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Associations between social factors, health behaviours, household expenditure and self-reported Diabetes Mellitus management in adults aged 50+ years, in China and India: Results from the WHO Study of global AGEing and adult health (SAGE).
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2015 (English)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Objectives: For adults aged 50 years and over in China and India who reported Diabetes Mellitus (DM), to describe the socio-demographic characteristics associated with DM medication use and investigate whether DM medication use is associated with catastrophic household expenditure after adjusting for social factors and health behaviours.

Methods: A secondary data analysis using data obtained from the World Health Organisation’s Study on Global AGEing and adult health (SAGE) was conducted for China and India among adults aged 50+ years. SAGE is a longitudinal study on ageing and adult health with nationally representative samples of persons aged 50 years and above, and comparison samples of 18-49 years, from China, Ghana, India, Mexico, Russian Federation and South Africa. Out of SAGE sample size of 18620 in China and India, 1236 respondents self-reported as using DM medication. Outcome variables were DM medication use, based on self-reporting using medication in the last 2 weeks or 12 months, and Catastrophic Health Expenditure, calculated as medicines expenditure consuming at least 40% of household average monthly spending. Univariable and multivariable logistic regression was undertaken to test associations between socio-demographic, health behaviour and DM medication use. Catastrophic health expenditure was calculated following merging of individual and household datasets. Univariable and multivariable logistic regressions were then performed to determine household and individual characteristics associated with catastrophic expenditure amongst those that were using DM medication.

Results: Among respondents who self-reported as using DM medication, multivariable logistic regression for China and India (pooled) showed that females were more likely to use medication compared to men (OR 1.54: 95% CI 1.05-2.26) as were those who reported lifestyle modification (OR 5.94: 95% CI 3.81-9.29). Medication use was not statistically significantly associated with catastrophic health expenditure in either univariable nor multivariable logistic regression. In China, rural residents were more likely to experience catastrophic expenditure (OR 1.61: 95% CI 1.00-2.59) and compared to the highest wealth quintile, those in the poorest wealth quintile were more likely to spend catastrophically. In India, compared with respondents reporting very good/good financial status, those with moderate (OR 0.17: 95% CI 0.05-0.61) and very bad/bad (OR 0.13: 95%CI 0.02-0.85) household financial status were less likely to experience catastrophic health expenditure.

Conclusion: Female respondents and those reporting lifestyle modification i.e. adopting a special diet, exercise regime or weight loss programme, were more likely to use DM medication. Regarding catastrophic health expenditure, those who were using DM medication were not more prone to catastrophic expenditure compared to those that were not using medication. In China, rural residents and those from poorer households were more likely to experience catastrophic health expenditure whilst in India, subjective moderate and very bad/bad financial status were less likely to spend catastrophic on health. In terms of public health implications, there is potential to influence evidence-based PH interventions and policy formulation thereby ensuring access to affordable and good quality care and such studies can trigger more epidemiological and health economic research among older people with DM.

Place, publisher, year, edition, pages
2015. , 39 p.
, Centre for Public Health Report Series, ISSN 1651-341x ; 2015:24
Keyword [en]
Medications, Lifestyle, Determinants, Out-of-pocket expenditure
National Category
Public Health, Global Health, Social Medicine and Epidemiology
URN: urn:nbn:se:umu:diva-104406OAI: diva2:819495
Educational program
Master's Programme in Public Health
2015-05-26, Vårdvetarhuset A110, Lasarettsbacken 907 46, Umeå, 16:37 (English)
Available from: 2015-12-21 Created: 2015-06-10 Last updated: 2015-12-21Bibliographically approved

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