Heterogeneous health profiles and healthcare utilization of the middle-aged and elderly with multiple health insurance schemes in China.

OBJECTIVES: China is facing an escalating demand of healthcare services from the middle-aged and elderly. Compared with the traditional view of health on symptoms and diseases, this study aimed to assess the heterogeneous health profiles of middle-aged and elderly Chinese by a person-centered approach. Furthermore, this study examined the effects of health profiles and associated factors on healthcare utilization within the context of China's multiple health insurance schemes. STUDY DESIGN: The study used the 2015 data of China Health and Retirement Longitudinal Study, a nationwide population-based sample of people aged 45 years and older. METHODS: Latent class analysis (LCA) was adopted to identify the heterogeneous health profiles. Two-part models were adopted to assess the effects of associated factors on healthcare utilization. RESULTS: Among 15,250 Chinese aged 45 years and older, six heterogeneous health profiles were identified and labeled as 'Quite Healthy', 'Relatively Healthy', 'Comprehensive Comorbidities', 'Functional Impairment', 'Severe Disability', and 'Relatively Frail'. The Relatively Frail profile was the heaviest healthcare user. The Severe Disability profile took the least use of outpatient services but had relatively high utilization of inpatient services and outpatient expenditure. The Comprehensive Comorbidities profile tended to have the smallest effect on the frequency of visits for both inpatient and outpatient services, but its effect on outpatient expenditure was high. After controlling for health profiles, the significant effects of different health insurance programs on healthcare utilization were discussed. CONCLUSIONS: Introducing health profiles by the person-centered approach of LCA has provided a holistic understanding of complex healthcare demands for middle-aged and elderly Chinese. It is valuable for policy makers to improve healthcare resource allocation targeted for the middle-aged and elderly.

Cataract surgery is associated with a reduced risk of dementia: a nationwide population-based cohort study.

BACKGROUND AND PURPOSE: Our purpose was to determine the association of cataract surgery with subsequent development of dementia in older adults with newly diagnosed cataract. METHODS: By using data from Taiwan National Health Insurance Research Database (NHIRD), a population-based cohort study including 491 226 subjects aged 70 or older with first-time diagnosis of cataract coded from 2000 to 2009 was conducted. After matching cataract patients receiving cataract surgery with cataract patients without receiving cataract surgery for age, sex, index date, Charlson Comorbidity Index score, interval between first coding of cataract diagnosis and index date, hypertension and diabetes mellitus, 113 123 patients in each cohort were enrolled. The main outcome measure was newly diagnosed dementia coded by neurologists or psychiatrists more than 365 days after cataract surgery. Incidence rate and hazard ratio of dementia were compared between the cataract surgery and cataract diagnosis cohorts. RESULTS: The incidence rate of dementia was 22.40 per 1000 person-years in the cataract surgery cohort and 28.87 per 1000 person-years in the cataract diagnosis cohort. The rate of dementia was significantly lower in the cataract surgery group (hazard ratio 0.77, 95% confidence interval 0.75-0.79, P < 0.001). Female gender (P < 0.001) and a shorter interval between the date of first coding of a cataract diagnosis and the date of cataract surgery (P = 0.009) were significantly associated with a lower incidence rate of dementia. CONCLUSION: In an NHIRD cohort of Taiwanese aged 70 years and older with a diagnosis of cataract, patients undergoing cataract surgery were associated with a reduced risk of subsequent dementia compared with those without cataract surgery.