Abstract
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.
Highlights
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 [1]
We found that the matched injured cases were slightly older than the unmatched injured cases (38.09 years vs 37.24 years), with a higher proportion of males (78.37% vs 75.74%), and much less educated (15.87% vs 38.35%)
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 coarsened exact matching (CEM), where the respondent in the comparison household did not report a road traffic injury
Summary
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 [1]. Studies estimating the costof-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 [14]. 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 [15] Such estimates 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 [16]
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