Global health action · 2026
Catastrophic health expenditure and associated factors in low-, lower-middle and upper-middle-income countries: systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Kabir Mohammod Akbar, Armstrong Maelodee Chong, Ahmed Sayem, Löve Jesper, Huque Rumana, Khan Jahangir
Аннотация
BACKGROUND: Reducing catastrophic health expenditure (CHE) is critical for achieving Universal Health Coverage (UHC), as high out-of-pocket healthcare spending can cause financial hardship and hinder access to care. However, evidence on CHE prevalence and associated factors in low-income (LICs), lower-middle-income (Lower-MICs), and upper-middle-income (UMICs) countries remains fragmented.
OBJECTIVES: To systematically review and synthesize evidence on the prevalence and factors of CHE in LICs, Lower-MICs, and UMICs.
METHODS: Following registered protocol (PROSPERO: CRD42024521553) and PRISMA guidelines, we searched CINAHL, PubMed, Scopus, and Web of Science for studies published between 2015 and 2023. Quantitative studies that measured CHE and/or associated factors at the 10% threshold of household total expenditure/income and/or the 40% threshold of non-food expenditure were included. Risk of bias was assessed using the AXIS tool. A random-effects meta-analysis estimated the pooled prevalence of CHE, and associated factors were synthesized narratively.
RESULTS: Forty studies were included. Key determinants increasing CHE risk were low income, elderly or chronically ill members, private facilities use, female-headed households, and lack of insurance, while education and employment were protective. Rural residence was generally associated with higher CHE despite mixed findings. Pooled CHE prevalence was 18% (95% CI: 14-23%) at the 10% threshold and 7% (95% CI: 5-10%) at the 40% threshold, with considerable heterogeneity (I2 > 99%). UMICs had the highest CHE prevalence, whereas LICs reported the lowest.
CONCLUSIONS: CHE remains considerable, particularly in Lower-MICs and UMICs, and varies across income groups. Achieving UHC requires policies to strengthen financial protection and reduce socioeconomic disparities.
OBJECTIVES: To systematically review and synthesize evidence on the prevalence and factors of CHE in LICs, Lower-MICs, and UMICs.
METHODS: Following registered protocol (PROSPERO: CRD42024521553) and PRISMA guidelines, we searched CINAHL, PubMed, Scopus, and Web of Science for studies published between 2015 and 2023. Quantitative studies that measured CHE and/or associated factors at the 10% threshold of household total expenditure/income and/or the 40% threshold of non-food expenditure were included. Risk of bias was assessed using the AXIS tool. A random-effects meta-analysis estimated the pooled prevalence of CHE, and associated factors were synthesized narratively.
RESULTS: Forty studies were included. Key determinants increasing CHE risk were low income, elderly or chronically ill members, private facilities use, female-headed households, and lack of insurance, while education and employment were protective. Rural residence was generally associated with higher CHE despite mixed findings. Pooled CHE prevalence was 18% (95% CI: 14-23%) at the 10% threshold and 7% (95% CI: 5-10%) at the 40% threshold, with considerable heterogeneity (I2 > 99%). UMICs had the highest CHE prevalence, whereas LICs reported the lowest.
CONCLUSIONS: CHE remains considerable, particularly in Lower-MICs and UMICs, and varies across income groups. Achieving UHC requires policies to strengthen financial protection and reduce socioeconomic disparities.