The effect of socioeconomic status, depression, and diabetes symptoms severity on diabetes patient's life satisfaction in India.

Evidence suggests that diabetes is on the rise in India, affecting many people's life satisfaction. Comprehensive estimation of life satisfaction among diabetes patients does not exist in the country. This study examined the effects of socioeconomic status, depression, and diabetes symptoms severity on the life satisfaction of diabetes patients by controlling various demographic variables. It was a cross-sectional study comprising 583 diabetes patients from Punjab, India. Patients were interviewed using a multi-stage purposeful random sampling method. Descriptive analysis and partial least squares structural equation modelling were used in the study to test the hypotheses. Results revealed that socioeconomic status, depression and diabetes symptoms severity significantly influence the life satisfaction of diabetes patients. A 1% drop in diabetes symptoms severity corresponds to a 0.849% increase in life satisfaction, whereas a 1% decrease in depression results in a 0.898% increase in life satisfaction. Patients with higher diabetes symptoms severity were coping with common mental disorders. Women reported higher diabetes symptoms severity and depression than men, resulting in lower life satisfaction. An experimental evaluation of the effects of socioeconomic status, depression and diabetes symptoms severity, and numerous demographic factors on life satisfaction was reported. The findings will help policymakers understand the problem associated with life satisfaction among diabetes patients in the country.

Gender differential in the pattern and severity of perceived symptoms among diabetes patients in India.

Objective: To analyze the pattern of diabetes symptoms and to estimate the association between diabetes symptom severity (level of discomfort perceived by a patient due to diabetes symptoms) among different socio-demographic variables for both women and men. Methods: Primary cross-sectional data of 583 diagnosed patients (51.3% and 48.7%, women and men, respectively) were collected from Punjab, India. Frequency percentage distribution and negative binomial regressions (NBR) were used for analysis. Results: More men were asymptomatic compared to women. Both genders perceived increased hunger, thirst, and frequent urination in their early stages of diabetes. More women than men have experienced hormonal change as their first symptom with a higher severity level. NBR analyzed the association between discomfort perceived by both genders due to symptoms among different socio-demographic categories. Urban patients (incidence rate ratio-IRR: 0.90) were significantly (p = 0.056) less likely to perceive discomfort than their rural counterparts, whereas men (IRR: 0.93) reported more significant discomfort than women (IRR: 0.88) in the urban area. Literate patients [Up to class 10 (IRR: 0.87), (p = 0.013) and 11-above (IRR: 0.85), (p = 0.022) categories] were significantly less likely to perceive discomfort. In all education categories, women professed more significant discomfort than men. Conclusion: Given the differences in symptoms between the two genders, this paper will help comprehend the disease development process and limit the possibilities of misdiagnosis. This study will assist in identifying the order of the symptoms among both genders.

Magnitude of health expenditure induced removable poverty in India: Some reflections of Ayushman Bharat.

The authors have measured the health expenditure-induced removable poverty in India using nationally representative consumer expenditure surveys of three quinquennial rounds conducted by the National Sample Survey Organization (NSSO). This study has also focused on the reflections of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the world's largest Government-funded health insurance scheme, on these poverty rates in the country. The study has used headcount, payment gap, and concentration index to measure the economic burden and impoverishment impact of out-of-pocket (OOP) health expenditure. The analysis shows that the incidence and depth of poverty are substantially understated because of overlooking OOP health expenditure in the country's standard poverty measure. Outpatient care contributes almost four times more than inpatient care to health expenditure-induced impoverishment in India, though this care has not been covered in the AB-PMJAY. Muslims, among all religious groups, Scheduled Castes among social groups, and casual labourers among different household types are more vulnerable to OOP health expenditure-induced removable poverty in the country. Poverty, in general, has dropped significantly, but the share of health expenditure-induced poverty in general poverty has increased substantially. It has risen considerably in rural areas and among India's most vulnerable sections of society in the past 20 years. We emphasised that universal health insurance coverage is needed in India. Implementing comprehensive health insurance schemes that cover both inpatient and outpatient care can help alleviate the financial burden of healthcare expenses on households and contribute to reducing poverty rates.

A Vulnerability Index for Mitigation and Prevention of Diabetes Growth in India: A Disaggregated Analysis.

OBJECTIVES: This study aimed to provide a vulnerability index (VI) for identifying vulnerable regions in different states of India, which may serve as a tool for state- and district-level planning for mitigation and prevention of diabetes growth in the country. METHODS: Using data on 13 indicators under 4 domains, we generated domain-specific and overall VIs at state (36 states/union territories) and district levels (640 districts) using the percentile ranking method. The association of diabetes with individuals' socioeconomic status at different levels of regional vulnerability has also been observed through multivariable logistic regression models. RESULTS: On a scale of 0 to 1, there are 13 states with an overall VI of >0.70, of which 5 states are from southern regions of India. A low VI has been achieved by socioeconomically backward states. We observed that prevalence rates and vulnerability levels for most of the top and bottom 11 states are in the same line. District-level analysis showed that the 20 most vulnerable and least vulnerable districts are mostly from coastal and socioeconomically backward states of the country, respectively. Furthermore, logistic regression revealed that rural adults and females are less likely to be diabetic in all vulnerability quartiles. The oldest, Muslims, wealthiest, widowed/deserted/separated, and those with schooling ≤12 years are significantly more likely to be diabetic than their counterparts. CONCLUSION: The constructed VI is vital for identifying vulnerable areas and planners and policy-makers may use this comprehensive index and domain-specific VIs to prioritize resource allocation.

Cardiovascular Diseases and Ageing in India: A Propensity Score Matching Analysis of the Effects of Various Risk Factors.

Cardiovascular diseases (CVDs) are one of the major causes of mortality and morbidity worldwide, with a significant burden, especially on older adults. This analysis aims to estimate the exclusive effects of various risk factors of CVDs among 59,073 older adults aged 45 years and above in India. Using data from wave 1 of the Longitudinal Ageing Study in India (LASI), the exposure effects of various risk factors on CVDs are estimated through propensity score matching. This analysis is further extended to different components of CVDs, such as hypertension, heart disease, and stroke. Results indicate that risk factors groups such as environmental, behavioral, physiological, and genetic risk factors have a positive and significant impact on CVDs. In the case of independent risk factor effects, diabetes has the highest effect on CVDs, followed by overweight, cholesterol, family history, alcohol consumption, and depression. We conclude that physiological risk factors among older adults are more severe than other factors.

Epidemiology and Economic Burden of Continuing Challenge of Infectious Diseases in India: Analysis of Socio-Demographic Differentials.

Unlike other low- and middle-income countries, infectious diseases are still predominant, and non-communicable diseases (NCDs) are emerging without replacing the burden of infectious diseases in India, where it is imposing a double burden of diseases on households in the country. This study aimed to analyse the socio-economic and demographic differentials in the magnitude of economic burden and coping strategies associated with health expenditure on infectious diseases in India. National Sample Survey Organization (NSSO) data on "Key Indicators of Social Consumption in India: Health, (2017-18)" have been employed in this study. The findings of the study revealed that more than 33% of the individuals are still suffering from infectious diseases out of the total ailing population in India. Based on the various socio-economic and demographic covariates, infectious diseases are highly prevalent among individuals with marginalized characteristics, such as individuals residing in rural areas, females, 0-14 age groups, Muslims, illiterates, scheduled tribes (STs), and scheduled castes (SCs), large family households, and economically poor people in the country. The per capita out-of-pocket (OOP) expenditure on infectious diseases is INR 7.28 and INR 29.38 in inpatient and outpatient care, respectively. Whereas, monthly per patient OOP expenditure on infectious diseases by infection-affected populations is INR 881.56 and INR 1,156.34 in inpatient and outpatient care in India. The study found that people residing in rural areas, SCs followed by other backward classes (OBCs), illiterates, poor, and very poor are more dependent on borrowings, sale of assets, and other distressed sources of financing. However, under National Health Policy 2017, many initiatives, such as "Ayushman Bharat," PM-JAY, and National Digital Health Mission (NDHM) in 2021, have been launched by the government of India in the recent years. These initiatives are holistically launched for ensuring better health facilities, but it is early to make any prediction regarding its outcomes; hopefully, the time will define it over the passing of a few more years. Finally, the study proposed the need for proper implementations of policy initiatives, awareness against unhygienic conditions and contamination of illnesses, immunisations/vaccination campaigns, subsidized medical facilities, and the country's expansion of quality primary health-care facilities.

Analysing the burden of morbidity, associated expenditure, and coping strategies among india's elderly population: Evidence from national sample survey 75th round.

Background: An increase in average life expectancy has raised a concern about whether these extra added years are characterized by good health and independence or health problems and dependency on others for care. The current study aimed to analyze the morbidity burden, associated expenditure, and coping strategies among India's elderly population. Data and Methods: The study uses cross-sectional data of the National Sample Survey 75th round. Multivariable logistic regression has been used to examine morbidity and associated expenditure differentials among the elderly population in different socioeconomic variables in India. Results: Findings show that cardiovascular diseases (CVDs) are the leading cause of morbidity and economic burden among the elderly population in India in the case of inpatient care. However, in outpatient care, CVDs are the leading cause of morbidity, while cancer is the main cause of economic burden (measured only through OOPE). Although CVDs are the leading cause of morbidity and economic burden, psychological and neurological, injuries, cancer, and gastrointestinal ailments force the elderly population to borrow for inpatient care. Further, it is the oldest, minority (Muslims) and richest section of the elderly population who are most likely to report health issues. Gender differential is also clear from the results as females are more likely to report for ailments in outpatient care, whereas the reverse is the incident in inpatients. Conclusion: The study concluded that there is a need to increase government spending on social security such as old age pensions like Indira Gandhi National Old Age Pension Scheme, keeping in view the changing needs of the elderly population.

Socioeconomic differentials in the burden of paying for healthcare in India: a disaggregated analysis.

By using nationally representative consumption expenditure surveys (CES) conducted by the National Sample Survey Organisation (NSSO) in 1999-2000, 2004-05 and 2011-12, this paper has analysed the socioeconomic differentials in the burden of paying for healthcare in India. The study found that in all waves of data, the concentration of population reporting OOP health expenditure has shown a shift towards poor population, while the concentration of overshoot expenditure is still constant among the rich which is more pronounced in the rural areas of the country. Furthermore, Muslims and Sikhs among different religions, Scheduled Casts among social categories, self-employed and casual/agricultural labour among household types and rural areas among sectors are more likely to incur OOP health expenditure as compared to their counterparts. This study argues for the universal health insurance coverage to protect households from the significant burden of expenditure on critical healthcare.

Unequal burden of equal risk factors of diabetes between different gender in India: a cross-sectional analysis.

Many studies have supported that the burden of diabetes is shared differently by different genders due to various factors associated with it. This study aims at capturing whether women and men with a similar background, dietary and smoking habits, and biological conditions (blood pressure and body mass index (BMI)) are being affected equally or differently by diabetes. We have used cross-sectional data of NFHS-4 by covering the age group 15-49 years. Association between socio-economic background, dietary habits, biological conditions, and diabetes has been estimated using two separate multivariate logistic regression models. Results show that the overall prevalence of diabetes is higher among men (2.63%) than women (2.35%). Whereas, women belonging to urban areas (3.53%), Christian category (3.92%), richer section (3.22%), women with no schooling (2.51%), those reported never to consume pulses (2.66%) and green vegetables (2.40%) and daily consuming eggs (3.66%) and chicken or meat (3.54%) are more affected by diabetes than their men counterparts. Whereas men residing in rural areas (2.30%), belonging to the general category (3.12%), SCs (2.37%) and STs (1.72%) are more affected than their women counterparts. Results have also shown a higher prevalence of diabetes among obese men (11.46%), non-vegetarian (2.71%) and those who watch television almost every day (3.03%) as compared to their women counterparts. Regression analyses show that the richest, hypertensive, and obese women and men are significantly more likely to suffer from diabetes. This study concludes that women and men with similar socio-economic status, biological conditions, dietary and smoking habits are being affected differently by diabetes. Thus, there is a need for gender dimension in research to understand and validate the differences in the needed interventions for diabetes control in India.

Association Between Solid Cooking Fuels and Respiratory Disease Across Socio-Demographic Groups in India.

BACKGROUND: The use of solid fuels in household cooking contributes to indoor air pollution and is the cause of more than 4 million deaths around the world annually. Solid fuel use varies with the level of development and ranges from 0% in high-income countries to more than 80% in low- and middle-income countries. Three billion people (more than 40% of the global population) are still dependent on solid fuels like firewood, dung cakes, coal, wood and agricultural residues in these countries. OBJECTIVES: The present study aims to analyze the association of certain respiratory diseases (tuberculosis (TB), acute upper respiratory infections (AURI), chronic obstructive pulmonary diseases (COPD), and bronchial asthma) with the use of solid fuels for cooking across sociodemographic groups in India. METHODS: The 71st round of the National Sample Survey, conducted in 2014, was used. In total, 54,985 inpatients who received medical treatment from any medical institution during the last 365 days preceding the survey and who reported various diseases, such as infections, cancers, blood diseases, cardiovascular diseases, and respiratory diseases were included in the analysis. Of these inpatients, 2513 participants who reported TB, AURI, COPD and bronchial asthma were considered the dependent variables in the study. The main variable was exposure to different types of fuels used as a primary source of energy for cooking. Multinomial logistic regression was used to explain associations. RESULTS: The results reveal a significant association between solid fuel use and respiratory diseases in India. Overall, more than 60% of the population uses firewood and cow dung as their primary source of energy for cooking and are at a higher risk of TB, COPD and bronchial asthma. In rural areas there is a high dependence on solid fuels (80.5%) and a higher risk of respiratory diseases compared to those residing in urban areas where people are less dependent on solid fuels (22%). Among different socio-demographic groups, the dependence on solid fuels is highest among Scheduled Tribes (87.42%), followed by Scheduled Castes (74.78%) and Other Backward Classes (OBCs) (a term used by the Indian government to categorize castes that face social or educational challenges) (64.47%). Scheduled Tribes have the highest risk of TB, followed by Scheduled Castes and OBCs, respectively. CONCLUSIONS: Exposure to solid fuels for cooking increases the potential risk of TB, COPD and bronchial asthma. Access to clean and efficient fuels for cooking is essential to reduce the burden of respiratory disease. Measures are needed to increase the availability of clean fuels for households, especially among socially disadvantaged and marginalized groups, to reduce the burden of respiratory diseases in India. COMPETING INTERESTS: The authors declare no competing financial interests.

Why people avoid prescribed medical treatment in India?

Avoidance in seeking prescribed medical treatment can result in adverse consequences. The study was conducted to find out the reasons to avoid prescribed medical treatment and associations with various socioeconomic variables in India. Data from the National Sample Survey Organisation 71st Round on "Key Indicators of Social Consumption: Health" (January and June 2014) have been used. Variables such as place of residence, social categories, religion, and socioeconomic status have been used to study the associations with the various reasons to avoid prescribed medical treatment. Nonseriousness about the ailment was found to be the primary reason for not seeking prescribed medical treatment. Lack of availability of medical facility, long-waiting time, and financial constraints were other important reasons. Understanding the socioeconomic differentials among the reasons why people avoid prescribed medical treatment is critical in improving the effectiveness of health-care facilities in India.

Measuring the impact of household energy consumption on respiratory diseases in India.

BACKGROUND: Most households in developing countries like India are not able to afford to get the services of efficient energy for cooking and lighting. Therefore, they rely mostly on solid fuels (firewood, dung cakes, crop residue, coal/coke/lignite). Such fuels cause respiratory diseases like tuberculosis, asthma respiratory cancer. Hence, this study aims to estimate the association between different types of energy used and the prevalence of respiratory diseases in India where more than 50% of the population relies on solid fuels for cooking. METHODS: The study is based on 117,752 respondents who were diagnosed with various chronic diseases such as diabetes, chronic heart diseases, leprosy, chronic renal diseases, tuberculosis, asthma etc. from District Level Household Survey (DLHS-4) which was conducted in 2012-13. Individuals who were diagnosed with a chronic illness after a proper medical examination have been considered as a dependent variable. Exposure to the type of cooking fuel is the main exposure variable, which recognises the dependence on energy. Logistic regression has been utilized to understand the association between the use of solid fuels for cooking and the prevalence of respiratory diseases. RESULTS: The dependence on solid fuels is very high in rural areas (72.22%) as compared to urban areas (21.43%). Among different castes, the reliance on solid fuels for cooking is highest among Scheduled Castes (61.79%) and Scheduled Tribes (70.46%). Individuals living in households where crop residue and coal/lignite is used for cooking suffer from asthma/chronic respiratory failure in the higher proportion as compared to others. Results further revealed that the use of solid fuels for cooking has a strong association with respiratory diseases. Individuals living in households where solid fuels like firewood [OR: 1.27 (0.001); C.I.: 1.19-1.35], crop residue [OR: 1.33 (0.001); C.I.:1.19-1.48], and coal [OR: 1.60 (0.001); C.I.:1.32-1.93] are used as primary fuel for cooking are 17 to 60% more likely to suffer from respiratory diseases. CONCLUSION: Use of solid fuels is associated with respiratory diseases like asthma, tuberculosis and cancer of the respiratory system. Assuming these associations are causal, therefore, about 17 to 60% of the respiratory diseases in India could be prevented by providing access to clean cooking fuel to the individuals.

Comparative Assessment of Economic Burden of Disease in Relation to Out of Pocket Expenditure.

Background: The economic costs associated with morbidity pose a great financial risk on the population. Household's over-dependence on out-of-pocket (OOP) health expenditure and their inability to cope up with the economic costs associated with illness often push them into poverty. The current paper aims to measure the economic burden and resultant impoverishment associated with OOP health expenditure for a diverse set of ailments in India. Methods: Cross-sectional data from National Sample Survey Organization (NSSO) 71st Round on "Key Indicators of Social Consumption: Health" has been employed in the study. Indices, namely the payment headcount, payment gap, concentration index, poverty headcount and poverty gap, are defined and computed. The measurement of catastrophic burden of OOP health expenditure is done at 10% threshold level. Results: Results of the study reveal that collectively non-communicable diseases (NCDs) have higher economic and catastrophic burden, individually infections rather than NCDs such as Cardio Vascular Diseases and cancers have a higher catastrophic burden and resultant impoverishment in India. Ailments such as gastro-intestinal, respiratory, musco-skeletal, obstetrics, and injuries also have a substantial economic burden on population and push them below the poverty line. Results also show that despite the pro-poor concentration of infections, their economic burden is more concentrated among the wealthier consumption groups. Conclusion: The study concludes that universal health coverage through adequate provision of pooled resources for health care and community-based health insurance is critical to reduce the economic burden and impoverishment related to OOP health expenditure. Measures should also be instituted to insulate people from economic burden on morbidity, especially the NCDs.

Economic burden, impoverishment, and coping mechanisms associated with out-of-pocket health expenditure in India: A disaggregated analysis at the state level.

INTRODUCTION: The high share of out-of-pocket (OOP) health expenditure imposes an extreme financial burden on households, and they have to incur a substantial amount of expenditure to avail health care services. This study analyses the inter-state differentials in the economic burden of OOP health expenditure, resultant impoverishment impact, and sources of finance used as coping mechanisms. MATERIALS AND METHODS: The study is based on health expenditure survey, namely the 71st Round on "Key Indicators of Social Consumption in India: Health," (2014) conducted in India by the National Sample Survey Organisation. The study uses headcount, payment gap, and concentration index to measure the economic burden, impoverishment impact of OOP health expenditure, and the level of inequality. RESULTS: On the basis of results, the states can be divided into four distinct categories: (1) States with low economic burden and low poverty impact of OOP health expenditure, (2) low economic burden and high poverty impact of OOP health expenditure, (3) high economic burden and low poverty impact of OOP health expenditure, and (4) high economic burden and high poverty impact of OOP health expenditure. CONCLUSIONS: Inter-state differentials in OOP health expenditure and impoverishment need proper attention of the government especially the policy makers.