Abstract
OBJECTIVE: This study examines the incidence, intensity, and inequality of catastrophic health expenditure (CHE) among households with hypertension and type 2 diabetes mellitus (T2DM) in cold regions of China. It also explores key drivers of CHE and compares across diseases. METHODS: Using data from the 2023 Seventh Health Services Survey in Heilongjiang Province, this study applies the World Health Organization's (WHO) normative algorithm for basic food needs to analyze CHE incidence, average gap (G(cat)), and mean positive gap (MPG) in 1,051 hypertension households and 294 T2DM households. The concentration curve and concentration index (CI) are used to quantify CHE inequality. Key drivers of CHE are analyzed through univariate analysis, Logistic regression, and Tobit regression models. RESULTS: The CHE incidence for hypertension and T2DM households were 31.11% and 34.69%, respectively. The G(cat) was 6.38% for hypertension households and 7.02% for T2DM households, while the MPG was 20.51% and 20.24%, respectively. The CI for hypertension and T2DM households were - 0.2541 and - 0.2762. CHE decreased as economic status improved but increased with the number of chronic conditions. Under different CHE thresholds, the incidence and G(cat) of CHE in T2DM households are generally higher than in hypertension households, but the MPG in hypertension households is slightly higher than in T2DM households. Determinant analysis revealed that low household economic status, multiple chronic conditions, and utilization of outpatient and inpatient services are significant drivers of CHE in chronic disease households, while being employed and having a larger household size are important protective factors. CONCLUSION: Households with hypertension and T2DM in cold regions of China face a high risk of CHE, particularly among those with lower economic status. There is a pressing need for a more equitable healthcare financing system and improved management of chronic diseases in these populations.