Psychiatric disorders linked to higher hospitalisation and catastrophic health costs in China

Chinese adults aged 45 and older who live with psychiatric disorders are hospitalised far more often than their peers without such diagnoses, and they face a substantially higher risk of catastrophic health expenditure, according to a nationwide cross-sectional study published in BMC Health Services Research. The analysis drew on five waves of the China Health and Retirement Longitudinal Study (CHARLS) covering 2011 to 2020 and included 93,953 individuals.

The researchers defined healthcare utilisation outcomes as hospitalisation in the past year, outpatient visits in the past month, catastrophic health expenditure (CHE) at two thresholds of household consumption spent out of pocket, and unmet healthcare need. CHE was flagged when out-of-pocket spending exceeded either 40 percent or 10 percent of household consumption. Multivariable logistic regression with robust standard errors produced adjusted odds ratios, and the team stratified results by insurance type.

The headline finding concerns hospitalisation. Among participants with psychiatric disorders, 27.7 percent had been hospitalised in the past year, compared with 14.6 percent of those without psychiatric disorders. After adjustment, this translated into an adjusted odds ratio of 1.29 (95 percent confidence interval 1.12 to 1.48), meaning the association persisted after accounting for other factors, including chronic disease multimorbidity.

Financial protection told a similar story. Catastrophic health expenditure at the 40 percent threshold affected 11.9 percent of participants with psychiatric disorders versus 5.8 percent of those without, an adjusted odds ratio of 1.33 (95 percent CI 1.02 to 1.73). Because the confidence interval sits close to the null value of 1, the precision of this estimate is limited, though the direction of the association was consistent across the analysis.

Not every utilisation measure moved in the same direction. Perhaps counterintuitively, participants with psychiatric disorders reported lower unmet healthcare need: 44.7 percent versus 47.4 percent among those without such disorders, with an adjusted odds ratio of 0.63 (95 percent CI 0.55 to 0.71). The authors report this pattern alongside the higher hospitalisation and expenditure figures, suggesting that people with psychiatric disorders may engage more with the hospital system even as financial strain rises.

Insurance type appeared to shape the expenditure association. Compared with rural insurance holders (adjusted odds ratio 1.22, not statistically significant) or uninsured participants (adjusted odds ratio 2.09, also not significant), the link between psychiatric disorders and CHE was marginally significant among urban insurance holders, with an adjusted odds ratio of 1.52 and a P value of 0.069. The study’s conclusion notes that urban insurance may have a potentially strong association with CHE, but the authors frame this cautiously given the marginal significance and the non-significant results in the comparison subgroups.

The study also tracked how the hospitalisation gap between groups evolved over the decade. The difference in hospitalisation rates between participants with and without psychiatric disorders widened from 7.7 percentage points in 2011 to 17.2 percentage points in 2020. As a cross-sectional pooled analysis, the study describes these patterns across waves rather than establishing causal trajectories over time, but the widening gap is a striking descriptive trend.

The authors conclude that psychiatric disorders independently increased the risk of hospitalisation and catastrophic health expenditure among Chinese older adults, even after accounting for chronic disease multimorbidity. They note that the healthcare utilisation patterns and CHE risk of older adults with psychiatric disorders in low- and middle-income countries remain poorly characterised, which motivated the study’s aim to quantify these associations among Chinese adults aged 45 and older. The study was published as open access research on 29 October 2026.

Subject of Research: Healthcare utilisation and catastrophic health expenditure among middle-aged and older Chinese adults with psychiatric disorders

Article Title: Healthcare utilisation and catastrophic health expenditure among middle-aged and older adults with psychiatric disorders: a nationwide cross-sectional study using CHARLS (2011–2020)

Article References: Du, J. (2026). Healthcare utilisation and catastrophic health expenditure among middle-aged and older adults with psychiatric disorders: a nationwide cross-sectional study using CHARLS (2011–2020). BMC Health Services Research. https://doi.org/10.1186/s12913-026-15911-2

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15911-2

Keywords: psychiatric disorders, catastrophic health expenditure, CHARLS, hospitalisation, healthcare utilisation, China, older adults, health insurance, out-of-pocket spending, unmet healthcare needs, health services research, cross-sectional study