{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T03:08:02Z","timestamp":1776481682389,"version":"3.51.2"},"reference-count":44,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Centers for Disease Prevention and Control, Atlanta, USA","award":["U01IP001074"],"award-info":[{"award-number":["U01IP001074"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2023,9,8]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Advocacy for the provision of public health resources, including vaccine for the prevention of acute respiratory illnesses (ARIs) among older adults in India, needs evidence on costs and benefits. Using a cohort of community-dwelling adults aged 60 years and older in India, we estimated the cost of ARI episode and its determinants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We enrolled 6016 participants in Ballabgarh, Chennai, Kolkata and Pune from July 2018 to March 2020. They were followed up weekly to identify ARI and classified them as acute upper respiratory illness (AURI) or pneumonia based on clinical features based on British Thoracic Society guidelines. All pneumonia and 20% of AURI cases were asked about the cost incurred on medical consultation, investigation, medications, transportation, food and lodging. The cost of services at public facilities was supplemented by WHO-Choosing Interventions that are Cost-Effective(CHOICE) estimates for 2019. Indirect costs incurred by the affected participant and their caregivers were estimated using human capital approach. We used generalised linear model with log link and gamma family to identify the average marginal effect of key determinants of the total cost of ARI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We included 2648 AURI and 1081 pneumonia episodes. Only 47% (range 36%\u201360%) of the participants with pneumonia sought care. The mean cost of AURI episode was US$13.9, while that of pneumonia episode was US$25.6, with indirect costs comprising three-fourths of the total. The cost was higher among older men by US$3.4 (95% CI: 1.4 to 5.3), those with comorbidities by US$4.3 (95% CI: 2.8 to 5.7) and those who sought care by US$17.2 (95% CI: 15.1 to 19.2) but not by influenza status. The mean per capita annual cost of respiratory illness was US$29.5.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Given the high community disease and cost burden of ARI, intensifying public health interventions to prevent and mitigate ARI among this fast-growing older adult population in India is warranted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2023-000103","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T13:11:31Z","timestamp":1697634691000},"page":"e000103","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Cost of acute respiratory illness episode and its determinants among community-dwelling older adults: a four-site cohort study from India"],"prefix":"10.1136","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9173-7811","authenticated-orcid":false,"given":"Anand","family":"Krishnan","sequence":"first","affiliation":[{"name":"Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kusum","family":"Shekhawat","sequence":"additional","affiliation":[{"name":"Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismael R","family":"Ortega-Sanchez","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suman","family":"Kanungo","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9839-800X","authenticated-orcid":false,"given":"Prabu","family":"Rajkumar","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumit Dutt","family":"Bhardwaj","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research,National Institute of Virology, Pune, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9383-0876","authenticated-orcid":false,"given":"Aslesh Ottapura","family":"Prabhakaran","sequence":"additional","affiliation":[{"name":"Influenza Program, Centers for Disease Control and Prevention, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giridara","family":"Gopal","sequence":"additional","affiliation":[{"name":"Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-909X","authenticated-orcid":false,"given":"Alok Kumar","family":"Chakrabarti","sequence":"additional","affiliation":[{"name":"Virology, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5464-1028","authenticated-orcid":false,"given":"Girish","family":"Kumar Chethrapilly Purushothaman","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varsha","family":"Potdar","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research,National Institute of Virology, Pune, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byomkesh","family":"Manna","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0702-5628","authenticated-orcid":false,"given":"Radhika","family":"Gharpure","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ritvik","family":"Amarchand","sequence":"additional","affiliation":[{"name":"Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avinash","family":"Choudekar","sequence":"additional","affiliation":[{"name":"Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn E","family":"Lafond","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lalit","family":"Dar","sequence":"additional","affiliation":[{"name":"Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uttaran","family":"Bhattacharjee","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Azziz-Baumgartner","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siddhartha","family":"Saha","sequence":"additional","affiliation":[{"name":"Influenza Program, Centers for Disease Control and Prevention, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"key":"2025083110371768000_1.1.e000103.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31012-1"},{"key":"2025083110371768000_1.1.e000103.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(22)00510-2"},{"key":"2025083110371768000_1.1.e000103.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32203-7"},{"key":"2025083110371768000_1.1.e000103.4","unstructured":"Office of the Registrar General and Census Commissioner of India . Cause of death statistics in India 2016-18. New Delhi, 2022."},{"key":"2025083110371768000_1.1.e000103.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-049689","article-title":"Magnitude of COVID-19 deaths relative to other leading causes of death: a global analysis","volume":"12","author":"Chan","year":"2022","journal-title":"BMJ Open"},{"key":"2025083110371768000_1.1.e000103.6","unstructured":"World Health Organization . Ageing and health October. 2022. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/ageing-and-health"},{"key":"2025083110371768000_1.1.e000103.7","unstructured":"United Nations Department of Economic and Social Affairs PD . World population prospects. New York: United Nations, 2019."},{"key":"2025083110371768000_1.1.e000103.8","unstructured":"American Lung Association . Preventing pneumonia. n.d. Available: https:\/\/www.lung.org\/lung-health-diseases\/lung-disease-lookup\/pneumonia\/preventing-pneumonia"},{"key":"2025083110371768000_1.1.e000103.9","first-page":"1102","article-title":"Updated recommendations for prevention of invasive Pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23)","volume":"59","year":"2010","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025083110371768000_1.1.e000103.10","unstructured":"World Health Organization . WHO SAGE seasonal influenza vaccination recommendations during the COVID-19 pandemic. 2020."},{"key":"2025083110371768000_1.1.e000103.11","unstructured":"Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India . Operational guidelines. National Programme for Health Care of the Elderly (NPHCE). 2019."},{"key":"2025083110371768000_1.1.e000103.12","doi-asserted-by":"crossref","first-page":"375","DOI":"10.2471\/BLT.21.287390","article-title":"Vaccination coverage among older adults: a population-based study in India","volume":"100","author":"Rizvi","year":"2022","journal-title":"Bull World Health Organ"},{"key":"2025083110371768000_1.1.e000103.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2020-000703","article-title":"Clinical and financial burden of hospitalised community-acquired pneumonia in patients with selected underlying comorbidities in England","volume":"7","author":"Campling","year":"2020","journal-title":"BMJ Open Respir Res"},{"key":"2025083110371768000_1.1.e000103.14","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2019.1675149"},{"key":"2025083110371768000_1.1.e000103.15","doi-asserted-by":"crossref","DOI":"10.1186\/s41479-017-0042-1","article-title":"Economic burden of community-acquired pneumonia among elderly patients: a Japanese perspective","volume":"9","author":"Konomura","year":"2017","journal-title":"Pneumonia (Nathan)"},{"key":"2025083110371768000_1.1.e000103.16","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2022.101410","article-title":"Economic evaluation of seasonal influenza vaccination in elderly and health workers: a systematic review and meta-analysis","volume":"47","author":"Dilokthornsakul","year":"2022","journal-title":"EClinicalMedicine"},{"key":"2025083110371768000_1.1.e000103.17","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1016\/j.jval.2022.03.011","article-title":"Systematic review on the cost-effectiveness of seasonal influenza vaccines in older adults","volume":"25","author":"Loong","year":"2022","journal-title":"Value Health"},{"key":"2025083110371768000_1.1.e000103.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-052473","article-title":"Cohort profile: Indian network of population-based surveillance platforms for influenza and other respiratory viruses among the elderly (INSPIRE)","volume":"11","author":"Krishnan","year":"2021","journal-title":"BMJ Open"},{"key":"2025083110371768000_1.1.e000103.19","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2009.121434"},{"key":"2025083110371768000_1.1.e000103.20","unstructured":"World Health Organization . WHO manual for estimating the economic burden of seasonal influenza. Geneva: WHO, 2016."},{"key":"2025083110371768000_1.1.e000103.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12962-018-0095-x","article-title":"Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery","volume":"16","author":"Stenberg","year":"2018","journal-title":"Cost Eff Resour Alloc"},{"key":"2025083110371768000_1.1.e000103.22","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2014.20.4.327"},{"key":"2025083110371768000_1.1.e000103.23","unstructured":"Department of Economic Affair Government of India . Economic survey 2021-2022 appendix. 2022."},{"key":"2025083110371768000_1.1.e000103.24","unstructured":"Reserve Bank of India . Exchange rate of Indian Rupee vu-A-vis US dollar, puund Sterling, Euro, Japenese Yen."},{"key":"2025083110371768000_1.1.e000103.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-022-03266-2","article-title":"Role of publicly funded health insurance in financial protection of the elderly from hospitalisation expenditure in India-findings from the longitudinal aging study","volume":"22","author":"Garg","year":"2022","journal-title":"BMC Geriatr"},{"key":"2025083110371768000_1.1.e000103.26","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-053953","article-title":"Prevalence, factors and inequalities in chronic disease multimorbidity among older adults in India: analysis of cross-sectional data from the nationally representative longitudinal aging study in India (LASI)","volume":"12","author":"Chauhan","year":"2022","journal-title":"BMJ Open"},{"key":"2025083110371768000_1.1.e000103.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12992-020-00619-7","article-title":"Equity and elderly health in India: reflections from 75th round national sample survey, 2017-18, amidst the COVID-19 pandemic","volume":"16","author":"Ranjan","year":"2020","journal-title":"Global Health"},{"key":"2025083110371768000_1.1.e000103.28","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-7-30","article-title":"I really should've gone to the doctor\": older adults and family caregivers describe their experiences with community-acquired pneumonia","volume":"7","author":"Kelly","year":"2006","journal-title":"BMC Fam Pract"},{"key":"2025083110371768000_1.1.e000103.29","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/j.vaccine.2016.03.013","article-title":"CAPECO: cost evaluation of community acquired pneumonia managed in primary care","volume":"34","author":"Personne","year":"2016","journal-title":"Vaccine"},{"key":"2025083110371768000_1.1.e000103.30","doi-asserted-by":"crossref","first-page":"764","DOI":"10.3904\/kjim.2014.29.6.764","article-title":"Disease burden of pneumonia in Korean adults aged over 50 years stratified by age and underlying diseases","volume":"29","author":"Lee","year":"2014","journal-title":"Korean J Intern Med"},{"key":"2025083110371768000_1.1.e000103.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-016-2015-z","article-title":"Hospitalization costs for community-acquired pneumonia in Dutch elderly: an observational study","volume":"16","author":"Vissink","year":"2016","journal-title":"BMC Infect Dis"},{"key":"2025083110371768000_1.1.e000103.32","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1080\/21645515.2017.1300730","article-title":"Burden of community-acquired pneumonia in adults over 18 Y of age","volume":"13","author":"Kosar","year":"2017","journal-title":"Hum Vaccin Immunother"},{"key":"2025083110371768000_1.1.e000103.33","article-title":"Community acquired pneumonia: a cost-of-illness analysis in Greece","volume":"20","author":"Naoum","year":"2020","journal-title":"Rural Remote Health"},{"key":"2025083110371768000_1.1.e000103.34","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2334-14-335","article-title":"Microbial aetiology, outcomes, and costs of hospitalisation for community-acquired pneumonia; an observational analysis","volume":"14","author":"Spoorenberg","year":"2014","journal-title":"BMC Infect Dis"},{"key":"2025083110371768000_1.1.e000103.35","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/irv.12254","article-title":"Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010","volume":"8","author":"Bhuiyan","year":"2014","journal-title":"Influenza Other Respir Viruses"},{"key":"2025083110371768000_1.1.e000103.36","doi-asserted-by":"publisher","DOI":"10.3810\/pgm.2010.03.2130"},{"key":"2025083110371768000_1.1.e000103.37","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0071375","article-title":"Clinical and economic burden of community-acquired pneumonia among adults in the Czech Republic, Hungary, Poland and Slovakia","volume":"8","author":"Tichopad","year":"2013","journal-title":"PLoS One"},{"key":"2025083110371768000_1.1.e000103.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2011.02.017"},{"key":"2025083110371768000_1.1.e000103.39","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e3180421c16"},{"key":"2025083110371768000_1.1.e000103.40","unstructured":"National Health Systems Resource Centre . National health accounts estimates for India (2019-20). New Delhi, 2023."},{"key":"2025083110371768000_1.1.e000103.41","doi-asserted-by":"crossref","DOI":"10.12688\/f1000research.75808.1","article-title":"A study of catastrophic health expenditures in India - evidence from nationally representative survey data: 2014-2018","volume":"11","author":"Sriram","year":"2022","journal-title":"F1000Res"},{"key":"2025083110371768000_1.1.e000103.42","doi-asserted-by":"crossref","DOI":"10.1016\/j.jvacx.2021.100095","article-title":"The economic burden of pneumonia in children under five in Uganda","volume":"8","author":"Ekirapa-Kiracho","year":"2021","journal-title":"Vaccine X"},{"key":"2025083110371768000_1.1.e000103.43","doi-asserted-by":"publisher","DOI":"10.1177\/0164027510395398"},{"key":"2025083110371768000_1.1.e000103.44","unstructured":"Ministry of Labour & Employment GoI . Rates of wages. 2020."}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2023-000103","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:37:28Z","timestamp":1756661848000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2023-000103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,10,18]]},"published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1136\/bmjph-2023-000103"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2023-000103","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10]]}}}