PT  - JOURNAL ARTICLE
AU  - Adrianna Murphy
AU  - Benjamin Palafox
AU  - Marjan Walli-Attaei
AU  - Timothy Powell-Jackson
AU  - Sumathy Rangarajan
AU  - Khalid F Alhabib
AU  - Alvaro Jr Avezum
AU  - Kevser Burcu Tumerdem Calik
AU  - Jephat Chifamba
AU  - Tarzia Choudhury
AU  - Gilles Dagenais
AU  - Antonio L Dans
AU  - Rajeev Gupta
AU  - Romaina Iqbal
AU  - Manmeet Kaur
AU  - Roya Kelishadi
AU  - Rasha Khatib
AU  - Iolanthe Marike Kruger
AU  - Vellappillil Raman Kutty
AU  - Scott A Lear
AU  - Wei Li
AU  - Patricio Lopez-Jaramillo
AU  - Viswanathan Mohan
AU  - Prem K Mony
AU  - Andres Orlandini
AU  - Annika Rosengren
AU  - Ismail Rosnah
AU  - Pamela Seron
AU  - Koon Teo
AU  - Lap Ah Tse
AU  - Lungiswa Tsolekile
AU  - Yang Wang
AU  - Andreas Wielgosz
AU  - Ruohua Yan
AU  - Karen E Yeates
AU  - Khalid Yusoff
AU  - Katarzyna Zatonska
AU  - Kara Hanson
AU  - Salim Yusuf
AU  - Martin McKee
TI  - The household economic burden of non-communicable diseases in 18 countries
AID  - 10.1136/bmjgh-2019-002040
DP  - 2020 Feb 01
TA  - BMJ Global Health
PG  - e002040
VI  - 5
IP  - 2
4099  - http://gh.bmj.com/content/5/2/e002040.short
4100  - http://gh.bmj.com/content/5/2/e002040.full
SO  - BMJ Global Health2020 Feb 01; 5
AB  - 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’ 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.