RT Journal Article SR Electronic T1 The household economic burden of non-communicable diseases in 18 countries JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e002040 DO 10.1136/bmjgh-2019-002040 VO 5 IS 2 A1 Adrianna Murphy A1 Benjamin Palafox A1 Marjan Walli-Attaei A1 Timothy Powell-Jackson A1 Sumathy Rangarajan A1 Khalid F Alhabib A1 Alvaro Jr Avezum A1 Kevser Burcu Tumerdem Calik A1 Jephat Chifamba A1 Tarzia Choudhury A1 Gilles Dagenais A1 Antonio L Dans A1 Rajeev Gupta A1 Romaina Iqbal A1 Manmeet Kaur A1 Roya Kelishadi A1 Rasha Khatib A1 Iolanthe Marike Kruger A1 Vellappillil Raman Kutty A1 Scott A Lear A1 Wei Li A1 Patricio Lopez-Jaramillo A1 Viswanathan Mohan A1 Prem K Mony A1 Andres Orlandini A1 Annika Rosengren A1 Ismail Rosnah A1 Pamela Seron A1 Koon Teo A1 Lap Ah Tse A1 Lungiswa Tsolekile A1 Yang Wang A1 Andreas Wielgosz A1 Ruohua Yan A1 Karen E Yeates A1 Khalid Yusoff A1 Katarzyna Zatonska A1 Kara Hanson A1 Salim Yusuf A1 Martin McKee YR 2020 UL http://gh.bmj.com/content/5/2/e002040.abstract 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.