title: Economic burden and cost determinants of coronary heart disease in rural southwest China: a multilevel analysis.
abstract: OBJECTIVE
  To estimate the economic burden of coronary heart disease (CHD) in a given year (2010), including direct and indirect costs, and examine the impact of contextual and individual socio-economic (SES) predictors on the costs of CHD among adults in rural southwest China.
  
  
  METHODS
  Cross-sectional community survey.
  
  
  METHODS
  In total, 4595 adults (aged ≥18 years) participated in this study. A prevalence-based cost-of-illness approach was used to estimate the economic burden of CHD. Information on demographic characteristics of the study population and the economic consequences of CHD was obtained using a standard questionnaire. Multilevel linear regression was used to model the variation in costs of CHD.
  
  
  RESULTS
  In the study population, the overall prevalence of CHD was 2.9% (3.5% for males, 2.3% for females). The total cost of CHD was estimated to be US$17 million. Inpatient hospitalizations represented the main component of direct costs of CHD, and direct costs accounted for the greatest proportion of the economic burden of CHD. Males were more likely to have a higher economic burden of CHD than females. A positive association was found between the individual's level of education and the economic burden of CHD. Residence in a higher-income community was associated with higher costs related to CHD.
  
  
  CONCLUSIONS
  This study found that both contextual and individual SES were closely associated with the costs of CHD. Future strategies for CHD interventions and improved access to affordable medications to treat and control CHD should focus on less-educated individuals and communities with lower SES.
authors.affiliation: School of Public Health, Kunming Medical University, Kunming, China. Electronic address: caile002@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Le
authors.affiliation: Kunming Centre for Disease Prevention and Control, Kunming, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Fang
authors.affiliation: School of Public Health, Kunming Medical University, Kunming, China.
authors.forename: W
authors.initials: W
authors.lastname: Linxiong
authors.affiliation: Guan Du Centre for Disease Prevention and Control, Kunming, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Shulan
authors.affiliation: Yale University, New Haven, CT, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Golden
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003327:Coronary Disease / Q000191:economics* / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D015995:Prevalence; D012044:Regression Analysis; D012423:Rural Health / Q000191:economics* / Q000706:statistics & numerical data; D017678:Sex Distribution; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: China; Contextual effect; Coronary heart disease; Economic burden