Journal Article

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

Gwatidzo, Shingai Douglas, Stewart Williams, Jennifer

2017

Overview

Background Expenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world’s two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India. Methods Using national standardised data collected from adults aged 50 years and above with DM (self-reported) in China ( N  = 773) and India ( N  = 463), multivariable logistic regression describes: 1) association between respondents’ socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N  = 630; India: N  = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007–2010). Results Prevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33). Conclusions The country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adults / Age Factors / Aged / Aged, 80 and over / Ageing / Aging / Blood pressure / China / Chronic Disease / Chronic illnesses / Developing Countries / Diabetes / Diabetes mellitus / Diabetes Mellitus - drug therapy / Diabetes Mellitus - economics / Diabetes therapy / Disease prevention / Drugs / Economic aspects / Economic development / Economic growth / Expenditures / Female / Financing / Geriatrics / Geriatrics/Gerontology / Health care / Health Expenditures / Humans / Hypoglycemic Agents - economics / Hypoglycemic Agents - therapeutic use / Impoverishment / India / Insulin / LDCs / Logistic Models / Low- and middle-income countries / Male / Medical care, Cost of / Medicine / Medicine & Public Health / Medicines / Middle Aged / Mortality / NCDs / Non communicable diseases / nutrition and epidemiology / Older people / OOP / Out-of-pocket / Population / Public health / Public policy / Rehabilitation / Research Article / Self Report / Social change / Social interactions / Socioeconomic Factors / Socioeconomics / Statistical analysis / Statistics / UCC / Universal healthcare coverage / Urbanization / World Health Organization / Young Adult