@article {Murphye002040, author = {Adrianna Murphy and Benjamin Palafox and Marjan Walli-Attaei and Timothy Powell-Jackson and Sumathy Rangarajan and Khalid F Alhabib and Alvaro Jr Avezum and Kevser Burcu Tumerdem Calik and Jephat Chifamba and Tarzia Choudhury and Gilles Dagenais and Antonio L Dans and Rajeev Gupta and Romaina Iqbal and Manmeet Kaur and Roya Kelishadi and Rasha Khatib and Iolanthe Marike Kruger and Vellappillil Raman Kutty and Scott A Lear and Wei Li and Patricio Lopez-Jaramillo and Viswanathan Mohan and Prem K Mony and Andres Orlandini and Annika Rosengren and Ismail Rosnah and Pamela Seron and Koon Teo and Lap Ah Tse and Lungiswa Tsolekile and Yang Wang and Andreas Wielgosz and Ruohua Yan and Karen E Yeates and Khalid Yusoff and Katarzyna Zatonska and Kara Hanson and Salim Yusuf and Martin McKee}, title = {The household economic burden of non-communicable diseases in 18 countries}, volume = {5}, number = {2}, elocation-id = {e002040}, year = {2020}, doi = {10.1136/bmjgh-2019-002040}, publisher = {BMJ Specialist Journals}, 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.Data may be obtained from a third party and are not publicly available. Participant-level data cannot be publicly deposited because consent to share individuals{\textquoteright} data publicly has not been obtained, and data collection is ongoing. Researchers wishing to access these data should contact the PURE Program Manager, Sumathy Rangarajan at sumathy.rangarajan@phri.ca.}, URL = {https://gh.bmj.com/content/5/2/e002040}, eprint = {https://gh.bmj.com/content/5/2/e002040.full.pdf}, journal = {BMJ Global Health} }