title: 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).
abstract: 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.
  
  
  
  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).
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Umeå International School of Public Health, Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185, Umeå, Sweden. shingai.gwatidzo@outlook.com.
authors.forename: Shingai Douglas
authors.initials: SD
authors.lastname: Gwatidzo
authors.affiliation: Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185, Umeå, Sweden.|Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, New Lambton Heights, Newcastle, NSW 2305, New South Wales, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stewart Williams
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D002908:Chronic Disease; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000191:economics*; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D007194:India; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057566:Self Report; D012959:Socioeconomic Factors; D014944:World Health Organization; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents
keywords: Ageing; Aging; Developing countries; Financing; Impoverishment; Low- and middle-income countries; Medicines; NCDs; Non communicable diseases; OOP; Out-of-pocket; UCC; Universal healthcare coverage