When age becomes the risk factor: understanding catastrophic health expenditure among older adults in a resource limited setting
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20261005Keywords:
Age, Catastrophic health expenditure, Older adults, Resource limited settingAbstract
Background: Catastrophic health expenditure (CHE) remains a hindrance to equitable healthcare access for older adults in resource limited countries. Little is still known about the demographic contributions to CHE among aging population in Nigeria. This study examined the prevalence and predictors of catastrophic health expenditure among older adults and assessed the contribution of demographic characteristics to financial burden.
Methods: A cross-sectional study was conducted among older adults receiving healthcare services at the outpatient clinic of a tertiary health facility. Data on sociodemographic characteristics, healthcare utilization and out-of-pocket expenditures were collected using a structured questionnaire. Catastrophic health expenditure was defined as out-of-pocket spending exceeding 20% of income. Multiple linear regression was performed to identify predictors of CHE.
Results: The prevalence of catastrophic health expenditure was high which indicates financial vulnerability among the study population. Age emerged as the only predictor of catastrophic health expenditure. Older age was associated with increased likelihood of experiencing CHE.
Conclusions: Catastrophic health expenditure is a major challenge among the study population and age stands out as an independent predictor of CHE. There is need for age-responsive health financing strategies and social security to mitigate the amplifying effect of aging on financial hardship.
Metrics
References
Aina FO, Fadare JO, Dada OD, Agbesanwa TA. Increasing burden of aging population on health services utilization: a myth or reality in a country with predominantly young population. Aging Med Healthcare. 2021;12(2):41-5. DOI: https://doi.org/10.33879/AMH.122.2020.07023
Khan MR, Malik MA, Akhtar SN, Yadav S, Patel R. Multimorbidity and its associated risk factors among older adults in India. BMC Public Health. 2022;22(1):746. DOI: https://doi.org/10.1186/s12889-022-13181-1
Wu D, Xu J, Zhang H, Zhang K, Zhu Y. Multimorbidity characteristics in older adults and their associated factors in complex networks: a cross-sectional study. Front Public Health. 2025;13. DOI: https://doi.org/10.3389/fpubh.2025.1473572
Chowdhury SR, Das DC, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. eClinicalMedicine. 2023;57. DOI: https://doi.org/10.1016/j.eclinm.2023.101860
Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA. Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2016;67:130-8. DOI: https://doi.org/10.1016/j.archger.2016.07.008
Soley-Bori M, Ashworth M, Bisquera A, Dodhia H, Lynch R, Wang Y, et al. Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature. Br J Gen Pract. 2021;71(702):e39-46. DOI: https://doi.org/10.3399/bjgp20X713897
Kallestrup-Lamb M, Marin AOK, Menon S, Søgaard J. Aging populations and expenditures on health. J Econom Ageing. 2024;29:100518. DOI: https://doi.org/10.1016/j.jeoa.2024.100518
Manole F, Marian P, Mekeres GM, Voiţă-Mekereş F. Systematic review of the effect of aging on health costs. Arch Pharm Pract. 2023;14(3-2023):58-61. DOI: https://doi.org/10.51847/npqdV19MYv
Mobolaji JW. Multidimensional deprivations and associated factors among older adults in urban geographies of Nigeria: implications for poor health outcomes in later life. Int J Public Health. 2024;69:1606572. DOI: https://doi.org/10.3389/ijph.2024.1606572
Kolasa A, Weychert E. The causal effect of catastrophic health expenditure on poverty in Poland. Eur J Health Econ. 2024;25(2):193-206. DOI: https://doi.org/10.1007/s10198-023-01579-6
Thornton M, Bowers K. Poverty in older adulthood: a health and social crisis. Online J Issues Nurs. 2024;29(1). DOI: https://doi.org/10.3912/OJIN.Vol29No01Man03
Dobarrio-Sanz I, Chica-Pérez A, Martínez-Linares JM, López-Entrambasaguas OM, Fernández-Sola C, Hernández-Padilla JM. Experiences of poverty amongst low-income older adults living in a high-income country: a qualitative study. J Adv Nurs. 2023;79(11):4304-17. DOI: https://doi.org/10.1111/jan.15750
Ahmad F, Mohanty PC. Incidence and intensity of catastrophic health expenditure and impoverishment among the elderly: an empirical evidence from India. Sci Rep. 2024;14(1):15908. DOI: https://doi.org/10.1038/s41598-024-55142-1
Rata Mohan DS, Jawahir S, Manual A, Abdul Mutalib NE, Mohd Noh SN, Ab Rahim I, et al. Gender differences in health-seeking behaviour: insights from the National Health and Morbidity Survey 2019. BMC Health Serv Res. 2025;25:900. DOI: https://doi.org/10.1186/s12913-025-13020-0
Obilor NM. Gender and health seeking behavior in rural Nigeria. Unizik J Gender Res. 2024;2(1).
Ballering AV, Olde Hartman TC, Verheij R, Rosmalen JGM. Sex and gender differences in primary care help-seeking for common somatic symptoms: a longitudinal study. Scand J Prim Health Care. 2023;41(2):132-9. DOI: https://doi.org/10.1080/02813432.2023.2191653
Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Aubrey-Bassler K. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study. BMC Fam Pract. 2016;17:38. DOI: https://doi.org/10.1186/s12875-016-0440-0
Kuo HL, Chou YC, Chang WN, Chang KV, Chan DC. Effectiveness of comprehensive geriatric assessment in frail older inpatients. J Formosan Med Assoc. 2025. DOI: https://doi.org/10.1016/j.jfma.2025.04.040
Benefits of Comprehensive Geriatric Assessment on an Emergency Surgical Unit. British Geriatrics Society. Available from: https://www.bgs.org.uk/ benefits-of-comprehensive-geriatric-assessment-on-an-emergency-surgical-unit. Accessed on 15 December 2025.
Sarker A. Healthcare service utilization and treatment costs among elderly citizens in Bangladesh. Arch Gerontol Geriatr Plus. 2025:100218. DOI: https://doi.org/10.1016/j.aggp.2025.100218
Yanushevsky R. How to decrease the cost of healthcare. J Med HealthCare. 2020;1-5. DOI: https://doi.org/10.47363/JMHC/2021(3)165
Swetha NB, Shobha S, Sriram S. Prevalence of catastrophic health expenditure and its associated factors, due to out-of-pocket health care expenses among households with and without chronic illness in Bangalore, India: a longitudinal study. J Prev Med Hyg. 2020;61(1):E92-7.
Wright KO, Adeniran A, Aderibigbe A, Akinyemi O, Fagbemi T, Ayodeji O, et al. Factors associated with catastrophic healthcare expenditure in communities of Lagos Nigeria: a megacity experience. PloS One. 2025;20(1):e0316814. DOI: https://doi.org/10.1371/journal.pone.0316814
Ajayi PO, Ibirongbe DO, Ipinnimo TM, Solomon OO, Ibikunle AI, Obiagwu AE. The prevalence of household catastrophic health expenditure in Nigeria: a rural-urban comparison. J Health Med Sci. 2021;4(2). DOI: https://doi.org/10.31014/aior.1994.04.02.160
Arsenijevic J, Pavlova M, Rechel B, Groot W. Catastrophic health care expenditure among older people with chronic diseases in 15 European countries. PloS One. 2016;11(7):e0157765. DOI: https://doi.org/10.1371/journal.pone.0157765
Eze OI, Iseolorunkanmi A, Adeloye D. The National Health Insurance Scheme (NHIS) in Nigeria: current issues and implementation challenges. J Glob Health Econ Policy. 2024;4. DOI: https://doi.org/10.52872/001c.120197
Tanyi PL, André P, Mbah P. Care of the elderly in Nigeria: Implications for policy. Cogent Soc Sci. 2018;4(1):1555201. DOI: https://doi.org/10.1080/23311886.2018.1555201
Idowu KO, Olanike KF. Pensions and pension reform in Nigeria. Pensions Int J. 2010;15(1):11-24. DOI: https://doi.org/10.1057/pm.2009.31
Song D, Liu D, Ning W, Chen Y, Yang J, Zhao C, et al. Incidence, prevalence and characteristics of multimorbidity in different age groups among urban hospitalized patients in China. Sci Rep. 2023;13(1):18798. DOI: https://doi.org/10.1038/s41598-023-46227-4