Association of Body Mass Index with Risk of Household Catastrophic Health Expenditure in China: A Population-Based Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Procedure
2.3. Outcome
2.4. Covariates
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Risk of CHE
3.3. Sensitivity Analyses and Subgroup Analyses
4. Discussions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total (n = 11,185, %) | BMI Group | χ2 | p-Value | |||
---|---|---|---|---|---|---|---|
Normal (n = 6833, %) | Underweight (n = 831, %) | Overweight (n = 2825, %) | Obesity (n = 696, %) | ||||
Gender | 36.359 | <0.001 | |||||
Male | 7864 (70.3) | 4859 (71.1) | 508 (61.1) | 2000 (70.8) | 497 (71.4) | ||
Female | 3321 (29.7) | 1974 (28.9) | 323 (38.9) | 825 (29.2) | 199 (28.6) | ||
Age group | 150.112 | <0.001 | |||||
16–39 | 2843 (25.4) | 1777 (26.0) | 223 (26.8) | 656 (23.2) | 187 (26.9) | ||
40–49 | 3452 (30.9) | 2134 (31.2) | 159 (19.1) | 937 (33.2) | 222 (31.9) | ||
50–59 | 2689 (24.0) | 1602 (23.4) | 173 (20.8) | 746 (26.4) | 168 (24.1) | ||
≥60 | 2201 (19.7) | 1320 (19.3) | 276 (33.2) | 486 (17.2) | 119 (17.1) | ||
Marital status | 172.815 | <0.001 | |||||
Married/partnered | 9836 (87.9) | 6013 (88.0) | 619 (74.5) | 2571 (91.0) | 633 (90.9) | ||
Other | 1349 (12.1) | 820 (12.0) | 212 (25.5) | 254 (9.0) | 63 (9.1) | ||
Education | 229.064 | <0.001 | |||||
Illiterate/semiliterate | 2732 (24.4) | 1749 (25.6) | 316 (38.0) | 546 (19.3) | 121 (17.4) | ||
Primary school | 2649 (23.7) | 1698 (24.9) | 204 (24.5) | 604 (21.4) | 143 (20.5) | ||
Middle school | 3461 (30.9) | 2069 (30.3) | 207 (24.9) | 951 (33.7) | 234 (33.6) | ||
High school and above | 2343 (20.9) | 1317 (19.3) | 104 (12.5) | 724 (25.6) | 198 (28.4) | ||
Insurance | 241.867 | <0.001 | |||||
None | 1394 (12.5) | 833 (12.2) | 121 (14.6) | 346 (12.2) | 94 (13.5) | ||
UEBMI | 1354 (12.1) | 692 (10.1) | 43 (5.2) | 471 (16.7) | 148 (21.3) | ||
URBMI | 757 (6.8) | 426 (6.2) | 39 (4.7) | 237 (8.4) | 55 (7.9) | ||
NRCMS | 6685 (59.8) | 4318 (63.2) | 532 (64.0) | 1506 (53.3) | 329 (47.3) | ||
Other | 995 (8.9) | 564 (8.3) | 96 (11.6) | 265 (9.4) | 70 (10.1) | ||
Self-reported health | 102.954 | <0.001 | |||||
Good | 5279 (47.2) | 3279 (48.0) | 296 (35.6) | 1395 (49.4) | 309 (44.4) | ||
Medium | 4237 (37.9) | 2557 (37.4) | 324 (39.0) | 1077 (38.1) | 279 (40.1) | ||
Poor | 1669 (14.9) | 997 (14.6) | 211 (25.4) | 353 (12.5) | 108 (15.5) | ||
Outpatient services | 17.269 | 0.002 | |||||
No | 9113 (81.5) | 5569 (81.5) | 636 (76.5) | 2342 (82.9) | 566 (81.3) | ||
Yes | 2072 (18.5) | 1264 (18.5) | 195 (23.5) | 483 (17.1) | 130 (18.7) | ||
Inpatient services | |||||||
No | 10,512 (94.0) | 6432 (94.1) | 779 (93.7) | 2652 (93.9) | 649 (93.2) | 1.075 | 0.783 |
Yes | 673 (6.0) | 401 (5.9) | 52 (6.3) | 173 (6.1) | 47 (6.8) | ||
Chronic diseases | 38.440 | <0.001 | |||||
No | 9550 (85.4) | 5940 (86.9) | 696 (83.8) | 2355 (83.4) | 559 (80.3) | ||
Yes | 1635 (14.6) | 893 (13.1) | 135 (16.2) | 470 (16.6) | 137 (19.7) | ||
Smoking | 38.664 | <0.001 | |||||
No | 6053 (54.1) | 3543 (51.9) | 460 (55.4) | 1649 (58.4) | 401 (57.6) | ||
Yes | 5132 (45.9) | 3290 (48.1) | 371 (44.6) | 1176 (41.6) | 295 (42.4) | ||
Drinking | 18.624 | <0.001 | |||||
No | 8364 (74.8) | 5091 (74.5) | 671 (80.7) | 2099 (74.3) | 503 (72.3) | ||
Yes | 2821 (25.2) | 1742 (25.5) | 160 (19.3) | 726 (25.7) | 193 (27.7) | ||
Residence | 238.227 | <0.001 | |||||
urban | 5084 (45.5) | 2828 (41.4) | 292 (35.1) | 1548 (54.8) | 416 (59.8) | ||
rural | 6101 (54.5) | 4005 (58.6) | 539 (64.9) | 1277 (45.2) | 280 (40.2) | ||
Family size | 75.962 | <0.001 | |||||
1–2 | 2165 (19.4) | 1245 (18.2) | 191 (23.0) | 592 (21.0) | 137 (19.7) | ||
3–4 | 5431 (48.6) | 3249 (47.5) | 344 (41.4) | 1457 (51.6) | 381 (54.7) | ||
≥5 | 3589 (32.1) | 2339 (34.2) | 296 (35.6) | 776 (27.5) | 178 (25.6) | ||
Family economic level | 185.968 | <0.001 | |||||
Lowest | 2941 (26.3) | 1863 (27.3) | 325 (39.1) | 625 (22.1) | 128 (18.4) | ||
Lower | 2567 (23.0) | 1642 (24.0) | 167 (20.1) | 616 (21.8) | 142 (20.4) | ||
Higher | 3164 (28.3) | 1910 (28.0) | 222 (26.7) | 824 (29.2) | 208 (29.9) | ||
Highest | 2513 (22.5) | 1418 (20.8) | 117 (14.1) | 760 (26.9) | 218 (31.3) | ||
Socioeconomic development level | 238.177 | <0.001 | |||||
Lowest | 2358 (21.1) | 1615 (23.6) | 268 (32.3) | 401 (14.2) | 74 (10.6) | ||
Lower | 3234 (28.9) | 1930 (28.2) | 211 (25.4) | 907 (32.1) | 186 (26.7) | ||
Higher | 2015 (18.0) | 1201 (17.6) | 111 (13.4) | 528 (18.7) | 175 (25.1) | ||
Highest | 3578 (32.0) | 2087 (30.5) | 241 (29.0) | 989 (35.0) | 261 (37.5) |
BMI Groups | Events/Incidence Rate * | Univariate Model | Model 1 | Model 2 | Model 3 | ||||
---|---|---|---|---|---|---|---|---|---|
cHR (95%CI) | p-Value | aHR (95%CI) | p-Value | aHR (95%CI) | p-Value | aHR (95%CI) | p-Value | ||
Total | 3275/3.85 | ||||||||
Normal | 1968/3.77 | Ref. | — | Ref. | — | Ref. | — | Ref. | — |
Underweight | 298/5.08 | 1.37 (1.22–1.55) | <0.001 | 1.18 (1.04–1.34) | 0.008 | 1.14 (1.01–1.29) | 0.036 | 1.15 (1.02–1.31) | 0.023 |
Overweight | 822/3.82 | 1.01 (0.93–1.10) | 0.761 | 1.06 (0.98–1.15) | 0.162 | 1.06 (0.97–1.15) | 0.177 | 1.05 (0.97–1.15) | 0.210 |
Obesity | 187/3.47 | 0.92 (0.79–1.07) | 0.293 | 0.98 (0.85–1.14) | 0.840 | 0.98 (0.84–1.13) | 0.750 | 0.98 (0.84–1.14) | 0.747 |
Male | 2288/3.79 | ||||||||
Normal | 1449/3.87 | Ref. | — | Ref. | — | Ref. | — | Ref. | — |
Underweight | 180/4.94 | 1.29 (1.11–1.51) | 0.001 | 1.07 (0.92–1.26) | 0.368 | 1.03 (0.88–1.21) | 0.706 | 1.05 (0.90–1.23) | 0.547 |
Overweight | 543/3.53 | 0.90 (0.82–1.00) | 0.045 | 0.98 (0.88–1.08) | 0.649 | 0.98 (0.89–1.08) | 0.702 | 0.97 (0.88–1.07) | 0.570 |
Obesity | 116/2.99 | 0.77 (0.64–0.93) | 0.007 | 0.89 (0.73–1.07) | 0.210 | 0.88 (0.73–1.07) | 0.196 | 0.87 (0.72–1.05) | 0.152 |
Female | 987/4.00 | ||||||||
Normal | 519/3.49 | Ref. | — | Ref. | — | Ref. | — | Ref. | — |
Underweight | 118/5.32 | 1.57 (1.28–1.91) | <0.001 | 1.43 (1.17–1.75) | 0.001 | 1.42 (1.16–1.74) | 0.001 | 1.42 (1.16–1.75) | 0.001 |
Overweight | 279/4.57 | 1.32 (1.14–1.52) | <0.001 | 1.28 (1.10–1.48) | 0.001 | 1.26 (1.09–1.46) | 0.002 | 1.26 (1.09–1.47) | 0.002 |
Obesity | 71/4.72 | 1.35 (1.06–1.73) | 0.017 | 1.23 (0.96–1.58) | 0.103 | 1.21 (0.94–1.56) | 0.132 | 1.22 (0.95–1.57) | 0.116 |
Subgroup | Normal Weight (Events/Objects) | Underweight | Overweight | ||||
---|---|---|---|---|---|---|---|
Events/Objects | aHR (95%CI) | p-Value | Events/Objects | aHR (95%CI) | p-Value | ||
All | 519/1974 | 118/323 | — | — | 279/825 | — | — |
Age group | |||||||
16–39 | 109/662 | 25/120 | 1.33 (0.85–2.07) | 0.213 | 35/181 | 1.07 (0.73–1.59) | 0.724 |
40–49 | 127/575 | 24/70 | 1.60 (1.02–2.50) | 0.042 * | 70/262 | 1.25 (0.92–1.68) | 0.150 |
50–59 | 125/400 | 24/47 | 1.69 (1.07–2.67) | 0.025 * | 99/238 | 1.45 (1.10–1.91) | 0.008 * |
≥60 | 158/337 | 45/86 | 1.23 (0.87–1.73) | 0.240 | 75/144 | 1.30 (0.97–1.75) | 0.078 |
Insurance | |||||||
None | 74/291 | 17/51 | 1.41 (0.80–2.47) | 0.232 | 39/132 | 1.20 (0.79–1.81) | 0.402 |
UEBMI | 48/254 | 3/18 | 0.90 (0.27–2.99) | 0.863 | 28/127 | 1.00 (0.61–1.64) | 0.994 |
URBMI | 48/187 | 4/20 | 1.11 (0.38–3.29) | 0.845 | 32/88 | 1.33 (0.79–2.26) | 0.283 |
NRCMS | 301/1029 | 81/189 | 1.52 (1.18–1.96) | 0.001 * | 151/407 | 1.24 (1.02–1.52) | 0.033 * |
Other | 48/213 | 13/45 | 1.71 (0.87–3.33) | 0.117 | 29/71 | 1.66 (0.99–2.79) | 0.052 |
Self-reported health | |||||||
Good | 175/823 | 34/122 | 1.16 (0.79–1.70) | 0.443 | 104/327 | 1.44 (1.12–1.86) | 0.005 * |
Medium | 199/791 | 43/126 | 1.53 (1.09–2.15) | 0.014 * | 108/335 | 1.23 (0.96–1.56) | 0.095 |
Poor | 145/360 | 41/75 | 1.53 (1.06–2.20) | 0.022 * | 67/163 | 1.09 (0.80–1.48) | 0.573 |
Current smoking | |||||||
No | 491/1876 | 113/307 | 1.47 (1.19–1.81) | <0.001 * | 269/810 | 1.24 (1.07–1.45) | 0.005 * |
Yes | 28/98 | 5/16 | 0.74 (0.21–2.60) | 0.639 | 10/15 | 2.60 (0.96–7.10) | 0.061 |
Current drinking | |||||||
No | 504/1910 | 115/314 | 1.44 (1.17–1.77) | 0.001 * | 262/791 | 1.23 (1.06–1.44) | 0.007 * |
Yes | 15/64 | 3/9 | 2.07 (0.40–10.80) | 0.386 | 17/34 | 3.64 (1.40–9.47) | 0.008 * |
Chronic diseases | |||||||
No | 416/1678 | 89/266 | 1.41 (1.11–1.78) | 0.004 * | 205/667 | 1.26 (1.06–1.50) | 0.008 * |
Yes | 103/296 | 29/57 | 1.58 (1.03–2.43) | 0.036 * | 74/158 | 1.35 (0.99–1.85) | 0.061 |
Outpatient services | |||||||
No | 381/1511 | 71/239 | 1.17 (0.90–1.51) | 0.239 | 202/641 | 1.19 (1.00–1.42) | 0.053 |
Yes | 138/463 | 47/84 | 2.17 (1.53–3.07) | <0.001 * | 77/184 | 1.36 (1.02–1.82) | 0.038 * |
Inpatient services | |||||||
No | 476/1830 | 110/295 | 1.45 (1.18–1.80) | 0.001 * | 261/768 | 1.30 (1.12–1.52) | 0.001 * |
Yes | 43/144 | 8/28 | 0.98 (0.43–2.25) | 0.969 | 18/57 | 0.63 (0.32–1.25) | 0.189 |
Residence | |||||||
Urban | 240/1048 | 35/138 | 1.17 (0.81–1.68) | 0.404 | 162/508 | 1.24 (1.01–1.52) | 0.044 * |
Rural | 279/926 | 83/185 | 1.60 (1.25–2.06) | <0.001 * | 117/317 | 1.27 (1.02–1.58) | 0.036 * |
Socioeconomic development level | |||||||
Lowest | 89/351 | 33/75 | 1.86 (1.23–2.82) | 0.003 * | 33/93 | 1.32 (0.87–2.00) | 0.192 |
Lower | 162/603 | 26/89 | 0.99 (0.65–1.52) | 0.974 | 99/291 | 1.23 (0.95–1.60) | 0.121 |
Higher | 91/320 | 14/41 | 1.64 (0.92–2.94) | 0.096 | 58/140 | 1.47 (1.04–2.07) | 0.029 * |
Highest | 177/700 | 45/118 | 1.33 (0.94–1.9) | 0.108 | 89/301 | 1.08 (0.84–1.41) | 0.541 |
Family economic level | |||||||
Lowest | 183/519 | 57/123 | 1.52 (1.12–2.07) | 0.008 * | 93/230 | 1.21 (0.93–1.58) | 0.148 |
Lower | 113/437 | 23/68 | 1.29 (0.80–2.08) | 0.291 | 55/186 | 1.12 (0.80–1.56) | 0.528 |
Higher | 138/585 | 26/86 | 1.24 (0.81–1.91) | 0.321 | 72/225 | 1.41 (1.05–1.90) | 0.024 * |
Highest | 85/433 | 12/46 | 1.79 (0.95–3.37) | 0.074 | 59/184 | 1.56 (1.10–2.22) | 0.012 * |
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Wang, Y.; Liu, M.; Liu, J. Association of Body Mass Index with Risk of Household Catastrophic Health Expenditure in China: A Population-Based Cohort Study. Nutrients 2022, 14, 4014. https://doi.org/10.3390/nu14194014
Wang Y, Liu M, Liu J. Association of Body Mass Index with Risk of Household Catastrophic Health Expenditure in China: A Population-Based Cohort Study. Nutrients. 2022; 14(19):4014. https://doi.org/10.3390/nu14194014
Chicago/Turabian StyleWang, Yaping, Min Liu, and Jue Liu. 2022. "Association of Body Mass Index with Risk of Household Catastrophic Health Expenditure in China: A Population-Based Cohort Study" Nutrients 14, no. 19: 4014. https://doi.org/10.3390/nu14194014