan, P. R. China
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  • Jie Zhao
    Correspondence
    Address correspondence to Jie Zhao, PhD, the First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, Henan, 450052, China.
    Affiliations
    Internet Medical and System Applications of National Engineering Laboratory, Zhengzhou, Henan, P. R. China

    Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
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Published:December 24, 2022DOI:https://doi.org/10.1016/j.jamda.2022.11.018

      Abstract

      Objectives

      To determine the impact of depressive symptoms on health service use and catastrophic health expenditure, and whether it varied by per-capita household consumption, health insurance schemes, and physical comorbidities.

      Design

      Population-based panel data analysis.

      Setting and Participants

      Participants were 8585 adults aged 45 years and older in 2011, and had completed a follow-up survey in 2013, 2015, and 2018 from the China Health and Retirement Longitudinal Study (CHARLS).

      Methods

      Depressive symptoms were assessed using the short form of the Center for Epidemiologic Studies Depression Scale. The number of outpatient visits and inpatient hospital days were used as proxies for health service use. When households’ out-of-pocket spending on health was 40% or above its total expenditure, it was defined as a catastrophic health expenditure. With the panel data approach, random-effects negative binomial regression and logistic regression were used to analyze the effect of depressive symptoms on health service use and health care expenditure, respectively.

      Results

      Depressive symptoms were associated with increased number of outpatient visits (incidence rate ratio 1.52; 95% CI 1.44–1.60) and days spent in the hospital as an inpatient (1.52; 1.43–1.62). Depressive symptoms were also associated with a significantly increased likelihood of catastrophic health expenditure (odds ratio 1.54; 95% CI 1.43–1.66). Their effect on outpatient visits, inpatient hospital days, and catastrophic health expenditure persisted in different age, per-capita household consumption, and physical comorbidities groups, and across all health insurance programs.

      Conclusions and Implications

      Depressive symptoms were risk indicators that can drive health service use and household financial stress. Given the rapidly aging population in China, there is an urgent need to integrate mental health care into routine physical examinations to alleviate the economic impacts of depressive symptoms on individuals in China. specifically for individuals with physical comorbidities and in poorer socioeconomic conditions.

      Keywords

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