Measuring the burden of accidental injuries in India: a cross-sectional analysis of the National Sample Survey (2017–18)

Globally, injuries are the leading cause of premature deaths and disability and account for nearly 9 per cent of total deaths worldwide. Like other countries, India also faces a very high burden of injuries, with the second most common cause of death and disability. Annually, 0.15 million people lose their lives due to accidental injuries/road traffic accidents in India, which is 11 per cent of the accident-related death worldwide. This study aims to analyse the socio-economic and demographic differentials in the magnitude of economic burden and coping strategies associated with accidental injuries in India. The study used the nationally representative cross-sectional data on the ‘Key Indicators of Social Consumption in India: Health, (2017–18)’ of the National Sample Survey Organisation (NSSO). Simple descriptive statistics have been used to measure the incidence and intensity of accidental injuries. The economic burden is estimated through out-of-pocket (OOP) health expenditure on accidental injuries and the use of different sources of finance to cope with the same. In addition, the logistic regression analysis has been used to analyse the association between socio-economic covariates and the likelihood of suffering from accidental injuries in India. The findings reveal that, unlike outpatient care, the high incidence in inpatient care reveals that hospitalisation is inevitable in most cases after accidental injuries. Among various socio-economic variables, the incidence of accidental cases is higher among individuals residing in urban areas, males, educated persons, and economically better-off sections of society. Also, the mean monthly OOP expenditure on the accidental injuries-affected population has been estimated at INR 2672 .46 (US$ 41.06) and INR 3041.64 (US$ 47.09) in inpatient and outpatient care, respectively. Almost the same sections and the individuals who received insurance spend more OOP expenditure on accidental injuries. However, OOP expenditure as a share of total consumption expenditure (TCE) is significantly high among their counterparts, such as rural inhabitants, illiterates, scheduled castes, the very poor and those who do not have any kind of health insurance coverage. In addition to savings/income, individuals depend more on the distress sources such as borrowings and selling of household assets to meet their OOP health expenditure in India. In conclusion, the high incidence of accidental injuries threatens people more than some of the other ailments in India. A strict motor vehicle act, administrative and political determination, awareness campaigns through various media platforms, diverse road lane systems and traffic norms can help reduce accidental fatalities in the country. Reducing the economic burden of accidental injuries requires increasing public spending on healthcare services as a percentage share of the country’s GDP. Furthermore, comprehensive universal health insurance coverage for all, including each component of healthcare expenditure, is the need of the hour.