Financial chains and caregiver strain:The True cost of Haemodialysis in rural India
1
Department of community medicine, Pacific medical college and hospital, Udaipur, India
Popul. Med. 2026;8(Supplement Supplement 1):A1167
ABSTRACT
BACKGROUND:
Haemodialysis places significant financial and caregiving strains on patients and caregivers, especially in low-resource settings. This study examines the relationship between out-of-pocket expenditure (OOPE) and caregiver burden among 110 haemodialysis patients in rural India, highlighting socio-economic and clinical factors.
OBJECTIVE:
To evaluate the extent of OOPE, categorize caregiver burden, and identify socio-demographic factors contributing to financial and caregiving stress.
METHODS:
A cross-sectional design employed the Zarit Burden Interview (ZBI-12) to assess caregiver burden (0–10: low; >20: high) and the Modified B.G. Prasad Classification (2024)1 for income stratification. OOPE encompassed medical, non-medical, and indirect costs 2.Statistical analyses, including Kruskal-Wallis and chi-square tests, were conducted to determine associations.
RESULTS:
• Financial Burden: The mean monthly OOPE was $113.7 (medical: $37.3; non-medical: $72.2), representing 45% of average household income ($253.9). Catastrophic expenditure (>40% of income) was observed in 16.4% (n=18) of patients. • Caregiver Burden: 36.4% (n=40) reported high burden (ZBI >20). Most caregivers had provided support for less than 3 years (63.6%, n=70), yet no significant association with burden was found (p=0.24). • Socio-Demographics: o 71.8% (n=79) were rural residents; 41.8% (n=46) were illiterate. o 33.6% (n=37) of patients exhibited severe depression (PHQ-9), correlating with increased OOPE. • Statistical Outcomes: There were no significant relationships between caregiver burden and gender (p=0.576) or caregiver duration (p=0.24).
CONCLUSIONS:
Despite the lack of significant statistical associations, haemodialysis patients endure substantial financial strain (45% of income spent on OOPE) and face a high caregiver burden. Factors such as rural residency, illiteracy, and depression worsen these challenges. Policymakers should prioritize subsidies for dialysis costs and support programs for caregivers to alleviate this dual burden in resource-limited settings.
Haemodialysis places significant financial and caregiving strains on patients and caregivers, especially in low-resource settings. This study examines the relationship between out-of-pocket expenditure (OOPE) and caregiver burden among 110 haemodialysis patients in rural India, highlighting socio-economic and clinical factors.
OBJECTIVE:
To evaluate the extent of OOPE, categorize caregiver burden, and identify socio-demographic factors contributing to financial and caregiving stress.
METHODS:
A cross-sectional design employed the Zarit Burden Interview (ZBI-12) to assess caregiver burden (0–10: low; >20: high) and the Modified B.G. Prasad Classification (2024)1 for income stratification. OOPE encompassed medical, non-medical, and indirect costs 2.Statistical analyses, including Kruskal-Wallis and chi-square tests, were conducted to determine associations.
RESULTS:
• Financial Burden: The mean monthly OOPE was $113.7 (medical: $37.3; non-medical: $72.2), representing 45% of average household income ($253.9). Catastrophic expenditure (>40% of income) was observed in 16.4% (n=18) of patients. • Caregiver Burden: 36.4% (n=40) reported high burden (ZBI >20). Most caregivers had provided support for less than 3 years (63.6%, n=70), yet no significant association with burden was found (p=0.24). • Socio-Demographics: o 71.8% (n=79) were rural residents; 41.8% (n=46) were illiterate. o 33.6% (n=37) of patients exhibited severe depression (PHQ-9), correlating with increased OOPE. • Statistical Outcomes: There were no significant relationships between caregiver burden and gender (p=0.576) or caregiver duration (p=0.24).
CONCLUSIONS:
Despite the lack of significant statistical associations, haemodialysis patients endure substantial financial strain (45% of income spent on OOPE) and face a high caregiver burden. Factors such as rural residency, illiteracy, and depression worsen these challenges. Policymakers should prioritize subsidies for dialysis costs and support programs for caregivers to alleviate this dual burden in resource-limited settings.
| eISSN: | 2654-1459 |
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