Economic burdens of health expenditure for multi-morbidity of older people with hypertension in China and Vietnam

Abstract

Background: Hypertension is prevalent in older adults and often coexists with other chronic diseases, increasing healthcare costs, especially in low- and middle-income countries (LMICs) like China and Viet Nam. These nations are experiencing rapid population aging, yet comparative evidence on the economic burden of hypertension-related multimorbidity is lacking. Objective(s): This study aimed to compare the financial burden, measured by out-of-pocket health expenditures (OOPHE) and catastrophic health expenditures (CHE), associated with hypertension and common comorbidities (joint disease, heart disease, and diabetes) among older adults in China and Viet Nam. Methods: Researchers analyzed data from national surveys in China (2018) and Viet Nam (2020) for adults aged 60+. They categorized hypertensive individuals by comorbidities and used regression models to assess the link between these disease clusters and OOPHE and CHE, adjusting for socioeconomic factors. CHE was defined as health spending at or above 40% of a household's capacity to pay. Findings: Comorbidities were common in both countries. In China, CHE prevalence was highest for individuals with hypertension and heart disease (30.8%), which was the comorbidity posing the greatest financial risk. In Viet Nam, the hypertension-diabetes cluster had the highest CHE risk (13.5%). In China, all comorbidity groups were associated with higher OOPHE. In Viet Nam, however, only the hypertension-diabetes group showed a significant increase in OOPHE. Conclusions: Multimorbidity significantly increases the financial burden for older adults with hypertension, with the key impactful diseases varying by country. Heart disease imposes the greatest burden in China, while diabetes is the primary driver in Viet Nam. Targeted policies, such as improving outpatient coverage and tailoring benefits to common disease combinations, are crucial to protect aging populations in LMICs from financial hardship.