The Impact of Cancer Incidence on Catastrophic Health Ex-penditure in Iran with a Bayesian Spatio-Temporal Analysis
-
Nazanin Fekri
,
Mahboubeh Parsaeian
,
Abolghasem Pourreza
,
Ben Swallow
,
Aminreza Amini
,
Abbas Rahimi Foroushani
Abstract
Background: We investigated the impact of cancer incidence on CHE in Iran by considering spatial variation across provinces as well as temporal trends.
Methods: Data from Household Income-Expenditure Survey were merged with cancer incidence rates during 2011-2016. We developed a Bayesian hierarchical model to explore the spatial and temporal patterns of CHE and its associated factors at provincial level. We used a Besag-York-Mollie2 prior and a random walk prior for spatial and temporal random effects respectively. All statistical analysis was carried out in R software.
Results: All-type cancer incidence (OR per SD (95% CrI) = 1.16 (1.02, 1.32)), unemployment rate (1.08 (1.01, 1.15)) and income equity (0.88 (0.81, 0.97)) have important association with CHE. Percentage of urbanization and percentage of poverty were not statistically significant.
Conclusion: The results suggest the development of new policies to protect cancer patients against financial hardship, narrow the gap in income inequality and solve the problem of high unemployment rate to reduce the level of CHE at provincial level.
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10. Sun X, Liabsuetrakul T, Xie X, et al (2019). Catastrophic health expenditure and impoverishment for type 2 diabetes mellitus patients in a multiethnic province in China using a Blinder–Oaxaca decomposition: A cross-sectional study. Medicine (Baltimore), 98(39):e17376.
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27. Xu K, Evans DB, Kawabata K, Zeramdini R, et al (2003). Household catastrophic health expenditure: a multicountry analysis. Lancet, 362(9378):111-7.
28. Yazdi-Feyzabadi V, Mehrolhassani MH, Darvishi A (2019). Measuring Catastrophic Health Expenditures and its Inequality: Evidence from Iran’s Health Transformation Program. Health Policy Plan, 34:316-325.
29. Leng A, Jing J, Nicholas S, Wang J (2019). Catastrophic health expenditure of cancer patients at the end-of-life: a retrospective observational study in China. BMC Palliat Care, 18(1):43.
30. Bona K, Dussel V, Orellana L, Kang T, et al (2014). Economic impact of advanced pediatric cancer on families. J Pain Symptom Manage, 47(3):594-603.
31. Fazaeli AA, Ghaderi H, Fazaeli AA, Lotfi F, et al (2015). Main determinants of catastrophic health expenditures: a Bayesian logit approach on Iranian household survey data (2010). Glob J Health Sci, 7(4):335-40.
32. Kien VD, Van Minh H, Giang KB, et al (2016). Socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam. International Journal for Equity in Health volume, 15:169.
33. Ahmadnezhad E, Murphy A, Alvandi R, et al (2019). The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications. Int J Health Plann Manage, 34(4):e1833-e1845.
34. Berman P, Ahuja R, Bhandari L (2010). The impoverishing effect of healthcare payments in India: new methodology and findings. Economic and Political Weekly,65-71.
35. Dunlop S, Coyte PC, McIsaac W (2000). Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey. Soc Sci Med, 51(1):123-33.
36. Organization WH (2015). Tracking universal health coverage: first global monitoring report. ed. World Health Organization.
37. Holowaty E (1998). Radiotherapy for breast cancer in Ontario: rate variation associated with region, age and income. Clin Invest Med, 21(3):125-34.
2. Azzani M, Roslani AC, Su TT (2019). Determinants of Household Catastrophic Health Expenditure: A Systematic Review. Malays J Med Sci, 26(1): 15–43.
3. Niëns L, Van de Poel E, Cameron A, et al (2012). Practical measurement of affordability: an application to medicines. Bull World Health Organ, 90(3): 219–227.
4. Piroozi B, Zarei B, Ghaderi B, et al (2019). Catastrophic health expenditure and its determinants in households with gastrointestinal cancer patients: evidence from new health system reform in Iran. International Journal of Human Rights in Healthcare, 12(4):249-257.
5. Masaeli A, Sadeghih H, Ghanbari A (2011). High health costs, financial catastrophic and impoverishment expenditures: concepts for policy formation. HEALTH INFORMATION MANAGEMENT, 12: 244 To 254.
6. Aryankhesal A, Etemadi M, Mohseni M, Azami-Aghdash S, Nakhaei M (2018). Catastrophic health expenditure in Iran: a review article. Iran J Public Health, 47:166.
7. Neelon B, Chang HH, Ling Q, et al (2016). Spatiotemporal hurdle models for zero-inflated count data: exploring trends in emergency department visits. Stat Methods Med Res, 25(6):2558-2576.
8. Alwan A (2011). Global status report on noncommunicable diseases 2010. ed. World Health Organization.
9. Bloom DE, Chisholm D, Jané-Llopis E, et al (2011). From Burden to “Best Buys”: Reducing the Economic Impact of Non-Communicable Diseases.
10. Sun X, Liabsuetrakul T, Xie X, et al (2019). Catastrophic health expenditure and impoverishment for type 2 diabetes mellitus patients in a multiethnic province in China using a Blinder–Oaxaca decomposition: A cross-sectional study. Medicine (Baltimore), 98(39):e17376.
11. Group AS (2015). Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries. BMC Medicine, 13:190.
12. Soni A (2009). The five most costly conditions, 1996 and 2006: Estimates for the US civilian noninstitutionalized population. Statistical Brief# 248. July 2009. Rockville, MD: Agency for Healthcare Research and Quality.
13. Roehrig C (2016). Mental disorders top the list of the most costly conditions in the United States: $201 billion. Health Aff (Millwood), 35(6):1130-5.
14. Mousavi SM, Gouya MM, Ramazani R, et al (2009). Cancer incidence and mortality in Iran. Ann Oncol, 20(3):556-63.
15. USA Today KFF, Harvard School of Public Health (2006). Toplines: National survey of households affected by cancer.
16. Ramsey S, Blough D, Kirchhoff A, et al (2013). Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood), 32(6):1143-52.
17. Iran SCo Household, Expenditure and Income. Statistical Center of Iran,
18. Parsaeian M, Farzadfar F, Zeraati H, et al (2014). Application of spatio-temporal model to estimate burden of diseases, injuries and risk factors in Iran 1990–2013. Arch Iran Med, 17(1):28-33.
19. (1990-2016) Data visualization, Cancer. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences,
20. Sardari F (2019). National and subnational pattern of cancers incidence in Islamic republic of Iran from 1990 to 2016. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences,
21. Van Lerberghe W (2008). The world health report 2008: primary health care: now more than ever. ed. World Health Organization.
22. Ghiasvand H, Gorji HA, Maleki M, et al (2015). Catastrophic health expenditure among Iranian rural and urban households, 2013-2014. Iran Red Crescent Med J, 17(9):e30974.
23. Raghfar H, Ebrahimi A (2008). Income inequality in Iran during 1984-2006. Social Welfare Quarterly, 7(28): 9-34.
24. Riebler A, Sørbye SH, Simpson D, et al (2016). An intuitive Bayesian spatial model for disease mapping that accounts for scaling. Stat Methods Med Res, 25:1145-1165.
25. Blangiardo M, Cameletti M (2015). Spatial and spatio-temporal Bayesian models with R-INLA. ed. John Wiley & Sons.
26. Khodamoradi A, Ghaffari S, Fazaeli AA, et al (2019). Measuring Equity in Iranian Healthcare System Financing: Experiences of Recent Health Reform Plan. Evidence Based Health Policy, Management and Economics, 3(2):87-95.
27. Xu K, Evans DB, Kawabata K, Zeramdini R, et al (2003). Household catastrophic health expenditure: a multicountry analysis. Lancet, 362(9378):111-7.
28. Yazdi-Feyzabadi V, Mehrolhassani MH, Darvishi A (2019). Measuring Catastrophic Health Expenditures and its Inequality: Evidence from Iran’s Health Transformation Program. Health Policy Plan, 34:316-325.
29. Leng A, Jing J, Nicholas S, Wang J (2019). Catastrophic health expenditure of cancer patients at the end-of-life: a retrospective observational study in China. BMC Palliat Care, 18(1):43.
30. Bona K, Dussel V, Orellana L, Kang T, et al (2014). Economic impact of advanced pediatric cancer on families. J Pain Symptom Manage, 47(3):594-603.
31. Fazaeli AA, Ghaderi H, Fazaeli AA, Lotfi F, et al (2015). Main determinants of catastrophic health expenditures: a Bayesian logit approach on Iranian household survey data (2010). Glob J Health Sci, 7(4):335-40.
32. Kien VD, Van Minh H, Giang KB, et al (2016). Socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam. International Journal for Equity in Health volume, 15:169.
33. Ahmadnezhad E, Murphy A, Alvandi R, et al (2019). The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications. Int J Health Plann Manage, 34(4):e1833-e1845.
34. Berman P, Ahuja R, Bhandari L (2010). The impoverishing effect of healthcare payments in India: new methodology and findings. Economic and Political Weekly,65-71.
35. Dunlop S, Coyte PC, McIsaac W (2000). Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey. Soc Sci Med, 51(1):123-33.
36. Organization WH (2015). Tracking universal health coverage: first global monitoring report. ed. World Health Organization.
37. Holowaty E (1998). Radiotherapy for breast cancer in Ontario: rate variation associated with region, age and income. Clin Invest Med, 21(3):125-34.
| Files | ||
| Issue | Vol 51 No 2 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i2.8697 | |
| Keywords | ||
| Catastrophic health expenditures Cancer incidence Spatio-temporal model | ||
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How to Cite
1.
Fekri N, Parsaeian M, Pourreza A, Swallow B, Amini A, Rahimi Foroushani A. The Impact of Cancer Incidence on Catastrophic Health Ex-penditure in Iran with a Bayesian Spatio-Temporal Analysis. Iran J Public Health. 2022;51(2):438-449.
