The bidirectional relationship between intrinsic capacity and catastrophic health expenditure in China: A Longitudinal Study

Yuting Kang; Hong Shi; Jie Zhang; Xue Meng; Chi Zhang; Ji Shen; Pengjun Zhang

doi:10.1093/gerona/glae301

The bidirectional relationship between intrinsic capacity and catastrophic health expenditure in China: A Longitudinal Study

J Gerontol A Biol Sci Med Sci. 2024 Dec 23:glae301. doi: 10.1093/gerona/glae301. Online ahead of print.

Authors

Yuting Kang¹, Hong Shi², Jie Zhang², Xue Meng¹, Chi Zhang³, Ji Shen², Pengjun Zhang⁴

Affiliations

¹ Department of Scientific Research, Office of National Clinical Research for Geriatrics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No.1, Dahua Road, Dongdan, Dongcheng District, Beijing, 100730, P. R. China.
² Department of Geriatrics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No.1, Dahua Road, Dongdan, Dongcheng District, Beijing, 100730, P. R. China.
³ The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, No.1, Dahua Road, Dongdan, Dongcheng District, Beijing, 100730, P. R. China.
⁴ Department of Scientific Research, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No.1, Dahua Road, Dongdan, Dongcheng District, Beijing, 100730, P. R. China.

PMID: 39713966
DOI: 10.1093/gerona/glae301

Abstract

Background: Intrinsic capacity (IC), as a potential proxy for healthy ageing, guidance on framing the concept is limited. Furthermore, research on the relationship between IC and catastrophic health expenditure (CHE) is scarce.The current study aims to construct a validated IC framework using structural equation modelling (SEM) and examine such an association among older adults in China.

Methods: Using a 4-year prospective observational study, we enrolled 5,427 participants from wave 1 and wave 3 in the China Health and Retirement Longitudinal Study (CHARLS) for analysis. The SEM was used to construct IC score, and assessed its association with medical and financial burdens by using negative binomial regression and logistic mixed-effect models, where financial burden was defined as CHE according to the World Bank definitions.

Results: The SEM results showed a clear 5-subfactor structure for IC. After adjustment for potential confounders, the populations with poor and moderate IC had 1.927 times [95% confidence intervals (95% CI): 1.559-2.382] and 1.548 times (95% CI: 1.281-1.872) higher risk for inpatient visits in comparison with the group showing high IC, respectively, and also experiencing 2.163 times (95% CI: 1.674-2.795) and 1.687 times (95% CI: 1.347-2.112) risk for CHE, respectively.

Conclusions: Our analysis with both cross-sectional and longitudinal representative national data, provided an extensive picture of the adverse effects of IC loss, demonstrating that a favorable IC is important to reduce medical and financial burden. IC is applicable to more widely as a usual clinical assessment tool to reduce effectively health burden.

Keywords: Cross-lagged panel models; Geriatric Assessment; Physical Function; Socio-Economic Issues; Successful Aging.

© The Author(s) 2024. Published by Oxford University Press on behalf of the Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.