Objective  To examine diabetes-related household catastrophic healthcare expenditure (CHE) and its income-related inequality in Shaanxi province.

  Methods  The data of the study was extracted from the Fifth National Health Service Survey conducted in 2013, which collected relevant information of 20 700 households in urban and rural Shaanxi province. The CHE was measured with the method defined by World Health Organization (WHO). Probit model, concentration index (CI), and decomposition of concentration index were adopted to analyze the inequality in CHE among the households surveyed.

  Results  During 2013, the occurrence rate of CHE was 16.10% and 21.98% among the urban and rural households with one or more family members suffering from diabetes; while, the occurrence rate was 9.73% and 12.47% among the urban and rural households with no family member suffering from non-communicable disease. Both the relative and absolute gap between the capability to pay healthcare expenditure and the CHE were higher among the households with one or more diabetes sufferers than the households with no non-communicable disease sufferers. The CI of CHE was – 0.287 and – 0.381 for the urban and rural households with one or more diabetes sufferers; whereas the CI of CHE was – 0.535 and – 0.482 for the urban and rural households with no non-communicable disease sufferers, indicating a pro-poor inequality in CHE. The majority of the inequality in CHE could be explained by economic status, whether having an elderly member in a family, and the accessibility of healthcare service.

  Conclusion  The diabetes sufferers in Shaanxi province are at a high risk of household catastrophic healthcare expenditure and have a pro-poor inequality in CHE.