The Impact of Cancer Incidence on Catastrophic Health Expenditure in Iran with a Bayesian Spatio-Temporal Analysis

BACKGROUND: We investigated the impact of cancer incidence on CHE in Iran by considering spatial variation across provinces as well as temporal trends. METHODS: Data from Household Income-Expenditure Survey were merged with cancer incidence rates during 2011–2016. We developed a Bayesian hierarchical model to explore the spatial and temporal patterns of CHE and its associated factors at provincial level. We used a Besag-York-Mollie2 prior and a random walk prior for spatial and temporal random effects respectively. All statistical analysis was carried out in R software. RESULTS: All-type cancer incidence (OR per SD (95% CrI) = 1.16 (1.02, 1.32)), unemployment rate (1.08 (1.01, 1.15)) and income equity (0.88 (0.81, 0.97)) have important association with CHE. Percentage of urbanization and percentage of poverty were not statistically significant. CONCLUSION: The results suggest the development of new policies to protect cancer patients against financial hardship, narrow the gap in income inequality and solve the problem of high unemployment rate to reduce the level of CHE at provincial level.