Date Published: October 21, 2016
Publisher: Public Library of Science
Author(s): Khurshid Alam, Ajay Mahal, Rachel A. Nugent.
Globally, road traffic injuries accounted for about 1.36 million deaths in 2015 and are projected to become the fourth leading cause of disability-adjusted life years (DALYs) lost by 2030. One-fifth of these deaths occurred in South Asia where road traffic injuries are projected to increase by 144% by 2020. Despite this rapidly increasing disease burden there is limited evidence on the economic burden of road traffic injuries on households in South Asia. We applied a novel coarsened exact matching method to assess the household economic burden of road traffic injuries using nationally representative World Health Survey data from five South Asian countries- Bangladesh, India, Nepal, Pakistan and Sri Lanka collected during 2002–2003. We examined the impact of road traffic injuries on household out-of-pocket (OOP) health spending, household non-medical consumption expenditure and the employment status of the traffic injury-affected respondent. We exactly matched a household (after ‘coarsening’) where a respondent reported being involved in a road traffic injury to households where the respondent did not report a road traffic injury on each of multiple observed household characteristics. Our analysis found that road traffic injury-affected households had significantly higher levels of OOP health spending per member (I$0.75, p<0.01), higher OOP spending on drugs per member (I$0.30, p = 0.03), and higher OOP hospital spending per member (I$0.29, p<0.01) in the four weeks preceding the survey. Indicators of “catastrophic spending” were also significantly higher in road traffic injury-affected households: 6.45% (p<0.01) for a threshold of OOP health spending to total household spending ratio of 20%, and 7.40% (p<0.01) for a threshold of OOP health spending to household ‘capacity to pay’ ratio of 40%. However, no statistically significant effects were observed for household non-medical consumption expenditure, and employment status of the road traffic injury-affected individual. Our analysis points to the need for financial risk protection against the road traffic injury-related OOP health expenditure and a focus on prevention.
Road traffic injuries accounted for nearly 1.36 million deaths worldwide in 2015, and ranked as the eighth leading cause of years of life lost (YLLs) in that year . Globally, the burden of road traffic injuries, measured in terms of number of disability-adjusted life years (DALYs) ranked ninth in 2015 but are projected to be the fourth leading cause of disease burden by 2030 [2, 3]. The low- and middle-income countries (LMICs) account for a disproportionate share of traffic injuries worldwide with nearly 85% of deaths and 90% of DALYs lost . One-fifth of these deaths occurred in South Asia with road traffic injuries being the 11th leading cause of DALYs lost in the region in 2010 [5, 6]. The reason for the rising death toll in LMICs such as in South Asia is rapid urbanization and motorization associated with rapid economic growth . Existing projections suggest a 144% increase in road traffic deaths in South Asia over the period from 2000 to 2020, so we can expect the relative significance of road traffic injuries in South Asia’s disease burden to rise rapidly in the future . Globally, more than 50% of road traffic injury-related deaths occur in the age group 15–49 years, an economically productive period [7, 9]. A similar age distribution has been noted in traffic injury deaths and related hospitalizations in countries of South Asia [9–12]. Road traffic injuries can also require expensive hospital-based treatment, including trauma care . As a consequence, studies estimating the cost-of-illness of road traffic injuries (direct costs of treatment and productivity losses) or the value of a statistical life arrive at measures of aggregate economic impacts that are staggering, ranging from 1.3% to 3.0% of gross domestic product (GDP) annually in South Asia . Estimates of national level economic impacts using the monetary value of a statistical life and cost-of-illness methods have faced a number of methodological challenges . In addition, such estimates also cannot tell us about the impact of road traffic injuries on the economic burden faced by the affected households, because some of the burden of injury care may be borne by others (e.g., subsidized public facilities), or may be pushed into the future as households with injured members incur debt or sell assets to finance care, and household members may experience earnings losses .
Table 1 presents summary statistics for the matching variables for three sets of households: injury-affected households, matched comparison households based on CEM and the full set of (unmatched) households. It is apparent that the means for matched households are considerably closer than when comparing the variable means of injury-affected households and unmatched control households.
Our analysis suggests that road traffic injury-affected households in South Asia face a greater economic burden than a comparison group of similar households, based on CEM, where the respondent in the comparison household did not report a road traffic injury. This burden is primarily through incurring higher OOP health spending associated with hospitalization and drugs. However, the effect size is much smaller in our study relative to previous studies [12, 23]. Our analysis also shows that road traffic injury-affected households in South Asia experience OOP health expenditures that exceed commonly used catastrophic thresholds in the literature [37, 40].
Our paper explores the economic burden of non-fatal road traffic injuries on households in the five major countries of South Asia. Our conclusions point to a significant economic burden of road traffic injuries on households in South Asia, largely due to OOP spending on healthcare services but also highlights that the inclusion of a comparison group lowers estimates of the household economic burden of road traffic injuries. Road traffic injuries also lead to a significant increase in the proportion of households reporting catastrophic OOP health spending. Our analysis points to the need for financial risk protection for households affected by road traffic injuries in South Asia. Moreover, with the economic burden expected to rise in the future, prevention measures are warranted.