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.

多重慢病较单一慢性病明显升高患者医疗费用，增加患者经济负担和因病返贫的风险。目前，我国农村基层医疗卫生机构中多重慢病患者的医疗支出状况和影响因素仍不明晰，不利于降低农村居民多重慢病的疾病负担。

了解广西壮族自治区乡镇卫生院多重慢病患者的住院费用及影响因素。

采用多阶段分层随机抽样法，抽取广西壮族自治区梧州市、南宁市、玉林市、柳州市、贵港市的各2家乡镇卫生院为样本机构。收集10家样本机构2021年1月—2023年6月所有多重慢病住院患者的去识别化病历资料（n=9 330）。比较不同慢性病数量及不同共病模式患者的次均住院费用、人均住院费用，采用多元无序Logistic回归分析探讨多重慢病患者次均住院费用、人均住院费用的影响因素。

9 330例多重慢病患者的次均住院费用为3 063.0（2 384.5，3 836.3）元，人均住院费用为4 175.0（2 704.0，7 966.7）元。患≥5种慢性病者的次均住院费用和人均住院费用最高，分别为4 535.7（3 718.3，5 288.2）元和11 897.7（6 536.5，21 940.2）元；其次是患4种慢性病者，分别为3 894.2（3 178.0，4 562.2）元和9 474.3（4 854.9，15 178.4）元；再次是患3种慢性病者，分别为3 306.9（2 649.5，3 976.3）元和4 926.0（3 180.6，8 793.8）元；最后是患2种慢性病者，分别为2 699.8（2 075.4，3 290.7）元和3 196.0（2 264.1，5 292.3）元；且任何患慢性病数量之间的次均和人均住院费用比较，差异有统计学意义（P<0.001）。在2、3、4、≥5种多重慢病中，各共病模式的患病率排序与次均及人均住院费用排序不完全一致。多元无序Logistic回归分析结果显示，年龄、民族、职业、医疗保险类型、吸烟情况、BMI、患慢性病数量、住院次数是次均住院费用的影响因素（P<0.05），性别、年龄、民族、文化程度、婚姻状况、医疗保险类型、吸烟情况、患慢性病数量是人均住院费用的影响因素（P<0.05）。

广西壮族自治区乡镇卫生院多重慢病患者的住院费用与患慢性病数量呈正相关关系，每增加1种共患慢性病均增加次均和人均住院费用；各共患模式中患病率较高者与住院费用较高者不完全一致；多重慢病住院费用影响因素的交互作用复杂多样，应采取多维度综合治理措施改善农村基层多重慢病的住院费用，降低农村居民多重慢病经济负担。