Characterization of knee osteoarthritis in Latin America. A comparative analysis of clinical and health care utilization in Argentina, Brazil, and Mexico / Características de la artrosis de la rodilla en América Latina. Análisis comparativo de la utilización de servicio clínicos y cuidados de la salud en Argentina, Brasil y México

Background: The burden of knee osteoarthritis (OA) in Latin America is unknown. Objective: To determine the demographic, clinical, and therapeutic characteristics of patients with OA in Argentina, Brazil, and Mexico. Material and methods: This is an observational, cross-sectional study of patients with symptomatic knee OA referred from first care medical centers to Rheumatology departments. Results: We included 1210 patients (Argentina 398, Brazil 402, Mexico 410; mean age 61.8 [12] years; 80.8% females). Knee OA pain lasted for 69 months; the duration and severity of the last episode were 190 days and (SD 5.2 [3.3]; 74% had functional limitations, but very few patients lost their job because of knee OA. Around 71% had taken medications, but 63% relied on their own pocket to afford knee OA cost. Most demographic and clinical variables differed across countries, particularly the level of pain, disability, treatment, and access to care. The variable country of origin influenced the level of pain, disability, and NSAIDs use in logistic regression models; age, pain, treatment, and health care access influenced at least 2 of the models. Conclusions: The burden of knee OA in Latin American depends on demographic, clinical, and therapeutic variables. The role of such variables differs across countries. The level of certain variables is significantly influenced by country of origin and health care system

Antecedentes: La carga de la artrosis de rodilla (OA) en América Latina se desconoce. Objetivo: Determinar las características demográficas, clínicas y terapéuticas de los pacientes con OA en Argentina, Brasil y México. Material y métodos: Se trata de un estudio observacional, transversal, de pacientes con OA sintomática que son derivados de centros de atención primeria a los departamentos de reumatología. Resultados: Se incluyeron 1.210 pacientes (Argentina 398, Brasil 402, México 410), con una media de edad de 61,8 (12) años; el 80,8% eran mujeres. El dolor de la OA de rodilla se prolongó durante 69 meses, la duración y la gravedad del último episodio fueron 190 días, y (DS 5,2 [3,3]; el 74% tenían limitaciones funcionales, pero muy pocos pacientes perdieron su empleo a causa de la OA de rodilla. El 71% había tomado medicamentos, pero el 63% lo pagó de su propio bolsillo. La mayoría de las variables demográficas y clínicas difieren entre los países, en particular el nivel de dolor, la discapacidad, el tratamiento y el acceso a la atención. La variable de país de origen influyó en el nivel de dolor, discapacidad y AINE a utilizar en los modelos de regresión logística; la edad, el dolor, el tratamiento y el acceso a la atención de salud influyó por lo menos a 2 de los modelos. Conclusiones: La carga de la OA de rodilla en América Latina depende de las variables demográficas, clínicas y terapéuticas. El papel de estas variables difiere entre países. El nivel de ciertas variables se ve influido significativamente por el país de origen y el sistema de atención de la salud (AU)

Heterogeneity in the costs of type 1 diabetes in a developing country: what are the determining factors?

BACKGROUND AND AIMS: Regional differences in the clinical care of Type 1 diabetes (T1D) in Brazil have been recently described. This study aimed to estimate the costs of T1D from the public health care system's perspective across the regions of Brazil and to determine the components that influence these costs. METHODS: This was a retrospective, cross-sectional and nationwide multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The study included 3,180 T1D subjects receiving healthcare from the National Brazilian Healthcare System (NBHCS) with a follow-up of at least one year. The direct medical costs were derived from the costs of medications, supplies, examinations, visits to the center, medical procedures and hospitalizations that occurred during the previous year. Clinical and demographic factors that determined the differences in the cost across four geographic regions (southeast, south, north/northeast and mid-west) were investigated. RESULTS: The per capita mean annual direct medical costs of T1D in US$ were 1,466.36, 1,252.83, 1,148.09 and 1,396.30 in southeast, south, north/northeast and mid-west regions, respectively. The costs of T1D in the southeast region were higher compared to south (p < 0.001) and north/northeast regions (p = < 0.001), but not to the mid-west (p = 0.146) region. The frequency of self-monitoring of blood glucose (SMBG) was different across the regions as well as the daily number of SMBG, use of insulin pumps or basal or prandial insulin analogs. Age, ethnicity, duration of diabetes, level of care, socioeconomic status and the prevalence of chronic diabetic complications differed among the regions. In a regression model the determinants of the costs were the presence of microvascular diabetes-related complications (p < 0.001), higher economic status (p < 0.001), and being from the southeast region (p < 0.001). CONCLUSIONS: The present data reinforce the regional differences in the costs of T1D and in the socioeconomic profile and health care provided to the patients with T1D in specialized public centers in Brazil. Both factors influenced directly the costs of T1D and should be considered for discussing future health policies.