European Journal of Epidemiology

, Volume 30, Issue 3, pp 163–188 | Cite as

The global impact of non-communicable diseases on households and impoverishment: a systematic review

  • Loes Jaspers
  • Veronica Colpani
  • Layal Chaker
  • Sven J. van der Lee
  • Taulant Muka
  • David Imo
  • Shanthi Mendis
  • Rajiv Chowdhury
  • Wichor M. Bramer
  • Abby Falla
  • Raha Pazoki
  • Oscar H. FrancoEmail author


The global economic impact of non-communicable diseases (NCDs) on household expenditures and poverty indicators remains less well understood. To conduct a systematic review and meta-analysis of the literature evaluating the global economic impact of six NCDs [including coronary heart disease, stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on households and impoverishment. Medline, Embase and Google Scholar databases were searched from inception to November 6th 2014. To identify additional publications, reference lists of retrieved studies were searched. Randomized controlled trials, systematic reviews, cohorts, case–control, cross-sectional, modeling and ecological studies carried out in adults and assessing the economic consequences of NCDs on households and impoverishment. No language restrictions. All abstract and full text selection was done by two independent reviewers. Data were extracted by two independent reviewers and checked by a third independent reviewer. Studies were included evaluating the impact of at least one of the selected NCDs and on at least one of the following measures: expenditure on medication, transport, co-morbidities, out-of-pocket (OOP) payments or other indirect costs; impoverishment, poverty line and catastrophic spending; household or individual financial cost. From 3,241 references, 64 studies met the inclusion criteria, 75 % of which originated from the Americas and Western Pacific WHO region. Breast cancer and DM were the most studied NCDs (42 in total); CKD and COPD were the least represented (five and three studies respectively). OOP payments and financial catastrophe, mostly defined as OOP exceeding a certain proportion of household income, were the most studied outcomes. OOP expenditure as a proportion of family income, ranged between 2 and 158 % across the different NCDs and countries. Financial catastrophe due to the selected NCDs was seen in all countries and at all income levels, and occurred in 6–84 % of the households depending on the chosen catastrophe threshold. In 16 low- and middle-income countries (LMIC), 6–11 % of the total population would be impoverished at a 1.25 US dollar/day poverty line if they would have to purchase lowest price generic diabetes medication. NCDs impose a large and growing global impact on households and impoverishment, in all continents and levels of income. The true extent, however, remains difficult to determine due to the heterogeneity across existing studies in terms of populations studied, outcomes reported and measures employed. The impact that NCDs exert on households and impoverishment is likely to be underestimated since important economic domains, such as coping strategies and the inclusion of marginalized and vulnerable people who do not seek health care due to financial reasons, are overlooked in literature. Given the scarcity of information on specific regions, further research to estimate impact of NCDs on households and impoverishment in LMIC, especially the Middle Eastern, African and Latin American regions is required.


Non-communicable diseases Impoverishment Households Systematic review 



Completion of this manuscript was supported by a Grant from the WHO. O.H. Franco and L. Jaspers work in ErasmusAGE, a center for aging research across the life course funded by Nestlé Nutrition (Nestec Ltd.); Metagenics Inc.; and AXA. Nestlé Nutrition (Nestec Ltd.); Metagenics Inc.; and AXA had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review or approval of the manuscript. V. Colpani is a visiting researcher supported by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), in Brazil. Dr. Shanthi Mendis from the WHO and co-author on this manuscript participated in the interpretation and preparation of this manuscript. The manuscript was approved by the WHO for submission.

Conflict of interest

With regard to potential conflicts of interest, there is nothing to disclose. Drs. Jaspers, Colpani and Franco had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Supplementary material

10654_2014_9983_MOESM1_ESM.doc (98 kb)
Supplementary material 1 (DOC 97 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Loes Jaspers
    • 1
  • Veronica Colpani
    • 1
  • Layal Chaker
    • 1
    • 2
  • Sven J. van der Lee
    • 1
  • Taulant Muka
    • 1
  • David Imo
    • 1
  • Shanthi Mendis
    • 3
  • Rajiv Chowdhury
    • 4
  • Wichor M. Bramer
    • 5
  • Abby Falla
    • 6
    • 7
  • Raha Pazoki
    • 1
  • Oscar H. Franco
    • 1
    Email author
  1. 1.Department of EpidemiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
  2. 2.Department of EndocrinologyErasmus MCRotterdamThe Netherlands
  3. 3.Chronic Diseases Prevention and Management, Department of Chronic Diseases and Health PromotionWorld Health OrganizationGenevaSwitzerland
  4. 4.Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
  5. 5.Medical LibraryErasmus MCRotterdamThe Netherlands
  6. 6.Department of Public HealthErasmus MCRotterdamThe Netherlands
  7. 7.Division of Infectious Disease ControlMunicipal Public Health Service (GGD) Rotterdam-RijnmondRotterdamThe Netherlands

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