Socioeconomic Burden of Type 2 Diabetes with Complications on Families: A Hospital-Based Study in Puducherry
Introduction India is on the verge of diabetes mellitus (DM) epidemic. Within the near future, DM will put a big burden on India’s already vulnerable and resourced health care system. The objectives of the study were to (1) estimate DM treatment-related out-of-pocket expenditure (OOPE) among type 2 DM patients with complications from a tertiary care hospital and (2) estimate the economic burden on the household income of these patients due to DM treatment-related OOPE.
Methods A hospital-based cross-sectional study was conducted among known type 2 diabetic individuals with complications admitted in a tertiary care hospital. Using a structured pretested questionnaire required data, such as sociodemographic details, direct costs, and indirect costs in health care of DM, which were collected by a personal interview method.
Results Males constituted around 57% of the 100 patients who participated in the study. The average age of the population was 56 ± 10.03 years. The mean monthly income of family (in Indian Rupees [INR]) was 10,375.00 ± 9,201.55. Total expenditure includes the cost of medication, investigation, consultation fee, transportation, and miscellaneous expenditure. The average monthly OOPE in the management of DM for government and private facilities was INR 74 and 1,540, respectively. Among the total cost, the highest share was accrued toward medicines followed by diagnostics, miscellaneous, and transportation. There were 22% of families incurring catastrophic expenditure at the highest threshold of 40%. Socioeconomic status, history of at least one hospitalization in the past 6 months, and type of medications were factors found to be associated with costs.
Conclusion Heavy economic burden highlights the urgent need for the health care agencies and policy bodies to plan and prioritize local health policies and DM management schemes accordingly.
07 January 2021 (online)
© 2020. Nitte University (Deemed to be University). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Zimmet P. Globalization, coca-colonization and the chronic disease epidemic: can the Doomsday scenario be averted?. J Intern Med 2001; 249 (S741) 17-26
- 2 Gupta M, Singh R, Lehl S. Diabetes in India: a long way to go. International Journal of Scientific Reports 2015; 1 (01) 1-2
- 3 Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care 2011; 34 (06) 1249-1257
- 4 Ramachandran A, Jali MV, Mohan V, Snehalatha C, Viswanathan M. High prevalence of diabetes in an urban population in south India. BMJ 1988; 297 (6648) 587-590
- 5 Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Metabolic syndrome in urban Asian Indian adults–a population study using modified ATP III criteria. Diabetes Res Clin Pract 2003; 60 (03) 199-204
- 6 Chandra P, Gogate B, Gogate P, Thite N, Mutha A, Walimbe A. Economic burden of diabetes in urban Indians. Open Ophthalmol J 2014; 8: 91-94
- 7 Mohan V, Madan Z, Jha R, Deepa R, Pradeepa R. Diabetes-social and economic perspectives in the new millenium. Int J Diabetes Dev Ctries 2004; 24 (02) 29-35
- 8 Ramaiya KL, Kodali VR, Alberti KG. Epidemiology of diabetes in Asians of the Indian subcontinent. Diabetes Metab Rev 1990; 6 (03) 125-146
- 9 Goryakin Y, Suhrcke M. The prevalence and determinants of catastrophic health expenditures attributable to non-communicable diseases in low- and middle-income countries: a methodological commentary. Int J Equity Health 2014; 13 (01) 107
- 10 Ramachandran A, Ramachandran S, Snehalatha C. et al. Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India. Diabetes Care 2007; 30 (02) 252-256
- 11 Gwatidzo SD, Williams JS. 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). BMC Geriatr 2017; 17 (01) 14
- 12 US Health Resources & Services Administration. Definition of Family. 2020. Available at: https://www.hrsa.gov/get-health-care/affordable/hill-burton/family.html#:~:text=Family%3A%20A%20family%20is%20a,as%20members%20of%20one%20family. Accessed December 21, 2020
- 13 World Bank. Out-of-pocket expenditure (% of current health expenditure). Available at: https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS. Accessed March 16, 2017
- 14 Mohan V, Deepa M, Deepa R. et al. Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India—the Chennai Urban Rural Epidemiology Study (CURES-17). Diabetologia 2006; 49 (06) 1175-1178
- 15 Fernandes SD, Fernandes SD. Economic burden of diabetes mellitus and its socio-economic impact on household expenditure in an urban slum area. Int J Res Med Sci. 2017; 5 (05) 1808-3
- 16 Grover S, Avasthi A, Bhansali A, Chakrabarti S, Kulhara P. Cost of ambulatory care of diabetes mellitus: a study from north India. Postgrad Med J 2005; 81 (956) 391-395
- 17 Javalkar SR. The economic burden of health expenditure on diabetes mellitus among urban poor: a cross sectional study. In. J Comm Med Pub Health 2019; 6 (03) 1162
- 18 Kapur A, Bjork S, Nair J, Kelkar S, Ramachandran A. Socio-economic determinants of the cost of diabetes in India. Diabetes Voice. 2004; 49: 18-23
- 19 Kumar A, Nagpal J, Bhartia A. Direct cost of ambulatory care of type 2 diabetes in the middle and high income group populace of Delhi: the DEDICOM survey. J Assoc Physicians India 2008; 56: 667-674