Objective  To study current status and related factors of catastrophic health expenditure (CHE) among rural inhabitants in Shandong province and to provide evidences for policy making.

  Methods  Using stratified random sampling, we conducted a household questionnaire survey among 2 337 residents of 754 families in rural areas of Shandong province between March and April 2014. CHE of each family was estimated with the method recommended by World Health Organization and influencing factors of CHE were explored with dichotomic classification logistic regression analysis.

  Results  Among the families, the incidence of CHE was 19.73% and the rate of CHE-related poverty was 9.54%. The results of logistic regression demonstrated that the households with elderly family members (odds ratio OR = 1.443, 95% confidence interval 95% CI: 1.273 – 1.631), with children aged < 5 years (OR = 1.639, 95% CI: 1.135 – 2.439), and with family members suffering from chronic diseases (OR = 2.285, 95% CI:1.935 – 2.516) were more likely to have CHE. Multiple risk factors increased CHE and the CHE was impacted by needs and utilizations of health care service and demographic characteristics of the households.

  Conclusion  The health care services covered by medical insurance should be expanded and supplementary medical insurance and serious illness insurance should be promoted among rural residents in Shandong province to alleviate out of pocket expenditure of the population.