Objective To analyze the trends of hospitalization costs and the impact of comorbidities and complications on hospitalization costs among hypertensive patients in county-level medical institutions in Henan Province from 2017 to 2024, thereby providing evidence for optimizing chronic disease management at the primary care level.

Methods A retrospective study was conducted. The inpatient data of hypertensive patients in the People's Hospital and Traditional Chinese Medicine Hospital in a certain county in Henan Province from 2017 to 2024 were collected, including information such as the number of hospitalizations, cost structure, comorbidities and complications. The Mann-Kendall trend test was applied to evaluate changes of the number of people and costs. Linear regression was used to investigate the impact of different complications/ comorbidities on the burden of hospitalization for patients.

Results Both the times of hospitalizations (8 154, 10 487, 13 401, 14 415, 14 571, 13 414, 15 841, 15 522, Tau = 0.79, Sen’s Sploe = 926.58) and the number of hospitalizations (6 947, 8 597, 10 742, 11 231, 11 692, 11 060, 13 229, 13 014, Tau = 0.79, Sen’s Sploe = 752.33) showed a consistent upward trend over the years. Similarly, the times of hospitalizations involving hypertensive patients with comorbidities and complications (comorbidities: Tau = 0.71, Sen's Sploe = 658.08; complications: Tau = 0.79, Sen's Sploe = 589.68) and the number of patients who were hospitalized only once a year (comorbidities: Tau = 0.86, Sen's Sploe = 528.38; complications: Tau = 0.86, Sen's Sploe = 402.50) also showed an increasing trend over the years. Despite the rising times of hospitalizations, the average cost per admission and the average length of stay showed a decreasing trend year by year. Linear regression analysis revealed that, compared to patients with hypertension alone, total costs increased for those with complications or comorbidities. The greatest increase was observed in patients with complications, who experienced a 71.51% (95% CI: 67.53% to 75.59%) rise in total costs. All cost components also increased to varying degrees. Furthermore, both costs and length of hospital stay increased with the rising number of complications/comorbidities.

Conclusions From 2017 to 2024, the hospitalization structure of hypertensive patients in a certain county in Henan Province became increasingly complex, and the number of people with comorbidities and complications increased significantly. Although the average cost per visit and the length of hospital stay decreased, the complexity of the disease was positively correlated with the cost of hospitalization, and there was a significant cumulative effect.