Disparity of secondary prevention among patients with rheumatic heart disease: A longitudinal study in Uganda

BackgroundRheumatic heart disease (RHD) is most prevalent in socially disadvantaged settings, placing a severe burden on patients and their households. The study aims to investigate the disparity of healthcare costs, including financial and time costs, among RHD patients in Uganda. MethodsWe enrolled 54 RHD households from the Uganda National RHD Registry between June 2019 and February 2021. The patients were interviewed in baseline and 12-month follow-up surveys. A random-effect model was applied to examine the disparity of RHD financial and time costs. Our primary outcomes are the total outpatient costs for RHD patients most recent visit, consisting of direct medical costs, direct non-medical costs, and time costs. ResultsFollowing the COVID-19 pandemic, the total financial cost of outpatient visits for RHD patients increased by 9 USD on average (P<0.01), with the change primarily driven by non-medical costs such as transportation and food (5.8 USD, P<0.05). Direct medical costs also increased significantly in the pandemic, with an average increase of 3.2 USD (P<0.1). Compared with their counterparts, non-medical costs were higher for patients with poor infrastructure, with less education, who were older, and who were male. Patients with employment experienced a higher time cost than those without (3.3 hours, P<0.01). ConclusionsThe COVID-19 pandemic significantly increased RHD outpatient costs, mainly caused by the increase in non-medical costs. Our study implies that improving infrastructure, investing in education, and providing employees with time to seek care have the potential to reduce non-medical barriers to RHD secondary prevention.