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Socioeconomic inequalities in self-reported chronic non-communicable diseases in urban Hanoi, Vietnam
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam; Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam.
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2015 (English)In: Global Public Health, ISSN 1744-1692, E-ISSN 1744-1706Article in journal (Refereed) Epub ahead of print
Abstract [en]

This study measures and decomposes socioeconomic inequalities in the prevalence of self-reported chronic non-communicable diseases (NCDs) in urban Hanoi, Vietnam. A cross-sectional survey of 1211 selected households was carried out in four urban districts in both slum and non-slum areas of Hanoi city in 2013. The respondents were asked if a doctor or health worker had diagnosed any household members with an NCD, such as cardiovascular diseases, chronic respiratory, diabetes or cancer, during last 12 months. Information from 3736 individuals, aged 15 years and over, was used for the analysis. The concentration index (CI) was used to measure inequalities in self-reported NCD prevalence, and it was also decomposed into contributing factors. The prevalence of chronic NCDs in the slum and non-slum areas was 7.9% and 11.6%, respectively. The CIs show gradients disadvantageous to both the slum (CI = -0.103) and non-slum (CI = -0.165) areas. Lower socioeconomic status and aging significantly contributed to inequalities in the self-reported NCDs, particularly for those living in the slum areas. The findings confirm the existence of substantial socioeconomic inequalities linked to NCDs in urban Vietnam. Future policies should target these vulnerable areas.

Place, publisher, year, edition, pages
2015.
Keyword [en]
decomposition, Inequality, non-communicable diseases, urban, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-114393DOI: 10.1080/17441692.2015.1123282PubMedID: 26727691OAI: oai:DiVA.org:umu-114393DiVA: diva2:895084
Available from: 2016-01-18 Created: 2016-01-18 Last updated: 2017-09-26
In thesis
1. Inequalities in non-communicable diseases in urban Hanoi, Vietnam: health care utilization, expenditure and responsiveness of commune health stations
Open this publication in new window or tab >>Inequalities in non-communicable diseases in urban Hanoi, Vietnam: health care utilization, expenditure and responsiveness of commune health stations
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality among adults in Vietnam. Little is known about the magnitude of socioeconomic inequalities in NCDs and other NCD-related factors in urban areas, in particular among the poor living in slum areas. Understanding these disparities are essential in contributing to the knowledge, needed to reduce inequalities and close the related health gaps burdening the disadvantaged populations in urban areas. 

Objective: To examine the burden and health system responsiveness to NCDs in Hanoi, Vietnam and investigate the role of socioeconomic inequalities in their prevalence, subsequent healthcare utilization and related impoverishment due to health expenditures. 

Methods: A cross-sectional study was conducted among 3,736 individuals aged 15 years and over who lived in 1211 randomly selected households in 2013 in urban Hanoi, Vietnam. The study collected information on household’s characteristics, household expenditures, and household member information. A qualitative approach was implemented to explore the responsiveness of commune health stations to the increasing burden of NCDs in urban Hanoi. In-depth interview approach was conducted among health staff involved in NCD tasks at four commune health stations in urban Hanoi. Furthermore, NCD managers at relevance district, provincial and national levels were interviewed. 

Results: The prevalence of self-reported NCDs was significantly higher among individuals in non-slum areas (11.6%) than those in slum areas (7.9%). However, the prevalence of self-reported NCDs concentrated among the poor in both slum and non-slum areas. In slum areas, the poor needed more health care services, but the rich consumed more health care services. Among households with at least one household member reporting diagnosis of NCDs, the proportion of household facing catastrophic health expenditure and impoverishment were the greater in slum areas than in non-slum areas. Poor households in slum areas were more likely to face catastrophic health expenditure and impoverishment. The poor in non-slum areas were also more likely to face impoverishment if their household members experienced NCDs. Health system responses to NCDs at commune health stations in urban Hanoi were weak, characterized by the lack of health information, inadequate human resources, poor financing, inadequate quality and quantity of services, lack of essential medicines. The commune health stations were not prepared to respond to the rising prevalence of NCDs in urban Hanoi. 

Conclusion: This thesis shows the existence of socioeconomic inequalities in the prevalence of self-reported NCDs in both non-slum and slum areas in urban Hanoi. NCDs associated with the inequalities in health care utilization, catastrophic health expenditure and impoverishment, particular in slum areas. Appropriate interventions should focus more on specific population groups to reduce the socioeconomic inequalities in the NCD prevalence and health care utilization related to NCDs to prevent catastrophic health expenditure and impoverishment among the households of NCD patients.  The functions of commune health stations in the urban setting should be strengthened through the development of NCDs service packages covered by the health insurance.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 76 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1845
Keyword
socioeconomic inequalities, non-communicable diseases, health care utilization, catastrophic health expenditure, impoverishment, health system, commune health stations, Hanoi, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-126045 (URN)978-91-7601-564-3 (ISBN)
Public defence
2016-10-21, Betula, Building 6M, Norrlands University Hospital, Umeå, 09:00 (English)
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Supervisors
Available from: 2016-09-30 Created: 2016-09-27 Last updated: 2016-10-19Bibliographically approved

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