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The household economic burden of non-communicable diseases in 18 countries

Murphy A 1 , Palafox B 1 , Walli-Attaei M 2 , Powell-Jackson T 1 , Rangarajan S 2 , Alhabib KF 3 Show all authors , Avezum AJ 4 , Calik KBT 5 , Chifamba J 6 , Choudhury T 7 , Dagenais G 8 , Dans AL 9 , Gupta R 10 , Iqbal R 11 , Kaur M 12 , Kelishadi R 13 , Khatib R 14 , Kruger IM 15 , Kutty VR 16 , Lear SA 17 , Li W 18 , Lopez-Jaramillo P 19 , Mohan V 20 , Mony PK 21 , Orlandini A 22 , Rosengren A 23 , Rosnah I 24 , Seron P 25 , Teo K 2 , Tse LA 26 , Tsolekile L 27 , Wang Y 28 , Wielgosz A 29 , Yan R 28 , Yeates KE 30 , Yusoff K 31 , Zatonska K 32 , Hanson K 1 , Yusuf S 2 , McKee M 1

Affiliations 

  • 1 London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
  • 2 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
  • 3 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 4 Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
  • 5 Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
  • 6 Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
  • 7 Independent University, Dhaka, Bangladesh
  • 8 Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Ontario, Canada
  • 9 Department of Medicine, University of the Philippines Manila, Manila, Philippines
  • 10 Eternal Heart Care Centre and Research Institute, Jaipur, India
  • 11 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
  • 12 School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 13 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of Iran
  • 14 Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  • 15 Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
  • 16 Health Action by People, Trivandrum, Kerala, India
  • 17 Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
  • 18 State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, University Teknologi MARA, Beijing, China
  • 19 FOSCAL, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
  • 20 Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
  • 21 St John's Medical College and Research Institute, Bangalore, India
  • 22 ECLA Foundation, Santa Fe, Argentina
  • 23 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University, Gothenburg, Sweden
  • 24 Community Health Department, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
  • 25 Facultad de Medicina, Universidad de La Frontera, Temucu, Chile
  • 26 JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
  • 27 School of Public Health, University of the Western Cape, Bellville, Western Cape, South Africa
  • 28 State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 29 Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  • 30 Department of Medicine, Queen's University, Kingston, New Hampshire, Canada
  • 31 UiTM, Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia
  • 32 Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
BMJ Glob Health, 2020;5(2):e002040.
PMID: 32133191 DOI: 10.1136/bmjgh-2019-002040

Abstract

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries.

METHODS: Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China.

RESULTS: The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs.

CONCLUSIONS: Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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