Annual medical expenditure associated with short sleep in China: estimates from a nationally representative sample.

Background: Short sleep is associated with increased morbidity risks and therefore can induce substantial medical costs. This study estimates the total and out-of-pocket amount of medical expenditure associated with short sleep among Chinese adults. Methods: We used nationally representative data from the China Family Panel Studies (CFPS) in 2018. Two-part regression models were used to examine the associations between short sleep and an individual's annual total or out-of-pocket medical expenditure. Counterfactual estimations were used to estimate individual and population medical cost due to very short sleep. Results: Individuals with very short sleep duration (<6h for 18-64 years; < 5h for 65+ years) were more likely to have medical expenditure (OR = 1.38, 95 % CI: 1.23-1.56), and when they did, they spent 1822.80 CNY more than those sleeping recommended hours (7-9h for 18-64 years; 7-8h for 65+ years). The corresponding estimates for out-of-pocket medical expenditure were 1.40 (OR, 95 % CI: 1.24-1.58) and 1138.66 CNY. The estimated cost of very short sleep contributed to 2.73 % of the expected total medical expenditure and 2.74 % of the expected out-of-pocket medical expenditure for an average person. The share of medical spending due to very short sleep is higher in groups who were female, divorced/widowed, less educated, rural, and working on farming jobs. The total national medical expenditure associated with very short sleep in 2018 was estimated to be 87.85 billion CNY (13.52 billion USD), including 55.25 billion CNY (8.50 billion USD) out-of-pocket expenditure (62.89 %). Conclusions: Short sleep was associated with increased total and out-of-pocket medical expenses in China. Our results have implications for public advice to get sufficient sleep, as it could help reduce medical expenditure, especially for disadvantaged groups.