Disability and household healthcare expenditure in Togo: evidence from a nationally representative survey

Disability may be associated with higher healthcare needs and increased household healthcare expenditure, potentially creating additional financial pressure for households in settings where access to affordable healthcare and financial protection remains limited. This study examines the association between disability severity and household healthcare expenditure in Togo. This study uses data from the 2021 EHCVM in Togo. From the original 6,171 households, 1,211 with complete information on disability, healthcare expenditure, and relevant covariates were retained for analysis. Disability severity was measured using functional limitation indicators. Given the highly skewed distribution of healthcare expenditure and the very low proportion of zero expenditures, a Gamma GLM with log link was used as the main model. A Two-Part Model was used for robustness, and simultaneous quantile regression examined heterogeneity across the distribution of positive expenditures. Models adjusted for demographic, socioeconomic, household, insurance, hospitalization, residential, and regional characteristics. The Gamma GLM shows a positive and statistically significant association between disability severity and household healthcare expenditure (β = 0.108; p = 0.025). On the log scale, this coefficient corresponds to approximately 11.4% higher expected healthcare expenditure for a one-unit increase in the disability severity index, holding other covariates constant. The Two-Part Model provides further evidence of a positive association between disability severity and healthcare expenditure. Quantile regression results indicate statistically significant positive associations at the 25th and 50th percentiles of the positive expenditure distribution, whereas the association is not statistically significant at the 75th percentile. Disability severity is positively associated with household healthcare expenditure in Togo. These findings suggest that households experiencing greater functional limitations may face additional healthcare-related financial pressures. Strengthening financial protection mechanisms and improving the accessibility and inclusiveness of healthcare services may therefore be relevant for reducing financial vulnerability among households affected by disability. However, given the cross-sectional nature of the data, the reported associations should not be interpreted as causal effects.