In comparison to single chronic disease, multimorbidity significantly increase patients' hospitalization spending, economic burdens, and even the risk of poverty due to illness. Currently, the hospitalization spending and associated factors of patients with multimorbidity in rural primary health care facilities in our country still remain unclear, which hampers effective decrease in disease burden of multimorbidity among rural inhabitants.

This study aims to understand the hospitalization spending and associated factors of patients with multimorbidity in rural township health centers in Guangxi.

The study employed a combination of multiple-phased stratified sampling and cluster sampling, and randomly sampled 2 rural township health centers from five cities of Guangxi respectively, including Nanning, Wuzhou, Liuzhou, Yulin, and Guigang. The de-identified health records of all inpatients with multimorbidity admitted between Jan 1th, 2021 and Jun 30th, 2023 of 10 sampled township health centers in total were collected (n=9 330). The average expenditure per hospitalization and the hospitalization expenditure per capita for various number of co-existing chronic diseases and for prevalent multimorbidity patterns were compared, and multivariate unordered Logistic regression analysis was used for identification of factors associated with the average expenditure per hospitalization and the hospitalization expenditure per capita of patients with multimorbidity.

The average expenditure per hospitalization for 9 330 patients with multimorbidity was 3 063.0 (2 384.5, 3 836.3) yuan, and the hospitalization expenditure per capita was 4 175.0 (2 704.0, 7 966.7) yuan. The patients with ≥5 co-existing chronic diseases demonstrated the highest levels of average expenditure per hospitalization and hospitalization expenditure per capita, as 4 535.7 (3 718.3, 5 288.2) yuan and 11 897.7 (6 536.5, 21 940.2) yuan, followed by those with 4 co-existing chronic diseases and the second highest levels as 3 894.2 (3 178.0, 4 562.2) yuan and 9 474.3 (4 854.9, 15 178.4) yuan, those with 3 co-existing chronic diseases and the third highest levels as 3 306.9 (2 649.5, 3 976.3) yuan and 4 926.0 (3 180.6, 8 793.8) yuan, and those with 2 co-existing chronic diseases and the lowest levels as 2 699.8 (2 075.4, 3 290.7) yuan and 3 196.0 (2 264.1, 5 292.3) yuan. The multimorbidity patterns ordered by prevalence were not identical to those by the level of hospitalization expenditure among patients with 2, 3, 4, ≥5 co-existing chronic diseases. The results of multivariate unordered Logistic regression analysis showed multiple factors, including age, ethnic group, vocation, medical insurance type, smoking history, BMI, number of co-existing chronic diseases, and hospitalization frequency, correlated with the average expenditure per hospitalization (P<0.05) ; similar factors, including gender, age, ethnic group, education level, marital status, medical insurance type, smoking history, and number of co-existing chronic diseases, were associated with the hospital expenditure per capita (P<0.05) .

The hospitalization spending of patients with multimorbidity positively correlates with number of co-existing chronic diseases in township health centers in Guangxi, and only one chronic disease added can lead to significant increases in both the average expenditure per hospitalization and the hospital expenditure per capita. Multimorbidity patterns with high prevalence were not identical to those with high hospitalization spending. Factors influencing hospitalization spending due to multimorbidity interact with each other intricately, emphasizing the need for comprehensive, multifaceted strategies to improve hospitalization spending of multimorbidity in rural areas and to reduce economic burden of multimorbidity amid rural residents.