ASSESSMENT OF SOCIO-ECONOMIC STATUS OF PATIENTS ON MAINTENANCE HEMODIALYSIS APPROACHING A PRIVATE DIALYSIS NETWORK USING SWIFT TOOL IN INDIA, 2023

Introduction:

Globally,14.5 million need kidney replacement therapy (KRT) with 98 % unable to receive it among low-income countries and 94% in lower-middle-income countries. However, the socio-economic status of the patients receiving KRT has not been studied well. As of 2007, the World Bank (WB) classified India as a lower-middle-income group. The WB updates global poverty lines based on purchasing power parities, a metric to compare different currencies and account for price differences across countries. The objective of this study is to estimate the proportion of patients among different income groups receiving maintenance hemodialysis from a private dialysis network.

Methods:

We conducted an observational cross-sectional study across 100 centers chosen by simple random sampling, among patients receiving hemodialysis from a single large dialysis network in India in 2023. The total sample size is 2,573. A pre-tested semi-structured questionnaire was used to interview the patient. A rapid income assessment tool, Survey of Well-Being via Instant and Frequent Tracking (SWIFT) designed by WB which estimates household income or expenditures to measure household poverty was used. The data was collected by trained designated staff present in the centre. RStudio software was used for analyzing data. We present the socio-demographic and income characteristics and different levels of aggregation such as payment type, hospital tier and region in proportion. Based on 2011 purchasing power parities, the international poverty line of $ 3.20 per day is considered for lower-middle-income countries which is used as the main income line to produce estimates in this study.

Results:

The median age of study participants was 53 ranging from 18 – 90 years. Majority (71%) were males and 95% of household size was < 5 members. Illiteracy in households was 32%, highest in the South. Head of the family was predominantly male (87%) with a literacy level of 83%. 72% of patients were under a public insurance program. Household characteristics: 88% had an electricity supply, 82% had a mobile phone, 66% had a refrigerator and 37% owned a laptop/tablet/computer. In the last month, 42% of them purchased stationery or hobby sports items, 20% purchased cooking or household appliances and 18% purchased furniture or furnishing items.  Distribution of patients by poverty line is as follows: 5.5% were <$1.9 per day, 6.6% were below the 40th percentile, 25.9% were <$ 3.20 per day and 81.1% were < $8 per day (Figure 1). 18% in Tier 1, 25% in Tier II and 38% in Tier III were below the poverty line. Likewise, segregation by payer type showed that 32% were under government insurance, 17% by direct cash payment and 12% by private insurance. The region-wise patient poverty level distribution based on the international poverty line was 35% in east, 30% in central, 22% in west and 13% in north.

Conclusions:

The study highlights that among the patients approaching one of India’s largest private networks for dialysis services, one out of three patients are below the international poverty line, residing in the rural sector, and more likely paid by government insurance followed by out-of-pocket.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.