Burden of chronic illness and associated disabilities in Bangladesh: Evidence from the Household Income and Expenditure Survey

Marufa Sultana, Rashidul Alam Mahumud, Abdur Razzaque Sarker, Marufa Sultana, Rashidul Alam Mahumud, Abdur Razzaque Sarker

Abstract

Objective: The purpose of this study was to investigate the distribution of chronic illness and associated disability, out-of-pocket payment (OOPP), and other related factors using survey data from Bangladesh.

Methods: This study analyzed Bangladesh Household Income and Expenditure Survey data that include socio-economic and demographic data, such as consumption, expenditures, and assets, along with information regarding chronic illness and disability. Multiple linear regression models were used to identify factors significantly associated with OOPP. Furthermore, a binary Logistic regression model was employed to assess the association of the explanatory variables with disability status.

Results: A higher prevalence of chronic illness was found for those with chronic gastritis (18.70%), and 41.92% of the population had at least one side disability. The average OOPP healthcare expenditure for chronic illness was estimated to be US$7.59. Higher OOPP was found among the upper 2 wealth quintiles. Overall OOPP health expenditure was significantly higher among individuals with an associated disability (P < 0.001). The likelihood of having an associated disability was higher among those individuals with a lower education level (OR = 2.36, 95% CI: 1.95-4.06), those who not earning an income (OR = 2.85, 95% CI: 2.53-3.21), those who did not seek care (OR = 1.73, 95% CI: 1.57-1.90), those who sought care from a pharmacy (OR = 8.91, 95% CI: 7.38-10.74), and those in the lowest wealth quintile (OR = 7.21, 95% CI: 6.41-8.12).

Conclusions: The high OOPP illustrates the necessity of financial risk protection for the population at low socio-economic status. Therefore, we recommend that the government strengthen the healthcare system with appropriate support directed to the rural and elderly populations.

Keywords: Bangladesh; Burden; Chronic illness; Disability; Out-of-pocket payments.

Figures

Fig. 1
Fig. 1
Distribution of reducing activities due to chronic disease with at least one disabilities.

References

    1. Kankeu H.T., Saksena P., Xu K., Evans D.B. The financial burden from non-communicable diseases in low-and middle-income countries: a literature review. BMC Heal Res Policy Syst. 2013;11:31.
    1. GBD 2015 Mortality and Causes of Death Collaborators Global, regional, and national life expectancy, all-cause mortality, and cause-specifi c mortality for 249 causes of death, 1980 – 2015: a systematic analysis for the Global Burden of Disease Study 2015. 2016;388:1459–1544.
    1. WHO . 2011. Global Status Report on Non-communicable Diseases 2010. Geneva, Switzerland. Available at:
    1. Islam A., Biswas T. Chronic non-communicable diseases and the healthcare system in Bangladesh: current status and way forward. Chronic Dis Int. 2014;1:1–6.
    1. Plianbangchang S, Narain JP. Health situation in the South-East Asia Region: challenges for the next decade. WHO South East Asia J Public Health. . Published 2012.
    1. Murray C.J.L., Lopez A.D. Estimating causes of death: new methods and global and regional application for 1990. In: Murray C.J.L., Lopez A.D., editors. Global Burden of Disease and Injury Series. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Harvard School of Public Health, on behalf of the World Health Organization and the World Bank; Boston: 1996. pp. 117–200.
    1. Sousa R.M., Ferri C.P., Acosta D. Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey. Lancet. 2009;374:1821–1830.
    1. Bleich S.N., Koehlmoos T.L., Rashid M., Peters D.H., Anderson G. Noncommunicable chronic disease in Bangladesh: overview of existing programs and priorities going forward. Health Policy (New York) 2011;100:282–289.
    1. Karar Z.A., Alam N., Streatfield P.K. Epidemiological transition in rural Bangladesh, 1986-2006. Glob Health Action. 2009;2:1–9.
    1. Islam M.M., Yen L., Valderas J.M., McRae I. Out-of-pocket expenditure by Australian seniors with chronic disease: the effect of specific diseases and morbidity clusters. BMC Public Health. 2014;14(1):1008.
    1. Yokota R.T., Van der Heyden J., Nusselder W.J. Impact of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. J Gerontol A Biol Sci Med Sci. 2016;71:903–909.
    1. Hwang W., Weller W., Ireys H., Anderson G. Out-of-pocket medical spending for care of chronic conditions. Health Aff. 2001;20:267–278.
    1. Rahman M.M., Gilmour S., Saito E., Sultana P., Shibuya K. Health-related financial catastrophe, inequality and chronic illness in Bangladesh. PLoS One. 2013;8(2):e56873.
    1. World Health Organization. WHO Global Health Expenditure Atlas. Geneva, Switzerland 2014. Available at: .
    1. MOHFW . Health Economics Unit, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh; Dhaka, Bangladesh: 2012. Expanding Social Protection for Health: Towards Universal Coverage, Health Care Financing Strategy 2012–2032.
    1. Zhong W., Finnie D.M., Shah N.D. Effect of multiple chronic diseases on health care expenditures in childhood. J Prim Care Community Health. 2015;6:2–9.
    1. Tareque M.I., Begum S., Saito Y. Inequality in disability in Bangladesh. PLoS One. 2014;9:e103681.
    1. Helmchen L.A., Lo Sasso A.T. How sensitive is physician performance to alternative compensation schedules? Evidence from a large network of primary care clinics. Health Econ. 2010;19(11):1300–1317.
    1. Onoka C.A., Onwujekwe O.E., Hanson K., Uzochukwu B.S. Examining catastrophic health expenditures at variable thresholds using household consumption expenditure diaries. Trop Med Int Heal. 2011;16:1334–1341.
    1. Wang Q., Fu A.Z., Brenner S., Kalmus O., Banda H.T., De Allegri M. Out-of-pocket expenditure on chronic non-communicable diseases in Sub-Saharan Africa: the case of Rural Malawi. PLoS One. 2015;10(1):e0116897.
    1. Brinda E.M., Kowal P., Attermann J., Enemark U. Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: the WHO Study on global AGEing and adult health (SAGE) J Epidemiol Community Health. 2015;69:489–494.
    1. Van Doorslaer E., O'Donnell O., Rannan-Eliya R.P. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet. 2006;368:1357–1364.
    1. Van Doorslaer E., O'Donnell O., Rannan-Eliya R.P. Catastrophic payments for health care in Asia. Health Econ. 2007;16:1159–1184.
    1. Wang Z., Li X., Chen M. Catastrophic health expenditures and its inequality in elderly households with chronic disease patients in China. Int J Equity Health. 2015;14:8.
    1. BBS (Bangladesh Bureau of Statistics) 2011. Bangladesh Household Income and Expenditure Survey 2010. Statistics Division, Ministry of Planning. Government of the People's Republic of Bangladesh: New Panama Printing Press. Available at: . Accessed 20 January 2017.
    1. Madans J.H., Loeb M.E., Altman B.M. Measuring disability and monitoring the UN Convention on the Rights of Persons with Disabilities: the work of the Washington Group on Disability Statistics. BMC Public Health. 2011;11(suppl 4):1–8.
    1. Tareque M.I., Begum S., Saito Y. Gender differences in disability-free life expectancy at old ages in Bangladesh. J Aging Health. 2013;25:1299–1312.
    1. Sarker A.R., Mahumud R.A., Sultana M., Ahmed S., Ahmed W., Khan J.A. The impact of age and sex on healthcare expenditure of households in Bangladesh. Springerplus. 2014,14;3:435.
    1. Pati S., Agrawal S., Swain S. Non communicable disease multimorbidity and associated health care utilization and expenditures in India: cross-sectional study. BMC Health Serv Res. 2014;14:451.
    1. WHO . 2014. Global Status Report on Noncommunicable Diseases 2014. Geneva, Switzerland. Available at: .
    1. Purty A.J., Bazroy J., Kar M., Vasudevan K., Veliath A.P.P. Morbidity pattern among the elderly population in the Rural Area of Tamilnadu, India. Turk Jr Med Sci. 2006;36:45–50.
    1. Joshi K., Kumar R., Avasthi A. Morbidity profile and its relationship with disability and pyschological distress among elderly people in Northern India. Int J Epidemiol. 2003;32:978–987.
    1. Britt H.C., Harrison C.M., Miller G.C., Knox S.A. Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008;189:72–77.
    1. Lee J.T., Hamid F., Pati S., Atun R., Millett C. Impact of noncommunicable disease multimorbidity on healthcare utilisation and out-of-pocket expenditures in middle-income countries: cross sectional analysis. PLoS One. 2015;10:e0127199.
    1. Basu S., King A.C. Disability and chronic disease among older adults in India: detecting vulnerable populations through the WHO SAGE Study. Am J Epidemiol. 2013;178:1620–1628.
    1. Stuckler D., Siegel K. Oxford University Press; Oxford: 2013. Sick Societies: Responding to the Global Challenge of Chronic Disease.
    1. Nolte E.E., McKee M. Caring for people with chronic conditions: a health system perspective. Int J Integr Care. 2009;9:e08.
    1. Schäfer I., Hansen H., Schön G. The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study. BMC Health Serv Res. 2012;12:89.
    1. Glynn L.G., Valderas J.M., Healy P. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011;28:516–523.
    1. Huntley A.L., Johnson R., Purdy S., Valderas J.M., Salisbury C. Measures of multimorbidity and morbidity burden for use in primary care and commu-nity settings: a systematic review and guide. Ann Fam Med. 2012;10:134–141.
    1. Mbchb R.A.P., Abel G.A., Mbbchir B.G., Mbchb S.W.M. Admissions to hospital: a retrospective cohort study. 2013;185(5):1–8.
    1. Murphy A., Mahal A., Richardson E., Moran A.E. The economic burden of chronic disease care faced by households in Ukraine: a cross-sectional matching study of angina patients. Int J Equity Health. 2013;12:38.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel