The household economic burden of non-communicable diseases in 18 countries

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. METHODS: Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. RESULTS: The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. CONCLUSIONS: Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs. (AU)

Effects of acrylonitrile on the pathological morphology and apoptosis of neurons in rats.

This study aimed to evaluate the effects of acrylonitrile (ACN) on neuronal morphology and apoptosis in rats. An ACN solution was administered to Wistar rats by gavage at doses of 0, 5, 10, or 20 mg/kg, 5 days a week for 13 weeks. The morphology of neurons and the presence of apoptosis was examined by light and electron microscope, DNA electrophoresis, immunohistochemistry, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling. Significant vacuolation and the widening of the interspaces around blood vessels were observed in the groups that received the highest dose. Disordered myelin sheaths, malformed neuronal nuclei, and chromatin condensation at the periphery of the nucleus that formed crescents were also observed in the treated rats. The number of apoptotic neurons was significantly decreased (P < 0.05) in the treated groups (5 mg/kg group: 1.5 ± 1.22 apoptotic neurons/slide; 10 mg/kg group: 2.5 ± 1.05 apoptotic neurons/slide; 20 mg/kg group: 2.34 ± 1.21 apoptotic neurons/slide) compared to the control group (4.5 ± 1.52 apoptotic neurons/slide). The number of Bcl-2-positive neurons and the levels of staining were increased in the treated rats compared to those of the control group. These results suggested that ACN may induce serious morphological changes in rat neurons and inhibit neuronal apoptosis in rats.