title: Catastrophic health expenditure: a comparative analysis of empty-nest and non-empty-nest households with seniors in Shandong, China.
abstract: The aim of this study was to compare the catastrophic health expenditure (CHE) prevalence and its determinants between empty-nest and non-empty-nest elderly households.
  
  
  
  Shandong province of China.
  
  
  
  A total of 2761 elderly households are included in the analysis.
  
  
  
  CHE incidence among elderly households was 44.9%. The CHE incidence of empty-nest singles (59.3%, p=0.000, OR=3.19) and empty-nest couples (52.9%, p=0.000, OR=2.45) are both statistically higher than that of non-empty-nest elderly households (31.4%). An inverse association was observed between CHE incidence and income level in all elderly household types. Factors including 1 or more household elderly members with non-communicable chronic diseases in the past 6 months, 1 or more elderly household members being hospitalised in the past year and lower household income, are significant risk factors for CHE in all 3 household types (p<0.05). Health insurance status was found to be a significant determinant of CHE among empty-nest singles and non-empty-nest households (p<0.05).
  
  
  
  CHE incidence among elderly households is high in China. Empty-nest households are at higher risk for CHE than non-empty-nest households. Based on these findings, we suggest that special insurance be developed to broaden the coverage of health services and heighten the reimbursement rate for empty-nest elderly in the existing health insurance schemes. Financial and social protection interventions are also essential for identified at-risk subgroups among different types of elderly households.
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Tingting
authors.initials: T
authors.lastname: Yang
authors.affiliation: Shandong Centre for Disease Control and Prevention, Jinan, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chu
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Chengchao
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Freeman Spogli Institute, Stanford University, Stanford, California, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Medina
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Cuicui
authors.initials: C
authors.lastname: Li
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Jiang
authors.affiliation: School of Public Health and Health Administration, Weifang Medical College, Weifang, China.
authors.forename: Wengui
authors.initials: W
authors.lastname: Zheng
authors.affiliation: School of Accountancy, Shandong University of Finance and Economics, Jinan, China.
authors.forename: Liyuan
authors.initials: L
authors.lastname: Sun
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics* / Q000592:standards; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012923:Social Class
keywords: China; catastrophic health expenditure; determinants; elderly; empty-nest