{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:15:33Z","timestamp":1788869733374,"version":"build-2803163510"},"reference-count":55,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,24]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Catastrophic health expenditure (CHE) and impoverishment due to out-of-pocket (OOP) expenditure are the most widely used metrics to assess financial protection in health. This study aimed to investigate the impact of OOP expenditure on CHE and impoverishment in Bangladesh and identify their determinants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A national cross-sectional survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>We used data from the latest Household Income and Expenditure Survey 2022 in Bangladesh.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>14\u2009395 households from eight administrative divisions in Bangladesh.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The well-known methodology developed by Wagstaff and Doorslaer was used in this study to estimate the prevalence of CHE and the effect of OOP spending on impoverishment. We used a generalised linear model with a log link and a gam ma distribution to assess the association between the explanatory variables and annual OOP expenditure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of CHE was estimated to be 17.72% (95% CI 17.71% to 17.73%)\u2009and 7.07% (95% CI 7.06% to 7.08%) using 10% and 25% of the total consumption expenditure as thresholds, respectively. Given the 40% of non-food expenditure threshold level, about 9.46% (95% CI 9.45% to 9.47%) of households faced CHE due to OOP expenditure in Bangladesh. In 2022, approximately 3.7% (95% CI 3.7% to 3.71%) of the population (6.13\u2009million people) fell into poverty in Bangladesh. The prevalence of CHE was higher among male-headed households, larger families, households with elderly members, households with members suffering from chronic illnesses, those using hospital care and individuals in the poorest wealth quintiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study indicated that the financial burden due to OOP expenditure was substantial in Bangladesh. Findings stress the need for prepayment schemes such as national health insurance for safeguarding households against falling into poverty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111600","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:00:10Z","timestamp":1788868810000},"page":"e111600","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Catastrophic health expenditures and medical impoverishment in Bangladesh: evidence from the Household Income and Expenditure Survey"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2022-7590","authenticated-orcid":false,"given":"Abdur Razzaque","family":"Sarker","sequence":"first","affiliation":[{"name":"Health Economic and Financing Research, Population Studies Division, Bangladesh Institute of Development Studies, Dhaka, Bangladesh"},{"name":"Health Economics and Simulation Modelling Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasedul","family":"Islam","sequence":"additional","affiliation":[{"name":"Health Economic and Financing Research, Population Studies Division, Bangladesh Institute of Development Studies, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0224-2858","authenticated-orcid":false,"given":"An","family":"Tran-Duy","sequence":"additional","affiliation":[{"name":"Health Economics and Simulation Modelling Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Methods and Implementation Support for Clinical and Health research (MISCH) Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"2026090805000712000_16.9.e111600.1","doi-asserted-by":"crossref","first-page":"276","DOI":"10.2471\/BLT.15.163832","article-title":"Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries","volume":"94","author":"Goeppel","year":"2016","journal-title":"Bull World Health Organ"},{"key":"2026090805000712000_16.9.e111600.2","unstructured":"WHO . 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