Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

The relationship between non-communicable disease occurrence and poverty-evidence from demographic surveillance in Matlab, Bangladesh

TitleThe relationship between non-communicable disease occurrence and poverty-evidence from demographic surveillance in Matlab, Bangladesh
Publication TypeJournal Article
Year of Publication2016
AuthorsMirelman, AJ, Rose, S, Khan, JA, Ahmed, S, Peters, DH, Niessen, LW, Trujillo, AJ
JournalHealth Policy Plan
Date PublishedFeb 3
ISBN Number1460-2237 (Electronic)0268-1080 (Linking)
Accession Number26843515
KeywordsBangladesh, Non-communicable disease, Poverty

In low-income countries, a growing proportion of the disease burden is attributable to non- communicable diseases (NCDs). There is little knowledge, however, of their impact on wealth, human capital, economic growth or household poverty. This article estimates the risk of being poor after an NCD death in the rural, low-income area of Matlab, Bangladesh. In a matched cohort study, we estimated the 2-year relative risk (RR) of being poor in Matlab households with an NCD death in 2010. Three separate measures of household economic status were used as outcomes: an asset-based index, self-rated household economic condition and total household landholding. Several estimation methods were used including contingency tables, log-binomial regression and regression standardization and machine learning. Households with an NCD death had a large and significant risk of being poor. The unadjusted RR of being poor after death was 1.19, 1.14 and 1.10 for the asset quintile, self-rated condition and landholding outcomes. Adjusting for household and individual level independent variables with log-binomial regression gave RRs of 1.19 [standard error (SE) 0.09], 1.16 (SE 0.07) and 1.14 (SE 0.06), which were found to be exactly the same using regression standardization (SE: 0.09, 0.05, 0.03). Machine learning-based standardization produced slightly smaller RRs though still in the same order of magnitude. The findings show that efforts to address the burden of NCD may also combat household poverty and provide a return beyond improved health. Future work should attempt to disentangle the mechanisms through which economic impacts from an NCD death occur.Key MessagesDespite a growing global awareness of the emerging burden of non-communicable diseases (NCDs) in low and middle-income countries, there is little evidence of the microeconomic household impact.In rural Bangladesh, information from a demographic surveillance site allows the identification of households with NCD deaths and the use of multiple economic outcomes in a longitudinal cohort analysis.We find that the presence of an NCD death leads to an increased 2-year risk that households are poor according to asset score, self-report as poor or are land-poor.