Estimating Hospitalization Expenditures Associated with Chronic Diseases and Multimorbidity for Older Adults — Guangzhou City, Guangdong Province, China, 2017–2019

Introduction: Chronic diseases and multimorbidity are increasingly prevalent among older adults in China, contributing substantially to hospitalization burden. However, real-world evidence on their direct medical expenditures remains limited. Methods: This study employed a retrospective analysis by using hospital discharge data from Guangzhou during 2017–2019, and adopted generalized linear models (GLMs) to estimate hospitalization expenditures across chronic disease and multimorbidity patterns. Results: Older patients with multimorbidity incurred nearly double the median annual hospitalization expenditures (3,708 USD vs. 1,844 USD) and 45% higher costs per additional condition compared to single diseases. Hospitalization cost varied by specific diseases and multimorbidity patterns. Schizophrenia (7,421.3 USD) has the highest annual total hospitalization expenditure (THE) among single chronic diseases while the combination of cancer + CVD + heart disease (10,698.8 USD for THE, 4,024.6 USD for out-of-pocket expenditure) ranked the top expenditures among multimorbidity patterns. Approximately 57.1% of disease combinations exhibited super-additive spending. Conclusion: This study provides robust evidence of the substantial economic burden of chronic diseases and multimorbidity. The findings underscore the need for an integrated care model, evidence-based strategies to optimize healthcare resource allocation and health outcomes in aging populations.