ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1598324
This article is part of the Research TopicHealth Policy Approaches to Chronic Disease ManagementView all 6 articles
The impact of long-term trends in continuity of care on the medical expenses of hypertensive patients: based on group-based trajectory model
Provisionally accepted
- 1School of Public Health, Fudan University, Shanghai, Shanghai Municipality, China
- 2Key Lab of Health Technology Assessment (Fudan University), National Health Commission, Shanghai, China
- 3The People's Hospital of Yuhuan, Taizhou, China
- 4Health Commission of Yuhuan, Taizhou, China
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Purpose This study aimed to identify long-term trends in continuity of care (COC) among hypertensive patients using group-based trajectory modeling (GBTM) and evaluate their association with medical expenses, thereby providing evidence for chronic disease management.We analyzed six-year (2016-2021) reimbursement data of the social health insurance from Yuhuan City, China, including 30,545 hypertensive adults. Continuity of Care Index (COCI) was calculated annually. GBTM was employed to classify patients into trajectory subgroups based on COCI trends, with the best-fitting model selection guided by Bayesian information criterion (BIC), average posterior probability (AvePP). Multiple linear regression assessed the relationship between trajectory groups and annual medical expenses, adjusting for age, gender, insurance type, and Charlson Comorbidity Index (CCI).Results Four COCI trajectories were identified: low-level maintenance (52.06%), low-level increase (17.14%), high-level decrease (18.94%), and high-level maintenance (11.87%). Patients in the highlevel maintenance group incurred the lowest annual medical expenses (mean range: ¥3,786-¥5,088), while the low-level maintenance group exhibited the highest (mean range: ¥6,450-¥10,321). After adjustment, the low-level maintenance group had significantly higher expenses than the high-level maintenance group (β = 3,049.44 CNY, p < 0.001). Older age, employee insurance coverage, and higher CCI were also associated with increased medical expenses (p < 0.001).Sustained high continuity of care correlates with reduced medical expenses in hypertensive patients. Long-term COC maintenance should be prioritized in chronic disease management to mitigate healthcare costs. Policymakers should incentivize care continuity through integrated health systems and targeted patient interventions.
Keywords: Hypertension, Continuity of care (COC), Medical expenses, group-based trajectory modeling (GBTM), Long-term trends
Received: 22 Mar 2025; Accepted: 27 Jun 2025.
Copyright: © 2025 Du, Liang, Zhang, Luo, Dong and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yongsong Luo, Health Commission of Yuhuan, Taizhou, China
Yin Dong, The People's Hospital of Yuhuan, Taizhou, China
Jiayan Huang, School of Public Health, Fudan University, Shanghai, 200032, Shanghai Municipality, China
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