Abstract:
Objective: To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low- and
middle-income countries (LMIC).
Background: Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce.
Methods and Findings: We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from
Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD
hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD
treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917
(India, high-income). Catastrophic health spending (CHS) was present in .50% of respondents in China, India, and Tanzania.
Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health
insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86,
7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial
decreases in individual functional health and productivity.
Conclusions: Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with
substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC
patients and their families.
