Urban-rural differences in catastrophic health expenditure among households with chronic non-communicable disease patients: evidence from China Family Panel Studies

Abstract BackgroundThe prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform. Little is known for the differences in catastrophic health expenditure (CHE) between urban and rural households with NCD patients. This study aims to measure the differences above and quantify the contribution of each variable in explaining the urban-rural differences.MethodsThe second and the fourth waves of the China Family Panel Studies (CFPS) data, conducted in 2012 and 2016, were employed in this cross-sectional study. The techniques of Fairlie nonlinear decomposition and Blinder-Oaxaca decomposition were employed to measure the contribution of each independent variable to the urban-rural differences.ResultsThe CHE incidence and intensity of households with NCD patients were significantly higher in rural areas than in urban areas. The explained disparity of CHE incidence increased from 3.15% in 2012 to 27.04% in 2016, and the corresponding values of CHE intensity rose from 21.30% in 2012 to 53.37% in 2016. The major contribution to the urban-rural differences in CHE was associated with household economic status, education level, health status and supplementary medical insurance (SMI).ConclusionsCompared with urban households with NCD patients, rural households with NCD patients have higher risk of incurring CHE and heavier economic burden of diseases. Policy interventions should give priority to decreasing the urban-rural disparity in observable characteristics mentioned above.

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Urban-rural differences in catastrophic health expenditure among households with chronic non-communicable disease patients : evidence from China Family Panel Studies

10.21203/rs.3.rs-37742/v1 ◽

2020 ◽

Author(s):

Xianzhi Fu ◽

Qi-wei Sun ◽

Chang-qing Sun ◽

Fei Xu ◽

Jun-jian He

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Health Expenditure ◽

Communicable Disease ◽

Rural Households ◽

Catastrophic Health Expenditure ◽

System Reform ◽

Cross Sectional ◽

Urban Rural ◽

Panel Studies

Abstract Background: The prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform. Little is known for the differences in catastrophic health expenditure (CHE) between urban and rural households with NCD patients. This study aims to measure the differences above and quantify the contribution of each variable in explaining the urban-rural differences.Methods: The second and the fourth waves of the China Family Panel Studies (CFPS) data, conducted in 2012 and 2016, were employed in this cross-sectional study. The techniques of Fairlie nonlinear decomposition and Blinder-Oaxaca decomposition were employed to measure the contribution of each independent variable to the urban-rural differences.Results: The CHE incidence and intensity of households with NCD patients were significantly higher in rural areas than in urban areas. The explained disparity of CHE incidence increased from 3.15% in 2012 to 27.04% in 2016, and the corresponding values of CHE intensity rose from 21.30% in 2012 to 53.37% in 2016. The major contribution to the urban-rural differences in CHE was associated with household economic status, education level, health status and supplementary medical insurance (SMI).Conclusions: Compared with urban households with NCD patients, rural households with NCD patients have higher risk of incurring CHE and heavier economic burden of diseases. Policy interventions should give priority to decreasing the urban-rural disparity in observable characteristics.

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Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013: two waves’ cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-023033 ◽

2019 ◽

Vol 9 (5) ◽

pp. e023033 ◽

Cited By ~ 4

Author(s):

Yafei Si ◽

Zhongliang Zhou ◽

Min Su ◽

Xiao Wang ◽

Xin Lan ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Health Expenditure ◽

Economic Status ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Urban China ◽

Shaanxi Province ◽

Vulnerable Groups ◽

Cross Sectional

ObjectiveDespite the latest wave of China’s healthcare reform initiated in 2009 has achieved unprecedented progress in rural areas, little is known for specific vulnerable groups’ catastrophic health expenditure (CHE) in urban China. This study aims to estimate the trend of incidence, intensity and inequality of CHE in hypertension households (households with one or more than one hypertension patient) in urban Shaanxi, China from 2008 to 2013.MethodsBased on the fourth and the fifth National Health Service Surveys of Shaanxi, we identified 460 and 1289 households with hypertension in 2008 and 2013, respectively for our analysis. We classified hypertension households into two groups: simplex households (with hypertension only) and mixed households (with hypertension plus other non-communicable diseases). CHE would be identified if out-of-pocket healthcare expenditure was equal to or higher than 40% of a household’s capacity to pay. Concentration index and its decomposition based on Probit regressions were employed to measure the income-related inequality of CHE.ResultsWe find that CHE occurred in 11.2% of the simplex households and 22.1% of the mixed households in 2008, and the 21.5% of the simplex households and the 46.9% of mixed households incurred CHE in 2013. Furthermore, there were strong pro-poor inequalities in CHE in the simplex households (−0.279 and −0.283) and mixed households (−0.362 and −0.262) both in 2008 and 2013. The majority of observed inequalities in CHE could be associated with household economic status, household head’s health status and having elderly members.ConclusionWe find a sharp increase of CHE occurrence and the sustained strong pro-poor inequalities for simplex and mixed households in urban Shaanxi Province of China from 2008 to 2013. Our study suggests that more concerns are needed for the vulnerable groups such as hypertension households in urban areas of China.

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The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison

Journal of Health and Medical Sciences ◽

10.31014/aior.1994.04.02.160 ◽

2021 ◽

Vol 4 (2) ◽

Author(s):

Paul Oladapo Ajayi ◽

◽

Demilade Olusola Ibirongbe ◽

Tope Michael Ipinnimo ◽

Oluremi Olayinka Solomon ◽

...

Keyword(s):

Urban Communities ◽

Rural Areas ◽

Urban Areas ◽

Health Expenditure ◽

Univariate Analysis ◽

Sampling Technique ◽

Catastrophic Health Expenditure ◽

Cross Sectional ◽

Rural And Urban ◽

Household Heads

Background: Catastrophic health expenditure occurs when the burden of Out-of-pocket health expenditure has reached a certain level that a household must forego the expenditure on other basic needs of life to meet the health expenses of its member(s) of the household. Worldwide, over 44 million households suffer annually from financial catastrophe. This study intends to determine the prevalence of household catastrophic health expenditure amongst rural and urban communities in Ekiti, Nigeria. Methodology: This is a comparative cross-sectional study of households within selected rural and urban communities in Ekiti State, Nigeria. A pre-tested interviewer-administered semi-structured questionnaire was used to collect data over a period of 4 months from a sample of 1,000 household heads, using a multistage sampling technique. Data obtained were then entered using the SPSS version 20 and analysed with STATA 12. Two different methodologies were used to calculate household catastrophic health expenditure, with sensitivity analysis done. Univariate analysis were used to describe the population in relation to relevant variables. Result: The prevalence of household catastrophic health expenditure is high using the two methodological calculations. It was significantly higher in the rural areas, 18.5% than the urban areas, 12.8% (p=0.015) for first method; it was also higher in the rural areas, 8.3% compared to the urban areas, 2.5% (p<0.001) for the second method. Conclusion: Prevalence of household catastrophic health expenditure is high in Nigeria, but worse in the rural areas. It’s therefore vital to establish financial and social intervention mechanisms that can protect households from incurring catastrophic health expenditure.

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Progress on Catastrophic Health Expenditure in China: Evidence from China Family Panel Studies (CFPS) 2010 to 2016

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234775 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4775 ◽

Cited By ~ 3

Author(s):

Xiaochen Ma ◽

Ziyue Wang ◽

Xiaoyun Liu

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Health Expenditure ◽

Catastrophic Health Expenditure ◽

Income Quintile ◽

Net Income ◽

Catastrophic Expenditure ◽

Robust Variance ◽

Out Of Pocket Payments ◽

Panel Studies

Background: To provide an updated estimate of the level and change in catastrophic health expenditure in China and examine the association between catastrophic health expenditure and family net income, we obtained data from four waves of the China Family Panel Studies conducted between 2010 and 2016. Method: We defined catastrophic health expenditure as out-of-pocket payments equaling or exceeding 40% of the household’s capacity to pay. The Poisson regression with robust variance and generalized estimated equation (Poisson-GEE) model was used to quantify the level and change of catastrophic health expenditure, as well as the association between catastrophic heath expenditure and family net income. Result: Overall, the incidence of catastrophic expenditure in China experienced a 0.70-fold change between 2010 (12.57%) and 2016 (8.94%). The incidence of catastrophic health expenditure (CHE) decreased more in the poorest income quintile than the richest income quintile (annual decrease of 1.17% vs. 0.24% in urban areas, p < 0.001; 1.64% vs. −0.02% in rural areas, p < 0.001). Every 100% increase in income was associated with a 14% relative-risk reduction in CHE (RR = 0.86, 95% CI: 0.85–0.88) after adjusting for demographics, health needs, and health utilization characteristics; this association was weaker in recent years. Conclusion: Our analysis found that China made progress to reduce catastrophic health expenditure, especially for poorer groups. Income growth is strongly associated with this change.

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The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison

10.31219/osf.io/k6x4f ◽

2021 ◽

Author(s):

Paul Oladapo Ajayi ◽

Demilade Olusola Ibirongbe ◽

Tope Michael Ipinnimo ◽

Oluremi Olayinka Solomon ◽

Austin Idowu Ibikunle ◽

...

Keyword(s):

Urban Communities ◽

Rural Areas ◽

Urban Areas ◽

Health Expenditure ◽

Univariate Analysis ◽

Sampling Technique ◽

Catastrophic Health Expenditure ◽

Cross Sectional ◽

Rural And Urban ◽

Household Heads

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Urban–rural disparity in cancer incidence in China, 2008–2012: a cross-sectional analysis of data from 36 cancer registers

BMJ Open ◽

10.1136/bmjopen-2020-042762 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042762

Author(s):

Shuai Yuan ◽

Shao-Hua Xie

Keyword(s):

Cancer Incidence ◽

Rural Areas ◽

Urban Areas ◽

Incidence Rates ◽

Cancer Type ◽

Anatomic Site ◽

Cross Sectional ◽

Rural And Urban Areas ◽

Rural And Urban ◽

Urban Rural

ObjectiveThe substantial differences in socioeconomic and lifestyle exposures between urban and rural areas in China may lead to urban–rural disparity in cancer risk. This study aimed to assess the urban–rural disparity in cancer incidence in China.MethodsUsing data from 36 regional cancer registries in China in 2008–2012, we compared the age-standardised incidence rates of cancer by sex and anatomic site between rural and urban areas. We calculated the rate difference and rate ratio comparing rates in rural versus urban areas by sex and cancer type.ResultsThe incidence rate of all cancers in women was slightly lower in rural areas than in urban areas, but the total cancer rate in men was higher in rural areas than in urban areas. The incidence rates in women were higher in rural areas than in urban areas for cancers of the oesophagus, stomach, and liver and biliary passages, but lower for cancers of thyroid and breast. Men residing in rural areas had higher incidence rates for cancers of the oesophagus, stomach, and liver and biliary passages, but lower rates for prostate cancer, lip, oral cavity and pharynx cancer, and colorectal cancer.ConclusionsOur findings suggest substantial urban–rural disparity in cancer incidence in China, which varies across cancer types and the sexes. Cancer prevention strategies should be tailored for common cancers in rural and urban areas.

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Acute food insecurity and short-term coping strategies of urban and rural households of Bangladesh during the lockdown period of COVID-19 pandemic of 2020: report of a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-043365 ◽

2020 ◽

Vol 10 (12) ◽

pp. e043365

Author(s):

Subhasish Das ◽

Md. Golam Rasul ◽

Md Shabab Hossain ◽

Ar-Rafi Khan ◽

Md Ashraful Alam ◽

...

Keyword(s):

Food Insecurity ◽

Coping Strategies ◽

Rural Areas ◽

Urban Areas ◽

Multinomial Logistic Regression ◽

Rural Households ◽

P Value ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Food Insecure Households

IntroductionWe conducted a cross-sectional survey to assess the extent and to identify the determinants of food insecurity and coping strategies in urban and rural households of Bangladesh during the month-long, COVID-19 lockdown period.SettingSelected urban and rural areas of Bangladesh.Participants106 urban and 106 rural households.Outcome variables and methodHousehold food insecurity status and the types of coping strategies were the outcome variables for the analyses. Multinomial logistic regression analyses were done to identify the determinants.ResultsWe found that around 90% of the households were suffering from different grades of food insecurity. Severe food insecurity was higher in urban (42%) than rural (15%) households. The rural households with mild/moderate food insecurity adopted either financial (27%) or both financial and food compromised (32%) coping strategies, but 61% of urban mild/moderate food insecure households applied both forms of coping strategies. Similarly, nearly 90% of severely food insecure households implemented both types of coping strategies. Living in poorest households was significantly associated (p value <0.05) with mild/moderate (regression coefficient, β: 15.13, 95% CI 14.43 to 15.82), and severe food insecurity (β: 16.28, 95% CI 15.58 to 16.97). The statistically significant (p <0.05) determinants of both food compromised and financial coping strategies were living in urban areas (β: 1.8, 95% CI 0.44 to 3.09), living in poorest (β: 2.7, 95% CI 1 to 4.45), poorer (β: 2.6, 95% CI 0.75 to 4.4) and even in the richer (β: 1.6, 95% CI 0.2 to 2.9) households and age of the respondent (β: 0.1, 95% CI 0.02 to 0.21).ConclusionBoth urban and rural households suffered from moderate to severe food insecurity during the month-long lockdown period in Bangladesh. But, poorest, poorer and even the richer households adopted different coping strategies that might result in long-term economic and nutritional consequences.

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Measuring Catastrophic Health Expenditures and its Inequality: Evidence from Iran’s Health Transformation Program

Health Policy and Planning ◽

10.1093/heapol/czz031 ◽

2019 ◽

Vol 34 (4) ◽

pp. 316-325 ◽

Cited By ~ 2

Author(s):

Vahid Yazdi-Feyzabadi ◽

Mohammad Hossein Mehrolhassani ◽

Ali Darvishi

Keyword(s):

Rural Areas ◽

Health Expenditure ◽

Catastrophic Health Expenditure ◽

Rural Populations ◽

Financial Protection ◽

Dominance Test ◽

Cross Sectional ◽

Poor Households ◽

Before And After ◽

Urban And Rural Areas

Abstract One of the important goals of Iran’s health transformation programme (HTP) is to improve financial protection for households against health expenditure. This study aimed to investigate the occurrence, intensity and inequality in distribution of catastrophic health expenditure (CHE) using the WHO and the World Bank (WB) methodologies with different thresholds in the years before and after HTP. We used data from seven annual national repeated cross-sectional surveys on households’ income and expenditures from 2011 to 2017. The intensity to CHE was calculated using overshoot and mean positive overshoot (MPO) indices. Finally, the inequality in distribution of exposure to CHE was calculated using the concentration index (CI), and the dominance test of concentration curves was used to inference about the significant changes in inequality of the years before and after HTP. The exposure rate to CHE in the total population and at 40% threshold of the WHO methodology changed from 1.99% in 2011 to 3.46% in 2017. Additionally, at 20% threshold of the WB methodology, it was changed from 5.14% to 8.68%. Overshoot and MPO indices increased on average based on two methodologies in urban and rural areas during seven years. The CIs for all the years show a negative value in both methodologies, indicating that CHE occurrence is higher among the poor households. In 2017, at 40% threshold of the WHO, the numerical values of the CIs were −0.15 and −0.14 in urban and rural populations, respectively. These values were −0.07 and −0.05 for the 20% threshold of WB, respectively. Results of dominance test showed no significant change in inequality for the years after than before HTP with two exceptions for total and rural populations based on the WB methodology. Generally, HTP had no considerable success in financial protection, requiring a review in actions to support pro-poor adaptation strategies.

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Urban–rural differences in the prevalence of diabetes mellitus among 25–74 year-old adults of the Yangon Region, Myanmar: two cross-sectional studies

BMJ Open ◽

10.1136/bmjopen-2017-020406 ◽

2018 ◽

Vol 8 (3) ◽

pp. e020406 ◽

Cited By ~ 10

Author(s):

Wai Phyo Aung ◽

Aung Soe Htet ◽

Espen Bjertness ◽

Hein Stigum ◽

Virasakdi Chongsuvivatwong ◽

...

Keyword(s):

Diabetes Mellitus ◽

Rural Areas ◽

Urban Areas ◽

Undiagnosed Diabetes ◽

Cross Sectional ◽

Who Steps Methodology ◽

Urban Rural ◽

Educational Groups ◽

Cross Sectional Studies ◽

Urban And Rural Areas

ObjectivesTo investigate the association between urban–rural location and the occurrence of diabetes mellitus (DM) in the Yangon Region, and to estimate the proportion of urban and rural participants already diagnosed with DM, and of those, the proportion under treatment and under control.DesignTwo cross-sectional studies, using the WHO STEPs methodology.SettingThe Yangon Region of Myanmar, urban and rural areas.ParticipantsMen and women, aged 25–74 years, included during the study period from September–November 2013 (urban) and 2014 (rural areas) (n=1372). Institutionalised people, physically and mentally ill person, monks and nuns were excluded.ResultsThe age-standardised prevalence of DM was 12.1% in urban and 7.1% in rural areas (p=0.039). In urban areas, the prevalence of DM was lowest in the highest educational groups (p<0.001). There were no differences in DM prevalence between gender or income levels. In rural areas, those who were physically inactive had a low intake of fruit and vegetable and were overweight/obese had a higher DM prevalence than others. In a logistic regression, the OR for DM in rural compared with urban areas was 0.38 (0.22, 0.65), adjusted for sociodemographic variables and behavioural risk factors. In urban areas, 43.1% of participants had the experience of receiving blood glucose measurements by a doctor or health worker, and 61.5% of all cases of DM were already diagnosed, 78.7% were under treatment and 45.8% were under control. The corresponding proportions in rural areas were 26.4%, 52.4%, 78.1% and 32.0%, respectively.ConclusionThe prevalence of DM in the Yangon Region was high, and significantly higher in urban than in rural areas. More health services are needed to serve this population with a large proportion of undiagnosed diabetes. Preventive measures to halt and reduce the prevalence of DM are urgently needed.

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Assessment of glycaemic control among self-reported cases of diabetes: an observation of a PPP model project

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20180237 ◽

2018 ◽

Vol 5 (2) ◽

pp. 611

Author(s):

Jagruti Prajapati ◽

Jaydip Oza ◽

B. B. Patel ◽

Sunil R. Avashia

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Economic Status ◽

Sociodemographic Factors ◽

Cross Sectional Study ◽

Cross Sectional ◽

Partnership Model ◽

Sociodemographic Determinants ◽

Urban Rural ◽

Diabetes Outcome

Background: Sociodemographic determinants of diabetes such as age, sex and socioeconomic status play a major role in diabetes outcome. It was necessary to design a research project to address this. The aim of this study is to determine the prevalence of diabetes and its sociodemographic factors such as age, gender, residential area, economic status and a level of education in the project districts. Methods: The cross sectional study was carried out in the project districts named Ahmedabad, Dahod and Valsad. Urban, rural and tribal population are above 30 years of age from different districts were covered to collect data on socio economic back ground and status of diabetes. Random blood sugar was measured by glucometer and glycosylated haemoglobin (HbA1c) by the HbA1c analyzer. Results: Proportion of male and female participants were near to equal. Percentage of self reported cases of diabetes (including controlled and uncontrolled) was 14.07% in urban areas while it was 5.24% in rural areas. Pre diabetes detection rate was more in rural area. During screening 11.83% of pre diabetes cases were identified. Difference between controlled and uncontrolled diabetes among illiterate and literate groups was statistically not significant. Conclusions: This preliminary observational study included more than 51000 participants visiting primary and community health centres from three districts of Gujarat. The public private partnership model helped in systematic approach towards screening and data collection. The study reported prediabetes cases higher than global prevalence. More controlled studies are required to define the mandatory screening protocol in resource constrained settings.

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