Objective   To analyze the direct economic burden and its influencing factors among rural elderly hypertension patients in rural areas of Yunnan province and to provide references for optimizing medical expenditure structure and improving health resources allocation.

  Methods   Using stratified multistage random sampling, we recruited 5 004 residents aged 60 years and above in rural areas of Yunnan province and carried out a questionnaire survey and physical examination in the residents between July 2016 and July 2017. The direct costs of hypertension was estimated with two-step model method; influencing factors of the costs were analyzed based on structural equation model (SEM).

  Results   Among the 4 833 residents completing the survey, totally 1 691 self-reported hypertensives were identified and the prevalence rate of hypertension was 34.99%. The average total annual direct cost of hypertension per capita was 2 203.7 Yuan (RMB), with the component costs of 940.8, 458.0, 20.0, 12.2, and 779.2 Yuan for hospitalization, outpatient service, accommodation and transportation, nutrition, and medicine, respectively. The results of SEM analysis indicated that the amount of the direct cost was associated with duration of hospitalization (standardized regression coefficient: 0.60), the grade of hospital hospitalized in (0.56), whether having hypertension-related hospitalization during previous one year (0.18), frequency of annual outpatient visits (0.16), and multi-morbidity of chronic diseases (0.14); the duration of hospitalization and the grade of hospital hospitalized in showed stronger impact on the amount of the direct cost.

  Conclusion   The direct medication cost is relatively high and reducing the duration of hypertension-related hospitalization may alleviate the direct cost among elderly hypertension patients in rural Yunnan province.