The household economic burden of non-communicable diseases in 18 countries
The household economic burden of non-communicable diseases in 18 countries
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DOI：
10.1136/bmjgh-2019-002040
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发表时间：
2020-02-01
影响因子：
8.1
通讯作者：
Mckee, Martin
中科院分区：
文献类型：
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作者：
Murphy, Adrianna;Palafox, Benjamin;Mckee, Martin
背景 非传染性疾病（NCD）是全球死亡的主要原因。 2014年，联合国承诺降低非传染性疾病导致的过早死亡率，包括减轻医疗费用负担。自 2014 年以来，前瞻性城乡流行病学 (PURE) 研究一直在收集 18 个国家患有非传染性疾病的家庭的医疗支出数据。 方法 利用 PURE 研究的数据，我们估计了至少一名患有非传染性疾病（心血管疾病、糖尿病、肾病、癌症和呼吸系统疾病；n=17 435）且仅患有高血压（非传染性疾病的主要危险因素）的家庭的灾难性医疗支出和贫困风险。 n=11 831) 或两者都没有 (n=22 654) 按国家收入组别：高收入国家（加拿大和瑞典）、中高收入国家（中低收入国家：巴西、智利、马来西亚、波兰、南非和土耳其）、中低收入国家（中低收入国家：菲律宾、哥伦比亚、印度、伊朗和巴勒斯坦被占领土）和低收入国家（低收入国家：孟加拉国、巴基斯坦、津巴布韦和坦桑尼亚）和中国。在中低收入国家和中国，患有非传染性疾病的家庭中灾难性支出和贫困率最高。调整可能推动卫生支出的协变量后，与没有非传染性疾病的中低收入国家家庭相比，患有非传染性疾病的家庭发生灾难性支出的绝对风险更高（风险差异=1.71%；95% CI 0.75至2.67）、中低收入国家（0.82%；95% CI 0.37至1.27）和中国（7.52%；95% CI 5.88至1.27）。 9.16）。在中低收入国家和中国也观察到类似的贫困模式。低收入国家中有很高比例的非传染性疾病患者，特别是女性（38.7%，男性为 12.6%），报告称由于费用而没有服药。结论 我们的研究结果表明，针对非传染性疾病患者的医疗费用的财务保护不足，特别是在中低收入国家和中国。虽然中低收入国家和中国的非传染性疾病护理负担似乎最大，但
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