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

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

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.

Related collections

Most cited references 25

Record: found
Abstract: found
Article: not found

The Prospective Urban Rural Epidemiology (PURE) study: examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries.

Koon Hoo Teo, Clara K Chow, Mário A.P. Vaz … (2009)

Marked changes in the prevalence of noncommunicable diseases such as obesity, diabetes, and cardiovascular disease have occurred in developed and developing countries in recent decades. The overarching aim of the study is to examine the relationship of societal influences on human lifestyle behaviors, cardiovascular risk factors, and incidence of chronic noncommunicable diseases. The Prospective Urban Rural Epidemiology (PURE) study is a large-scale epidemiological study that plans to recruit approximately 140,000 individuals residing in >600 communities in 17 low-, middle-, and high-income countries around the world. Individual data collection includes medical history, lifestyle behaviors (physical activity and dietary profile), blood collection and storage for biochemistry and future genetic analysis, electrocardiogram, and anthropometric measures. In addition, detailed information is being collected with respect to 4 environmental domains of interest-the built environment, nutrition and associated food policy, psychosocial/socioeconomic factors, and tobacco environment. A minimum follow-up of 10 years is currently planned. This report describes the design, justification, and methodology of the PURE study. The PURE study has been recruiting since 2002 and has enrolled 139,506 individuals by March 31, 2009. The PURE study builds on the work and experience gained through conduct of the INTERHEART study. Its design and extensive data collection are geared toward addressing major questions on causation and development of the underlying determinants of cardiovascular disease in populations at varying stages of epidemiologic transition.

0 comments Cited 193 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Women’s autonomy in health care decision-making in developing countries: a synthesis of the literature

Pauline E Osamor, Christine Grady (2016)

Autonomy is considered essential for decision-making in a range of health care situations, from health care seeking and utilization to choosing among treatment options. Evidence suggests that women in developing or low-income countries often have limited autonomy and control over their health decisions. A review of the published empirical literature to identify definitions and methods used to measure women’s autonomy in developing countries describe the relationship between women’s autonomy and their health care decision-making, and identify sociodemographic factors that influence women’s autonomy and decision-making regarding health care was carried out. An integrated literature review using two databases (PubMed and Scopus) was performed. Inclusion criteria were 1) publication in English; 2) original articles; 3) investigations on women’s decision-making autonomy for health and health care utilization; and 4) developing country context. Seventeen articles met inclusion criteria, including eleven from South Asia, five from Africa, and one from Central Asia. Most studies used a definition of autonomy that included independence for women to make their own choices and decisions. Study methods differed in that many used study-specific measures, while others used a set of standardized questions from their countries’ national health surveys. Most studies examined women’s autonomy in the context of reproductive health, while neglecting other types of health care utilized by women. Several studies found that factors, including age, education, and income, affect women’s health care decision-making autonomy. Gaps in existing literature regarding women’s autonomy and health care utilization include gaps in the areas of health care that have been measured, the influence of sex roles and social support, and the use of qualitative studies to provide context and nuance.

0 comments Cited 138 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty.

Owen O'Donnell, J Krishnakumar, Eddy van Roon … (2008)

In the absence of formal health insurance, we argue that the strategies households adopt to finance health care have important implications for the measurement and interpretation of how health payments impact on consumption and poverty. Given data on source of finance, we propose to (a) approximate the relative impact of health payments on current consumption with a 'coping'-adjusted health expenditure ratio, (b) uncover poverty that is 'hidden' because total household expenditure is inflated by financial coping strategies and (c) identify poverty that is 'transient' because necessary consumption is temporarily sacrificed to pay for health care. Measures that ignore coping strategies not only overstate the risk to current consumption and exaggerate the scale of catastrophic payments but also overlook the long-run burden of health payments. Nationally representative data from India reveal that coping strategies finance as much as three-quarters of the cost of inpatient care. Payments for inpatient care exceed 10% of total household expenditure for around 30% of hospitalized households but less than 4% sacrifice more than 10% of current consumption to accommodate this spending.Ignoring health payments leads to underestimate poverty by 7-8% points among hospitalized households; 80% of this adjustment is hidden poverty due to coping.

0 comments Cited 122 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): BMJ Glob Health

Journal ID (iso-abbrev): BMJ Glob Health

Journal ID (hwp): bmjgh

Journal ID (publisher-id): bmjgh

Title: BMJ Global Health

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2059-7908

Publication date Collection: 2020

Publication date (Electronic): 11 February 2020

Volume: 5

Issue: 2

Electronic Location Identifier: e002040

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 ] departmentDepartment 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 ] departmentDepartment of Health Management, Faculty of Health Sciences , Marmara University , Istanbul, Turkey

[6 ] departmentDepartment 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 ] departmentDepartment of Medicine , University of the Philippines Manila , Manila, Philippines

[10 ] Eternal Heart Care Centre and Research Institute , Jaipur, India

[11 ] departmentDepartment of Community Health Sciences , Aga Khan University , Karachi, Pakistan

[12 ] departmentSchool 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 ] departmentDepartment of Neurology , Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA

[15 ] departmentAfrica Unit for Transdisciplinary Health Research , North-West University , Potchefstroom, South Africa

[16 ] Health Action by People , Trivandrum, Kerala, India

[17 ] departmentFaculty of Health Sciences , Simon Fraser University , Vancouver, British Columbia, Canada

[18 ] departmentState 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 ] departmentDepartment of Molecular and Clinical Medicine , Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University , Gothenburg, Sweden

[24 ] departmentCommunity Health Department, Faculty of Medicine , UKM Medical Centre , Kuala Lumpur, Malaysia

[25 ] departmentFacultad de Medicina , Universidad de La Frontera , Temucu, Chile

[26 ] departmentJC School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong

[27 ] departmentSchool of Public Health , University of the Western Cape , Bellville, Western Cape, South Africa

[28 ] departmentState 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 ] departmentDepartment of Medicine , University of Ottawa , Ottawa, Ontario, Canada

[30 ] departmentDepartment of Medicine , Queen's University , Kingston, New Hampshire, Canada

[31 ] UiTM, Selayang, Selangor and UCSI University , Cheras, Kuala Lumpur, Malaysia

[32 ] departmentDepartment of Social Medicine , Wroclaw Medical University , Wroclaw, Poland

Author notes

[Correspondence to ] Dr Adrianna Murphy; adrianna.murphy@ 123456lshtm.ac.uk

Author information

Adrianna Murphy http://orcid.org/0000-0003-4065-6744

Benjamin Palafox http://orcid.org/0000-0003-3775-4415

Article

Publisher ID: bmjgh-2019-002040

DOI: 10.1136/bmjgh-2019-002040

PMC ID: 7042605

PubMed ID: 32133191

SO-VID: 2f2d42d3-6978-495a-a295-96e495892de0

License:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

History

Date received : 01 October 2019

Date revision received : 07 January 2020

Date accepted : 09 January 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;

Award ID: 104349/Z/14/Z

Custom metadata

special-feature unlocked

Keywords: health economics,health insurance,cardiovascular disease,health systems,diabetes

Data availability:

Keywords: health economics, health insurance, cardiovascular disease, health systems, diabetes

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

Read this article at

Abstract

Related collections

UCL: UN SDG 03 Good Health and Well-Being

Most cited references 25

The Prospective Urban Rural Epidemiology (PURE) study: examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries.

Women’s autonomy in health care decision-making in developing countries: a synthesis of the literature

Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty.

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 177

Cited by 61

Most referenced authors 1,375