title: A cross-sectional study of the microeconomic impact of cardiovascular disease hospitalization in four low- and middle-income countries.
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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Huffman
authors.forename: Krishna D
authors.initials: KD
authors.lastname: Rao
authors.forename: Andres
authors.initials: A
authors.lastname: Pichon-Riviere
authors.forename: Dong
authors.initials: D
authors.lastname: Zhao
authors.forename: S
authors.initials: S
authors.lastname: Harikrishnan
authors.forename: Kaushik
authors.initials: K
authors.lastname: Ramaiya
authors.forename: V S
authors.initials: VS
authors.lastname: Ajay
authors.forename: Shifalika
authors.initials: S
authors.lastname: Goenka
authors.forename: Juan I
authors.initials: JI
authors.lastname: Calcagno
authors.forename: Joaquín E
authors.initials: JE
authors.lastname: Caporale
authors.forename: Shaoli
authors.initials: S
authors.lastname: Niu
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.forename: K R
authors.initials: KR
authors.lastname: Thankappan
authors.forename: Meena
authors.initials: M
authors.lastname: Daivadanam
authors.forename: Jan
authors.initials: J
authors.lastname: van Esch
authors.forename: Adrianna
authors.initials: A
authors.lastname: Murphy
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gaziano
authors.forename: Marc
authors.initials: M
authors.lastname: Suhrcke
authors.forename: K Srinath
authors.initials: KS
authors.lastname: Reddy
authors.forename: Stephen
authors.initials: S
authors.lastname: Leeder
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
mesh_terms: D001118:Argentina; D002318:Cardiovascular Diseases / Q000191:economics*; D002681:China; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007182:Income; D007194:India; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013636:Tanzania