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


Adrianna Murphy, London School of Hygiene & Tropical Medicine
Benjamin Palafox, London School of Hygiene & Tropical Medicine
Marjan Walli-Attaei, Hamilton Health Sciences
Timothy Powell-Jackson, London School of Hygiene & Tropical Medicine
Sumathy Rangarajan, Hamilton Health Sciences
Khalid F. Alhabib, King Khalid University Hospital
Alvaro Jr Avezum, Instituto Dante Pazzanese de Cardiologia
Kevser Burcu Tumerdem Calik, Marmara Üniversitesi
Jephat Chifamba, University of Zimbabwe
Tarzia Choudhury, Independent University, Bangladesh
Gilles Dagenais, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval
Antonio L. Dans, University of the Philippines Manila
Rajeev Gupta, Eternal Heart Care Centre and Research Institute
Romaina Iqbal, The Aga Khan University
Manmeet Kaur, Postgraduate Institute of Medical Education & Research, Chandigarh
Roya Kelishadi, Isfahan Cardiovascular Research Center, Isfahan UMS
Rasha Khatib, Advocate Aurora Health
Iolanthe Marike Kruger, North-West University
Vellappillil Raman Kutty, Health Action by People
Scott A. Lear, Simon Fraser University
Wei Li, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
Patricio Lopez-Jaramillo, Universidad de Santander
Viswanathan Mohan, Madras Diabetes Research Foundation
Prem K. Mony, St. John's Medical College
Andres Orlandini, ECLA Foundation
Annika Rosengren, Göteborg University, Sahlgrenska Academy
Ismail Rosnah, UKM Medical Centre
Pamela Seron, Universidad de la Frontera
Koon Teo, Hamilton Health Sciences
Lap Ah Tse, Chinese University of Hong Kong
Lungiswa Tsolekile, University of the Western Cape
Yang Wang, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College


© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. 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.

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