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

被引：100

作者：

Murphy, Adrianna ^{[1
]}

Palafox, Benjamin ^{[1
]}

Walli-Attaei, Marjan ^{[2
,3
]}

Powell-Jackson, Timothy ^{[1
]}

Rangarajan, Sumathy ^{[2
,3
]}

Alhabib, Khalid F. ^{[4
]}

Avezum, Alvaro Jr ^{[5
]}

Calik, Kevser Burcu Tumerdem ^{[6
]}

Chifamba, Jephat ^{[7
]}

Choudhury, Tarzia ^{[8
]}

Dagenais, Gilles ^{[9
]}

Dans, Antonio L. ^{[10
]}

Gupta, Rajeev ^{[11
]}

Iqbal, Romaina ^{[12
]}

Kaur, Manmeet ^{[13
]}

Kelishadi, Roya ^{[14
]}

Khatib, Rasha ^{[15
]}

Kruger, Iolanthe Marike ^{[16
]}

Kutty, Vellappillil Raman ^{[17
]}

Lear, Scott A. ^{[18
]}

Li, Wei ^{[19
]}

Lopez-Jaramillo, Patricio ^{[20
]}

Mohan, Viswanathan ^{[21
]}

Mony, Prem K. ^{[22
]}

Orlandini, Andres ^{[23
]}

Rosengren, Annika ^{[24
,25
]}

Rosnah, Ismail ^{[26
]}

Seron, Pamela ^{[27
]}

Teo, Koon ^{[2
,3
]}

Tse, Lap Ah ^{[28
]}

Tsolekile, Lungiswa ^{[29
]}

Wang, Yang ^{[30
]}

Wielgosz, Andreas ^{[31
]}

Yan, Ruohua ^{[30
]}

Yeates, Karen E. ^{[32
]}

Yusoff, Khalid ^{[33
,34
]}

Zatonska, Katarzyna ^{[35
]}

Hanson, Kara ^{[1
]}

Yusuf, Salim ^{[2
,3
]}

Mckee, Martin ^{[1
]}

机构：

[1] London Sch Hyg & Trop Med, Fac Publ Hlth & Policy, London, England

[2] Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada

[3] McMaster Univ, Hamilton, ON, Canada

[4] King Saud Univ, King Fahad Cardiac Ctr, Coll Med, Dept Cardiac Sci, Riyadh, Saudi Arabia

[5] Dante Pazzanese Inst Cardiol, Sao Paulo, Brazil

[6] Marmara Univ, Fac Hlth Sci, Dept Hlth Management, Istanbul, Turkey

[7] Univ Zimbabwe, Dept Physiol, Harare, Zimbabwe

[8] Independent Univ, Dhaka, Bangladesh

[9] Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, Canada

[10] Univ Philippines Manila, Dept Med, Manila, Philippines

[11] Eternal Heart Care Ctr & Res Inst, Jaipur, Rajasthan, India

[12] Aga Khan Univ, Dept Community Hlth Sci, Karachi, Pakistan

[13] Postgrad Inst Med Educ & Res, Sch Publ Hlth, Chandigarh, India

[14] Isfahan Univ Med Sci, Cardiovasc Res Inst, Isfahan Cardiovasc Res Ctr, Esfahan, Iran

[15] Northwestern Univ, Feinberg Sch Med, Dept Neurol, Chicago, IL 60611 USA

[16] North West Univ, Africa Unit Transdisciplinary Hlth Res, Potchefstroom, South Africa

[17] Hlth Act People, Trivandrum, Kerala, India

[18] Simon Fraser Univ, Fac Hlth Sci, Vancouver, BC, Canada

[19] Univ Teknol MARA, Fuwai Hosp, State Key Lab Cardiovasc Dis, Natl Ctr Cardiovasc Dis, Beijing, Peoples R China

[20] Univ Santander UDES, Sch Med, FOSCAL, Bucaramanga, Colombia

[21] Dr Mohans Diabet Special Ctr & Madras Diabet Res, Chennai, Tamil Nadu, India

[22] St Johns Med Coll & Res Inst, Bangalore, Karnataka, India

[23] ECLA Fdn, Rosario, Santa Fe, Argentina

[24] Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med, Gothenburg, Sweden

[25] Sahlgrenska Univ, Gothenburg, Sweden

[26] UKM Med Ctr, Fac Med, Dept Community Hlth, Kuala Lumpur, Malaysia

[27] Univ La Frontera, Fac Med, Temucu, Chile

[28] Chinese Univ Hong Kong, JC Sch Publ Hlth & Primary Care, Fac Med, Hong Kong, Peoples R China

[29] Univ Western Cape, Sch Publ Hlth, Bellville, Western Cape, South Africa

[30] Chinese Acad Med Sci & Peking Union Med Coll, Natl Ctr Cardiovasc Dis, State Key Lab Cardiovasc Dis, Fuwai Hosp, Beijing, Peoples R China

[31] Univ Ottawa, Dept Med, Ottawa, ON, Canada

[32] Queens Univ, Dept Med, Kingston, ON, Canada

[33] Univ Teknol MARA, Selayang, Selangor, Malaysia

[34] UCSI Univ, Kuala Lumpur, Malaysia

[35] Wroclaw Med Univ, Dept Social Med, Wroclaw, Poland

来源：

BMJ GLOBAL HEALTH | 2020年 / 5卷 / 02期

基金：

瑞典研究理事会; 新加坡国家研究基金会; 英国惠康基金; 英国经济与社会研究理事会; 加拿大健康研究院;

关键词：

LOW-INCOME COUNTRIES; MIDDLE-INCOME; HEALTH-CARE; CARDIOVASCULAR-DISEASE; SECONDARY PREVENTION; SOCIOECONOMIC-STATUS; PURE; AFFORDABILITY; AVAILABILITY; HYPERTENSION;

D O I：

10.1136/bmjgh-2019-002040

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

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

引用

页数：13

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