Interlinkages between Chronic Illness and Urban Poverty in Bangladesh

Abstract

Bangladesh is now in an advanced stage of the epidemiologic transition, and in the upcoming years, the burden of chronic illness will continue to rise. As chronic illnesses are the leading cause of death globally, and Out-Of-Pocket (OOP) payments for healthcare have been increasing steadily in Bangladesh, which pushes the households into poverty by catastrophic health expenditure (CHE), it is an urgent issue to investigate this area. Therefore, this study aims to identify the determinants of chronic illnesses and examine the interlinkages between chronic illness and poverty in Bangladesh, especially from an urban perspective. The study is conducted using the nationally representative and the latest Household Income and Expenditure Survey (HIES) 2022. The Cost of Basic Needs (CBN) approach is used for estimating the poverty line. Moreover, this study has estimated the poverty impact of OOP payments (i.e., impoverishment due to OOP healthcare expenditure) by comparing the difference between the average level of headcount poverty with and without OOP healthcare payments. Probit regression models are employed to identify the determinants of chronic illness and impoverishment due to OOP healthcare payments. This study identifies that approximately one-third of the urban population (29.17%) and approximately two-thirds of urban households (71.37%) in Bangladesh suffer from at least one chronic illness. Among the households with chronic illness, 33.6% are found with one chronic illness, 25.9% with two chronic illnesses, and 11.9% with more than two chronic illnesses. The most prevalent chronic illnesses include gastric/ulcer (8.28%), high blood pressure (8.01%), diabetes (5.06%), arthritis/ rheumatism (3.96%), and chronic heart disease (3.13%). The prevalence of chronic illnesses rises with age. The prevalence is only 5.11% among children aged 0–12 years, whereas it is 77.14% among the elderly (65+ years), suggesting a strong linkage between chronic health issues and aging. Gender-specific findings reveal the higher prevalence of chronic illnesses among women compared to men (male: 31.69% vs. female: 26.65 %). The prevalence is much higher among the formerly married individuals—those who are widowed, divorced, or separated— in comparison with the currently married individuals (formerly married: 68.78% vs. currently married 43.25 %). The highest prevalence is found for the households belonging to the highest income quantile (78.04%). The mean age in a household, the share of dependent members, households with a never married, widowed, divorced, or separated, proportion of literate members, and households belonging to higher income quantiles are positively and significantly associated with the presence of chronic illness. Whereas the proportion of earners in the household has a strong negative relationship, the female proportion in the household has no significant relationship with chronic illness. In urban areas, the overall OOP healthcare expenditure per month per household stands at BDT 2,503; however, the figure is significantly higher (BDT 2,980) among households that report having at least one chronic illness compared to those with no chronic illness (BDT 1,002). The share of OOP health expenditure in total household expenditure is more than double among the urban households that are suffering from at least one chronic illness (7.5%) compared to those 6 who are not suffering from any chronic disease (3.5%). Lower-income households faces higher OOP burden (21.26% of household income) compared to the highest income households (3.96%). Notably, the prevalence of CHE is alarmingly high (70.51%) among the urban households with at least one chronic illness compared to those who report having no chronic illness (29.49%), at 10% of total expenditure as the threshold level, indicating that chronic illnesses significantly increase financial vulnerability. About 2.77 percent of households fall into poverty due to OOP healthcare expenditure in urban areas in Bangladesh. Households with at least one member suffering from a chronic illness are 3.5 percentage points more likely to fall into poverty (p<0.01) in comparison to households without any members experiencing chronic illnesses. Moreover, the impoverished households are 24.2 percentage points more likely to have a chronic illness (p<0.01), which indicates that poverty enhances the risk of chronic disease. Moreover, households with at least one member suffering from a chronic illness are affected by a substantially higher impoverishment rate due to OOP health spending (3.40%), nearly three times higher than that of households without chronic illnesses (1.22%). Similar findings are also evident for normalized poverty gap as the households that face chronic illness has greater normalized poverty gap (4.29%), which is almost double than who have no chronic illness (2.31%). Thus, the findings from the Probit regression models reveal a strong interlinkage between chronic illness and poverty in urban Bangladesh.The study findings suggest that chronic illnesses are responsible for high costs, high catastrophic expenditures, and vulnerability to households (i.e., non-poor households become poor due to OOP healthcare expenditure) in urban areas in Bangladesh. The government and non-government health organizations need to address this urgently by paying proper attention to handling the burden of chronic disease in Bangladesh. An effective risk pooling mechanism might reduce household financial burden related to chronic illnesses. It is essential to take urban health protection schemes that target vulnerable urban populations to ensure that healthcare services are accessible and affordable, especially for chronic illnesses, in line with the Bangladesh National Urban Health Strategy. Some insights determined from this Bangladesh case study can also be useful in the context of other developing countries, to reduce chronic illnesses and thereby reduce the likelihood of falling into poverty, especially for urban areas.