Catastrophic health expenditure & coping strategies associated with acute coronary syndrome in Kerala, India.

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dc.contributor.authorDaivadanam, Meena
dc.contributor.authorThankappan, K R
dc.contributor.authorSarma, P S
dc.contributor.authorHarikrishnan, S
dc.date.accessioned2013-01-29T07:20:57Z
dc.date.available2013-01-29T07:20:57Z
dc.date.issued2012-10
dc.description.abstractBackground & objectives: India contributes a significant number of deaths attributed to coronary artery disease (CAD) compared to the rest of the world. Data on catastrophic health expenditure (CHE) related to acute coronary syndrome (ACS), the major cause of deaths in CAD, are limited in the literature. We estimated the magnitude of CHE and studied the strategies used to cope with CHE. Methods: Two hundred and ten ACS patients (mean age 56 yr, 83% men) were randomly selected proportionately from six hospitals in Thiruvananthapuram district, Kerala, India. Information on demographics, ACS-related out-of-pocket expenditure and coping strategies was collected using a pre-tested structured interview schedule. CHE, defined as ACS-related expenditures exceeding 40 per cent of a household's capacity to pay, was estimated using the World Health Organization methods. Health security was defined as protection against out-of-pocket expenditure through an employer or government provided social security scheme. Socio-demographic variables, effect on participants’ employment, loans or asset sales for treatment purposes, health security coverage and type of treatment were considered as potential correlates of CHE. Multiple logistic regression analyses were conducted to identify the correlates of CHE. Results: CHE was experienced by 84 per cent (95% CI: 79.04, 88.96) of participants as a consequence of treating ACS. Participants belonging to low socio-economic status (SES) were 15 times (odds ratio (OR): 14.51, 95% CI: 1.69-124.41), whose jobs were adversely affected were seven times (OR: 7.21, CI: 1.54-33.80), who had no health security were six times (OR: 6.00, CI: 2.02-17.81) and who underwent any intervention were three times (OR: 3.24, CI: 1.03-10.16) more likely to have CHE compared to their counterparts. The coping strategies adopted by the participants were loans (41%), savings (14%), health insurance (8%) and a combination of the above (37%). Interpretation & conclusions: Our findings show that viable financing mechanism for treating ACS is warranted to prevent CHE particularly among low SES participants, those having no health security, requiring intervention procedures and those with adversely affected employment.en_US
dc.identifier.citationDaivadanam Meena, Thankappan K R, Sarma P S, Harikrishnan S. Catastrophic health expenditure & coping strategies associated with acute coronary syndrome in Kerala, India. Indian Journal of Medical Research. 2012 Oct; 136(4): 585-592.en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/144785
dc.language.isoenen_US
dc.source.urihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516025/en_US
dc.subjectCardiovascular diseasesen_US
dc.subjectcatastrophic health expenditureen_US
dc.subjectcoping strategiesen_US
dc.subjectcoronary artery diseaseen_US
dc.subjectepidemiologyen_US
dc.subjectheart diseasesen_US
dc.subjectlifestyleen_US
dc.subjectmyocardial infarctionen_US
dc.subject.meshAcute Coronary Syndrome --epidemiology
dc.subject.meshAcute Coronary Syndrome --etiology
dc.subject.meshAcute Coronary Syndrome --prevention & control
dc.subject.meshAdaptation, Psychological
dc.subject.meshAdult
dc.subject.meshFemale
dc.subject.meshHealth --economics
dc.subject.meshHumans
dc.subject.meshIndia --epidemiology
dc.subject.meshLife Style
dc.subject.meshMale
dc.subject.meshSocioeconomic Factors
dc.titleCatastrophic health expenditure & coping strategies associated with acute coronary syndrome in Kerala, India.en_US
dc.typeArticleen_US
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