Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria.
Department of Economics, Faculty of Economics & Management Sciences, University of Ibadan, Ibadan, Nigeria.
PLoS One. 2022 Jul 18;17(7):e0271568. doi: 10.1371/journal.pone.0271568. eCollection 2022.
Cardiovascular diseases (CVDs) present a huge threat to population health and in addition impose severe economic burden on individuals and their households. Despite this, there is no research evidence on the microeconomic impact of CVDs in Nigeria. Therefore, this study estimated the incidence and intensity of catastrophic health expenditures (CHE), poverty headcount due to out-of-pocket (OOP) medical spending and the associated factors among the households of a cohort of CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan, Nigeria.
This study adopts a descriptive cross-sectional study design. A standardized data collection questionnaire developed by the Initiative for Cardiovascular Health Research in Developing Countries was adapted to electronically collect data from all the 744 CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan between 4th November 2019 to the 31st January 2020. A sensitivity analysis, using rank-dependent thresholds of CHE which ranged from 5%-40% of household total expenditures was carried out. The international poverty line of $1.90/day recommended by the World Bank was utilized to ascertain poverty headcounts pre-and post OOP payments for healthcare services. Categorical variables like household socio-demographic and clinical characteristics, CHE and poverty headcounts, were presented using percentages and proportions. Unadjusted and adjusted logistic regression models were used to assess the factors associated with CHE and poverty. Data were analyzed using STATA version 15 and estimates were validated at 5% level of significance.
Catastrophic OOP payment ranged between 3.9%-54.6% and catastrophic overshoot ranged from 1.8% to 12.6%. Health expenditures doubled poverty headcount among households, from 8.13% to 16.4%. Having tertiary education (AOR: 0.49, CI: 0.26-0.93, p = 0.03) and household size (AOR: 0.40, CI: 0.24-0.67, p = 0.001) were significantly associated with CHE. Being female (AOR: 0.41, CI: 0.18-0.92, p = 0.03), household economic status (AOR: 0.003, CI: 0.0003-0.25, p = <0.001) and having 3-4 household members (AOR: 0.30, CI: 0.15-0.61, p = 0.001) were significantly associated with household poverty status post payment for medical services.
OOP medical spending due to CVDs imposed enormous strain on household resources and increased the poverty rates among households. Policies and interventions that supports universal health coverage are highly recommended.
心血管疾病（CVDs）对人口健康构成巨大威胁，此外还给个人及其家庭带来了严重的经济负担。尽管如此，尼日利亚在 CVDs 的微观经济影响方面尚无研究证据。因此，本研究旨在估算在伊巴丹的公立和专科医院接受医疗服务的 CVD 患者队列的家庭中，灾难性卫生支出（CHE）的发生率和强度、因自付医疗费用而导致的贫困人数以及相关因素。
本研究采用描述性的横断面研究设计。采用由发展中国家心血管健康研究倡议制定的标准化数据收集问卷，从 2019 年 11 月 4 日至 2020 年 1 月 31 日期间，在伊巴丹的公立和专科医院接受医疗服务的 744 名 CVD 患者中，以电子方式收集所有数据。使用 CHE 的依赖于等级的阈值（范围从家庭总支出的 5%-40%）进行敏感性分析。使用世界银行推荐的国际贫困线（每天 1.90 美元）来确定支付医疗服务费用前后的贫困人数。使用百分比和比例来表示家庭的社会人口学和临床特征、CHE 和贫困人数等分类变量。使用未调整和调整后的逻辑回归模型来评估与 CHE 和贫困相关的因素。使用 STATA 版本 15 进行数据分析，估计值在 5%的显著性水平上进行验证。
自付医疗费用占比在 3.9%-54.6%之间，过度自付占比在 1.8%-12.6%之间。医疗支出使家庭的贫困人数增加了一倍，从 8.13%增加到 16.4%。接受高等教育（AOR：0.49，CI：0.26-0.93，p = 0.03）和家庭规模（AOR：0.40，CI：0.24-0.67，p = 0.001）与 CHE 显著相关。女性（AOR：0.41，CI：0.18-0.92，p = 0.03）、家庭经济状况（AOR：0.003，CI：0.0003-0.25，p <0.001）和家庭有 3-4 名成员（AOR：0.30，CI：0.15-0.61，p = 0.001）与支付医疗服务费用后的家庭贫困状况显著相关。
CVD 导致的自付医疗费用给家庭资源带来了巨大压力，增加了家庭的贫困率。强烈建议采取支持全民健康覆盖的政策和干预措施。
