Catastrophic health expenditure among Chinese adults living alone with cognitive impairment: a national cohort study

Abstract Background: Catastrophic health expenditure of older adults has serious consequences; however, whether cognitive status and living situation contribute to such financial burden is uncertain. Our aim was to compare the differences in catastrophic health expenditure between adults living alone with cognitive impairment and those living with others and with normal cognition.Methods: We identified 909 observations of participants living alone with cognitive impairment (cases) and 37432 observations of participants living with others and with normal cognition (comparators) from the 2011/2012, 2013, 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We used propensity score matching (1:2) to create matched cases and compartors used in a covariate adjusted logistic regression. Catastrophic health expenditure was defined out-of-pocket cost for healthcare ≥ 40% of a household’s capacity to pay.Results: In comparison with participants living with others and with normal cognition, those living alone with cognitive impairment reported a higher percentage of catastrophic health expenditure (19.5% vs. 11.8%, P<0.001). When controlling for age, sex, education, marital status, residence status, alcohol consumption, smoking status, and disease counts, we found that this subpopulation had significantly higher odds of having catastrophic health expenditure (odds ratio [OR] = 1.89, 95% confidence interval [CI]: 1.40, 2.56). Sensitivity analyses confirmed the robustness of the results.Conclusions: For the first time, this study reveals that Chinese adults living alone with cognitive impairment experience a higher burden of catastrophic health expenditure. Healthcare policies on social health insurance and medical assistance should consider these vulnerable adults.