Hojman Daniel A, Duarte Fabian, Ruiz-Tagle Jaime, Budnich Marilu, Delgado Carolina, Slachevsky Andrea
Department of Economics, Faculty of Economics and Business, University of Chile, Santiago, Chile.
Centre for Social Conflict and Cohesion Studies, Santiago, Chile.
PLoS One. 2017 Mar 7;12(3):e0172204. doi: 10.1371/journal.pone.0172204. eCollection 2017.
We study the economic cost of dementia in Chile, and its variation according to socioeconomic status (SES). We use primary data from a survey of 330 informal primary caregivers who completed both a RUD-Lite and a socio-demographic questionnaire to evaluate the severity of dementia and caregiver's burden. The costs of dementia are broken into three components: direct medical costs (medical care, drugs, tests); direct social costs (social service, daycare); and indirect costs (mostly associated to informal care). The average monthly cost per patient is estimated at US$ 1,463. Direct medical costs account for 20 per cent, direct social costs for 5 per cent and indirect costs for 75 per cent of the total cost. The mean monthly cost is found to be inversely related to SES, a pattern largely driven by indirect costs. The monthly cost for high SES is US$ 1,083 and US$ 1,588 for low SES. A multivariate regression analysis suggests that severity of dementia and caregiver's burden account for between 49 and 70 per cent of the difference in the indirect cost across SES. However, between one-third and one-half of the variation across SES is not due to gradient in severity of dementia. Direct medical costs increase in higher SES, reflecting differences in purchasing power, while indirect costs are inversely related to SES and more than compensate differences in medical costs. Moreover, in lower SES groups, female caregivers, typically family members who are inactive in the labor market, mostly provide informal care. The average annual cost of dementia in Chile (US$ 17,559) is lower in comparison to high-income countries (US$ 39,595) and the proportion of cost related to informal cost is higher (74 per cent compared to 40 per cent). SES is a key determinant in the cost of dementia. In the absence of universal access to treatment, part of the social cost of dementia potentially preserves or increases income and gender inequality.
我们研究了智利痴呆症的经济成本及其根据社会经济地位(SES)的变化情况。我们使用了一项对330名非正式主要照料者的调查的原始数据,这些照料者同时完成了一份简易痴呆症评定量表(RUD-Lite)和一份社会人口统计学调查问卷,以评估痴呆症的严重程度和照料者的负担。痴呆症的成本分为三个部分:直接医疗成本(医疗护理、药物、检查);直接社会成本(社会服务、日托);以及间接成本(主要与非正式照料相关)。每位患者的平均每月成本估计为1463美元。直接医疗成本占总成本的20%,直接社会成本占5%,间接成本占75%。研究发现,平均每月成本与社会经济地位呈负相关,这种模式在很大程度上是由间接成本驱动的。高社会经济地位者的每月成本为1083美元,低社会经济地位者为1588美元。多变量回归分析表明,痴呆症的严重程度和照料者的负担占社会经济地位间间接成本差异的49%至70%。然而,社会经济地位间三分之一到二分之一的差异并非由于痴呆症严重程度的梯度。直接医疗成本在较高社会经济地位群体中增加,反映了购买力的差异,而间接成本与社会经济地位呈负相关,且超过了医疗成本的差异。此外,在较低社会经济地位群体中,女性照料者(通常是劳动力市场上不活跃的家庭成员)大多提供非正式照料。与高收入国家(39595美元)相比,智利痴呆症的平均年度成本(17559美元)较低,且与非正式成本相关的成本比例较高(74%,而高收入国家为40%)。社会经济地位是痴呆症成本的关键决定因素。在无法普遍获得治疗的情况下,痴呆症的部分社会成本可能会维持或加剧收入和性别不平等。
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