title: The relationship between non-communicable disease occurrence and poverty-evidence from demographic surveillance in Matlab, Bangladesh.
abstract: In low-income countries, a growing proportion of the disease burden is attributable to non-communicable diseases (NCDs). There is little knowledge, however, of their impact on wealth, human capital, economic growth or household poverty. This article estimates the risk of being poor after an NCD death in the rural, low-income area of Matlab, Bangladesh. In a matched cohort study, we estimated the 2-year relative risk (RR) of being poor in Matlab households with an NCD death in 2010. Three separate measures of household economic status were used as outcomes: an asset-based index, self-rated household economic condition and total household landholding. Several estimation methods were used including contingency tables, log-binomial regression and regression standardization and machine learning. Households with an NCD death had a large and significant risk of being poor. The unadjusted RR of being poor after death was 1.19, 1.14 and 1.10 for the asset quintile, self-rated condition and landholding outcomes. Adjusting for household and individual level independent variables with log-binomial regression gave RRs of 1.19 [standard error (SE) 0.09], 1.16 (SE 0.07) and 1.14 (SE 0.06), which were found to be exactly the same using regression standardization (SE: 0.09, 0.05, 0.03). Machine learning-based standardization produced slightly smaller RRs though still in the same order of magnitude. The findings show that efforts to address the burden of NCD may also combat household poverty and provide a return beyond improved health. Future work should attempt to disentangle the mechanisms through which economic impacts from an NCD death occur.
authors: Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK, andrew.mirelman@york.ac.uk.
authors: Andrew J
authors: AJ
authors: Mirelman
authors: Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
authors: Sherri
authors: S
authors: Rose
authors: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden and International Center for Diarrheal Disease Research (Icddr,B), Mohakhali, Dhaka, Bangladesh.
authors: Jahangir Am
authors: JA
authors: Khan
authors: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden and International Center for Diarrheal Disease Research (Icddr,B), Mohakhali, Dhaka, Bangladesh.
authors: Sayem
authors: S
authors: Ahmed
authors: Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA and.
authors: David H
authors: DH
authors: Peters
authors: Liverpool School of Tropical Medicine, University of Liverpool, Pembroke Place, Liverpool, L3 5QA, UK.
authors: Louis W
authors: LW
authors: Niessen
authors: Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK.
authors: Antonio J
authors: AJ
authors: Trujillo
mesh_terms: D000368:Aged; D001459:Bangladesh; D002908:Chronic Disease / Q000401:mortality*; D015331:Cohort Studies; D003710:Demography / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012959:Socioeconomic Factors
keywords: Bangladesh; Non-communicable disease; poverty