title: Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh: an analysis over a 24-year period.
abstract: BACKGROUND
  Little is known about long-term changes linking chronic diseases and poverty in low-income countries such as Bangladesh. This study examines how chronic disease mortality rates change across socioeconomic groups over time in Bangladesh, and whether such mortality is associated with households falling into poverty.
  
  
  METHODS
  Age-sex standardized chronic diseases mortality rates were estimated across socioeconomic groups in 1982, 1996 and 2005, using data from the health and demographic surveillance system in Matlab, Bangladesh. Changes in households falling below a poverty threshold after a chronic disease death were estimated between 1982-96 and 1996-2005.
  
  
  RESULTS
  Age-sex standardized chronic disease mortality rates rose from 646 per 100 000 population in 1982 to 670 in 2005. Mortality rates were higher in wealthier compared with poorer households in 1982 [Concentration Index = 0.037; 95% confidence interval (CI): 0.002, 0.072], but switched direction in 1996 (Concentration Index = -0.007; 95% CI: -0.023, 0.009), with an even higher concentration in the poor by 2005 (Concentration Index = -0.047; 95% CI: -0.061, -0.033). Between 1982-96 and 1996-2005, the highest chronic disease mortality rates were found among those households that fell below the poverty line. Households that had a chronic disease death in 1982 were 1.33 (95% CI: 1.03, 1.70) times more likely to fall below the poverty line in 1996 compared with households that did not.
  
  
  CONCLUSIONS
  Chronic disease mortality is a growing proportion of the disease burden in Bangladesh, with poorer households being more affected over time periods, leading to future household poverty.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden and jahangir.khan@lstmed.ac.uk.
authors.forename: Jahangir Am
authors.initials: JA
authors.lastname: Khan
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Trujillo
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
authors.forename: Sayem
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
authors.forename: Ali Tanweer
authors.initials: AT
authors.lastname: Siddiquee
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
authors.forename: Nurul
authors.initials: N
authors.lastname: Alam
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Mirelman
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
authors.forename: Tracey Perez
authors.initials: TP
authors.lastname: Koehlmoos
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Louis Wilhelmus
authors.initials: LW
authors.lastname: Niessen
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D001459:Bangladesh; D002908:Chronic Disease / Q000401:mortality*; D003920:Diabetes Mellitus / Q000401:mortality; D005191:Family Characteristics; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D012424:Rural Population / Q000706:statistics & numerical data*; D012923:Social Class; D020521:Stroke / Q000401:mortality; D055815:Young Adult
keywords: Chronic disease; mortality; poverty; social class