The household economic burden of non-communicable diseases in 18 countries
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 c...
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BMJ Publishing Group
2020-02-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/2/e002040.full |
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| author | Annika Rosengren Khalid Yusoff Lap Ah Tse Viswanathan Mohan Yang Wang Martin McKee Karen E Yeates Wei Li Rajeev Gupta Kara Hanson Koon Teo Sumathy Rangarajan Scott A Lear Rasha Khatib Patricio Lopez-Jaramillo Romaina Iqbal Khalid F Alhabib Jephat Chifamba Gilles Dagenais Andreas Wielgosz Salim Yusuf Adrianna Murphy Timothy Powell-Jackson Pamela Serón Marjan Walli-Attaei Lungiswa Tsolekile Prem K Mony Benjamin Palafox Alvaro Jr Avezum Kevser Burcu Tumerdem Calik Tarzia Choudhury Antonio L Dans Manmeet Kaur Roya Kelishadi Iolanthe Marike Kruger Vellappillil Raman Kutty Andres Orlandini Ismail Rosnah Ruohua Yan Katarzyna Zatonska |
| author_facet | Annika Rosengren Khalid Yusoff Lap Ah Tse Viswanathan Mohan Yang Wang Martin McKee Karen E Yeates Wei Li Rajeev Gupta Kara Hanson Koon Teo Sumathy Rangarajan Scott A Lear Rasha Khatib Patricio Lopez-Jaramillo Romaina Iqbal Khalid F Alhabib Jephat Chifamba Gilles Dagenais Andreas Wielgosz Salim Yusuf Adrianna Murphy Timothy Powell-Jackson Pamela Serón Marjan Walli-Attaei Lungiswa Tsolekile Prem K Mony Benjamin Palafox Alvaro Jr Avezum Kevser Burcu Tumerdem Calik Tarzia Choudhury Antonio L Dans Manmeet Kaur Roya Kelishadi Iolanthe Marike Kruger Vellappillil Raman Kutty Andres Orlandini Ismail Rosnah Ruohua Yan Katarzyna Zatonska |
| author_sort | Annika Rosengren |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T11:44:02Z |
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| id | doaj.art-d0c56c120f6245948281da0f6cb9f90f |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-03-11T11:44:02Z |
| publishDate | 2020-02-01 |
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| series | BMJ Global Health |
| spelling | doaj.art-d0c56c120f6245948281da0f6cb9f90f2023-11-09T20:05:07ZengBMJ Publishing GroupBMJ Global Health2059-79082020-02-015210.1136/bmjgh-2019-002040The household economic burden of non-communicable diseases in 18 countriesAnnika Rosengren0Khalid Yusoff1Lap Ah Tse2Viswanathan Mohan3Yang Wang4Martin McKee5Karen E Yeates6Wei Li7Rajeev Gupta8Kara Hanson9Koon Teo10Sumathy Rangarajan11Scott A Lear12Rasha Khatib13Patricio Lopez-Jaramillo14Romaina Iqbal15Khalid F Alhabib16Jephat Chifamba17Gilles Dagenais18Andreas Wielgosz19Salim Yusuf20Adrianna Murphy21Timothy Powell-Jackson22Pamela Serón23Marjan Walli-Attaei24Lungiswa Tsolekile25Prem K Mony26Benjamin Palafox27Alvaro Jr Avezum28Kevser Burcu Tumerdem Calik29Tarzia Choudhury30Antonio L Dans31Manmeet Kaur32Roya Kelishadi33Iolanthe Marike Kruger34Vellappillil Raman Kutty35Andres Orlandini36Ismail Rosnah37Ruohua Yan38Katarzyna Zatonska39Department of Cardiology, Sahlgrenska University Hospital, Goteborg, SwedenUiTM, Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia1 JC School of Public Health and Primary Care, The Chinese University, Hong Kong SAR, People`s Republic of ChinaMadras Diabetes Research Foundation, Chennai, IndiaNational Clinical Research Centre of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People`s Republic of ChinaDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKDepartment of Medicine, Queen`s University, Kingston, New Hampshire, Canada1 Faculty of Psychology, Southwest University, Beibei, Chongqing, ChinaMedicine, Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, Indiaprofessor of health system economicsPopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, CanadaPopulation Health Research Institute, McMaster University, Hamilton, Ontario, CanadaFaculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, CanadainvestigatorprofessorDepartment of Community Health Sciences and Medicine, Aga Khan University, Karachi, PakistanDepartment of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi ArabiaprofessorInstitut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Ontario, Canadaprofessorprofessor2 Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UKDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UKDepartamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile5 Population Health Research Institute, Hamilton, Ontario, CanadaSchool of Public Health, University of the Western Cape, Bellville, Western Cape, South AfricaDivision of Epidemiology & Population Health, St John`s Medical College and Research Institute, Bangalore, IndiaLondon School of Hygiene and Tropical Medicine, London, UKDante Pazzanese Institute of Cardiology, São Paulo, BrazilDepartment of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, TurkeyIndependent University, Dhaka, BangladeshDepartment of Medicine, University of the Philippines Manila, Manila, PhilippinesDepartment of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, IndiaIsfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of IranAfrica Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South AfricaHealth Action by People, Trivandrum, Kerala, Indiamanaging directorCommunity Health Department, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, MalaysiaState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaprofessorBackground 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.https://gh.bmj.com/content/5/2/e002040.full |
| spellingShingle | Annika Rosengren Khalid Yusoff Lap Ah Tse Viswanathan Mohan Yang Wang Martin McKee Karen E Yeates Wei Li Rajeev Gupta Kara Hanson Koon Teo Sumathy Rangarajan Scott A Lear Rasha Khatib Patricio Lopez-Jaramillo Romaina Iqbal Khalid F Alhabib Jephat Chifamba Gilles Dagenais Andreas Wielgosz Salim Yusuf Adrianna Murphy Timothy Powell-Jackson Pamela Serón Marjan Walli-Attaei Lungiswa Tsolekile Prem K Mony Benjamin Palafox Alvaro Jr Avezum Kevser Burcu Tumerdem Calik Tarzia Choudhury Antonio L Dans Manmeet Kaur Roya Kelishadi Iolanthe Marike Kruger Vellappillil Raman Kutty Andres Orlandini Ismail Rosnah Ruohua Yan Katarzyna Zatonska The household economic burden of non-communicable diseases in 18 countries BMJ Global Health |
| title | The household economic burden of non-communicable diseases in 18 countries |
| title_full | The household economic burden of non-communicable diseases in 18 countries |
| title_fullStr | The household economic burden of non-communicable diseases in 18 countries |
| title_full_unstemmed | The household economic burden of non-communicable diseases in 18 countries |
| title_short | The household economic burden of non-communicable diseases in 18 countries |
| title_sort | household economic burden of non communicable diseases in 18 countries |
| url | https://gh.bmj.com/content/5/2/e002040.full |
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