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1.
Clín. investig. arterioscler. (Ed. impr.) ; 32(1): 15-26, ene.-feb. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187003

RESUMO

Introducción: Los objetivos del estudio fueron determinar las tasas de prevalencia brutas y ajustadas por edad y sexo de diabetes mellitus (DM), DM tipo 1 (DM1) y DM tipo 2 (DM2), y comparar la asociación de factores de riesgo cardiovascular, enfermedades cardiovasculares, enfermedad renal crónica y enfermedades metabólicas entre las poblaciones con y sin DM. Métodos: SIMETAP-DM es un estudio observacional transversal realizado en atención primaria, con una muestra aleatoria de base poblacional de 10.579 adultos. Tasa de respuesta: 66%. Los diagnósticos de DM, DM1 y DM2 se basaron en criterios clínicos y bioquímicos y/o en la comprobación de estos diagnósticos en las historias clínicas. Se determinaron las prevalencias brutas y ajustadas por edad y sexo (estandarizadas con la población española). Resultados: Las prevalencias brutas de DM1, DM2 y DM fueron del 0,87% (intervalo de confianza al 95% [IC 95%]: 0,67-1,13), el 14,7% (IC 95%: 13,9-15,6) y el 15,6% (IC 95%: 14,7-16,5), respectivamente. Las prevalencias ajustadas por edad y sexo de DM1, DM2 y DM fueron del 1,0% (1,3% para hombres y 0,7% para mujeres), el 11,5% (13,6% para hombres y 9,7% para mujeres) y el 12,5% (14,9% para hombres y 10,5% para mujeres), respectivamente. La prevalencia de DM en la población ≥ 70 años era el doble (30,3% [IC 95%: 28,0-32,7]) que en la población entre 40 y 69 años (15,3% [IC 95%: 14,1-16,5%]). La hipertensión arterial, la enfermedad arterial periférica, el índice cintura-talla aumentado, la albuminuria, la enfermedad coronaria, la dislipidemia aterogénica y la hipercolesterolemia se asociaban con la DM. Conclusiones: En el ámbito de la atención primaria española, las prevalencias ajustadas por edad de DM1, DM2 y DM en la población adulta fueron del 1,0, el 11,5 y el 12,5%, respectivamente. Un tercio de la población mayor de 70 años padecía DM


Introduction: The aims of this study were to determine the age- and sex-adjusted prevalence rates of DM, type-1 DM (T1DM), and type-2 DM (T2DM), and to compare the relationship with cardiovascular risk factors, cardiovascular diseases, chronic kidney disease, and metabolic diseases between populations with and without DM. Methods: SIMETAP-DM is a cross-sectional observational study conducted in a Primary Care setting with a random population-based sample of 10,579 adults. Response rate: 66%. The diagnoses of DM, T1DM and T2DM were based on clinical and biochemical criteria and/or the checking of these diagnoses in the medical records. The crude and age- and sex-adjusted (standardised for Spanish population) prevalence rates were calculated. Results: The crude prevalence rates of T1DM, T2DM, and DM were 0.87% (95% confidence interval [95% CI]: 0.67-1.13), 14.7% (95% CI: 13.9-15.6), and 15.6% (95% CI: 14.7-16.5), respectively. The age- and sex-adjusted prevalence rates of T1DM, T2DM, and DM were 1.0% (1.3% for men and 0.7% for women), 11.5% (13.6% for men and 9.7% for women), and 12.5% (14.9% for men and 10.5% for women), respectively. The prevalence of DM in the population ≥ 70 years was double (30.3% [95% CI: 28.0-32.7]) that of the population between 40 and 69 years (15.3% [95% CI: 14.1-16.5]). Hypertension, peripheral arterial disease, increased waist-to-height ratio, albuminuria, coronary heart disease, atherogenic dyslipidaemia and hypercholesterolaemia were associated with DM. Conclusions: In a Spanish primary care setting, the age-adjusted prevalences of T1DM, T2DM and DM in the adult population were 1.0, 11.5, and 12.5%, respectively. One-third (33%) of the population over 70 years had DM


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/epidemiologia , Atenção Primária à Saúde , Fatores de Risco , Doenças Cardiovasculares/complicações , Espanha/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Metabólicas/epidemiologia , Nefropatias/epidemiologia , Estudos Transversais , Hipertensão/complicações , Diabetes Mellitus/economia , Diabetes Mellitus/classificação , Razão de Chances , Análise Multivariada
2.
PLoS One ; 15(1): e0227806, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31935256

RESUMO

Since 2010, Indonesian government has initiated a chronic disease management program, Prolanis (Program Pengendalian Penyakit Kronis) targeted for diabetes and hypertension. The program is continued at the commencement of universal health coverage (UHC) in 2014. "This study aimed to report the utilization and cost of the implementation of Prolanis in Indonesia from 2014 to 2016, or two years since the commencement of Indonesian universal health coverage." Secondary data analysis was performed using publicly available data and data obtained from the national health insurance agency (BPJS); while data on disease prevalence were collected from basic national health survey. There was an increase trend of Prolanis participants, from around 11,000 participants in 2014 to more than 250,000 in 2016. More than 70% of participants were adults living in Java, however, the acceptance rate was very low in other area. Across different activities in Prolanis, physical activity was the most participated ones. In comparison to other regions, regions in Java were the most active area. The total expenditure for Prolanis program in 2016 increased almost triple from the annual cost in 2014. However, the cost per person was actually decreased more than 50%. Within two years of UHC implementation, there were increase covered participants and total costs, but cost per individual was decreased and there was significant difference in of cost between Java and outside Java. Further study and routine monitoring-evaluation process by health authority is needed to assess whether the cost difference would affect the service quality.


Assuntos
Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Programas de Assistência Gerenciada , Adulto , Estudos Transversais/economia , Diabetes Mellitus/economia , Custos de Cuidados de Saúde , Humanos , Hipertensão/economia , Indonésia/epidemiologia , Programas de Assistência Gerenciada/economia , Prevalência , Cobertura Universal do Seguro de Saúde/economia
3.
BMC Public Health ; 20(1): 24, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914972

RESUMO

BACKGROUND: Increasing medicines availability and affordability is a key goal of Brazilian health policies. "Farmácia Popular" (FP) Program is one of the government's key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability. METHODS: Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012). RESULTS: FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$ = reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget. CONCLUSIONS: FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Hipertensão/economia , Hipertensão/terapia , Adulto , Idoso , Brasil , Custo Compartilhado de Seguro/estatística & dados numéricos , Feminino , Programas Governamentais , Humanos , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
4.
J Assoc Physicians India ; 67(10): 44-47, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571452

RESUMO

Introduction: Diabetes is one of the expensive diseases due to its chronic nature and gradual involvement of multiple organs, Moreover loss of economic productivity further enhances the cost of care. Several factors were reported to have impact on overall economic burden in diabetic patients. So, the present study aims to determine influence of various socio-demographic and clinical factors on expenditure of diabetes care among patients residing in resettlement colony of East Delhi. Methodology: A community based one year longitudinal study was conducted in Kalyanpuri area of East Delhi. All the diabetes patients aged 25 years and who were the permanent residents of Kalyanpuri, attending the Diabetic Clinic of a government hospital in November-December 2014 were selected for the study. A pre-tested semi-structured interview schedule was used as study tool. Each subject was followed up 3 monthly from January to December 2015. Results: Data of 150 study subjects was analyzed. Out of 150 subjects 45(30 %) were male and 105 (70%) female. Overall mean age of study subjects was 53 ± 10 years Among socio-demographic factors, Expenditure on diabetes care showed significant association with male gender and among clinical factors, longer duration since diagnosis, use of Insulin with Oral Hypoglycemic drugs, hospitalization and utilization of private care has shown positive association with expenditure on diabetes care. Conclusion: The present study concludes that there is need of better provisioning of services for diabetes care in government health facilities to cater needs of growing diabetic population..


Assuntos
Diabetes Mellitus/terapia , Gastos em Saúde , Adulto , Diabetes Mellitus/economia , Feminino , Humanos , Índia , Insulina , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
5.
Diabetes Metab Syndr ; 13(4): 2469-2472, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405662

RESUMO

The Indian diabetic population is predicted to reach more than 80 million by the year 2030. It indicates that immediate health policy restructuring and investment will be needed if the best use is to be made of scarce health care resources with accompanying economic constraints. The costs of treatment of diabetes exists among the patients of all socioeconomic groups.A recent study showed that, in India, the total annual expenditure by patients on diabetes care was, on average, Rs. 10,000 in urban areas and Rs. 6260 in rural areas. The studies related to diabetes indicate that the direct and indirect cost implications of diabetes are multifold worldwide. The direct costs are related to the medical and non-medical cost of people with diabetes, mostly the burden on individual and at the family level. The indirect costs are related to the society and government, which are associated to loss of productivity. The review also finds that the annual direct and indirect medical costs per patient increase with the number of microvascular and macrovascular complications. A study in India during the years 2008 and 2009 found that total costs for patients without complications were Rs. 4493 compared to Rs. 14,692for patients with complications.The review reveals that it is imperative to work effectively towards implementing a holistic programme for diabetes prevention and reduce diabetic expenditure burden in the community.


Assuntos
Efeitos Psicossociais da Doença , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Incidência , Índia/epidemiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-31261638

RESUMO

Diabetes mellitus is considered a public health issue worldwide, with a high prevalence. It is a direct cause of death, disability, and high health costs. In addition, it generates a series of complications of variable types and degrees that have frequent negative effects on the quality of life of the people who suffer from it. Efficiency in public health implies a reduction in costs and improvements in citizens' quality of life. With the twofold aim of rationalizing costs and promoting an improvement in the care of people with diabetes, we propose a project: a Diabetes Day Hospital (DDH) in Extremadura (Spain). This involves a new organizational model which has already been implemented in other European regions, generating satisfactory results. This study includes details on the structure and operation of the DDH, as well as the expected costs. The DDH allows for a proper coordination among the parties involved in the monitoring and treatment of the disease, and reduces the costs derived from unnecessary admissions and chronic complications. Results show that efficiency in the regional health system could be improved and a significant amount of money could be saved.


Assuntos
Diabetes Mellitus/terapia , Hospitais Especializados/organização & administração , Controle de Custos , Diabetes Mellitus/economia , Custos de Cuidados de Saúde , Hospitais Especializados/economia , Humanos , Qualidade de Vida , Espanha
7.
PLoS One ; 14(6): e0217771, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31166971

RESUMO

OBJECTIVE: The study aimed to identify the common gaps in skills and self-efficacy for diabetes self-management and explore other factors which serve as enablers of, and barriers to, achieving optimal diabetes self-management. The information gathered could provide health professionals with valuable insights to achieving better health outcomes with self-management education and support for diabetes patients. METHODS: International online survey and telephone interviews were conducted on adults who have type 1 or type 2 diabetes. The survey inquired about their skills and self-efficacy in diabetes self-management, while the interviews assessed other enablers of, and barriers to, diabetes self-management. Surveys were analysed using descriptive and inferential statistics. Interviews were analysed using inductive thematic analysis. RESULTS: Survey participants (N = 217) had type 1 diabetes (38.2%) or type 2 diabetes (61.8%), with a mean age of 44.56 SD 11.51 and were from 4 continents (Europe, Australia, Asia, America). Identified gaps in diabetes self-management skills included the ability to: recognize and manage the impact of stress on diabetes, exercise planning to avoid hypoglycemia and interpreting blood glucose pattern levels. Self-efficacy for healthy coping with stress and adjusting medications or food intake to reach ideal blood glucose levels were minimal. Sixteen participants were interviewed. Common enablers of diabetes self-management included: (i) the will to prevent the development of diabetes complications and (ii) the use of technological devices. Issues regarding: (i) frustration due to dynamic and chronic nature of diabetes (ii) financial constraints (iii) unrealistic expectations and (iv) work and environment-related factors limited patients' effective self-management of diabetes. CONCLUSIONS: Educational reinforcement using technological devices such as mobile application has been highlighted as an enabler of diabetes self-management and it could be employed as an intervention to alleviate identified gaps in diabetes self-management. Furthermore, improved approaches that address financial burden, work and environment-related factors as well as diabetes distress are essential for enhancing diabetes self-management.


Assuntos
Diabetes Mellitus/terapia , Autogestão , Adolescente , Adulto , Idoso , Análise de Variância , Efeitos Psicossociais da Doença , Diabetes Mellitus/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autoeficácia , Adulto Jovem
8.
PLoS One ; 14(6): e0217696, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216301

RESUMO

BACKGROUND: Approximately 28% of adults have ≥3 chronic conditions (CCs), accounting for two-thirds of U.S. healthcare costs, and often having suboptimal outcomes. Despite Institute of Medicine recommendations in 2001 to integrate guidelines for multiple CCs, progress is minimal. The vast number of unique combinations of CCs may limit progress. METHODS AND FINDINGS: To determine whether major CCs segregate differentially in limited groups, electronic health record and Medicare paid claims data were examined in one accountable care organization with 44,645 Medicare beneficiaries continuously enrolled throughout 2015. CCs predicting clinical outcomes were obtained from diagnostic codes. Agglomerative hierarchical clustering defined 13 groups having similar within group patterns of CCs and named for the most common CC. Two groups, congestive heart failure (CHF) and kidney disease (CKD), included 23% of beneficiaries with a very high CC burden (10.5 and 8.1 CCs/beneficiary, respectively). Five groups with 54% of beneficiaries had a high CC burden ranging from 7.1 to 5.9 (descending order: neurological, diabetes, cancer, cardiovascular, chronic pulmonary). Six groups with 23% of beneficiaries had an intermediate-low CC burden ranging from 4.7 to 0.4 (behavioral health, obesity, osteoarthritis, hypertension, hyperlipidemia, 'other'). Hypertension and hyperlipidemia were common across groups, whereas 80% of CHF segregated to the CHF group, 85% of CKD to CKD and CHF groups, 82% of cancer to Cancer, CHF, and CKD groups, and 85% of neurological disorders to Neuro, CHF, and CKD groups. Behavioral health diagnoses were common only in groups with a high CC burden. The number of CCs/beneficiary explained 36% of the variance (R2 = 0.36) in claims paid/beneficiary. CONCLUSIONS: Identifying a limited number of groups with high burdens of CCs that disproportionately drive costs may help inform a practical number of integrated guidelines and resources required for comprehensive management. Cluster informed guideline integration may improve care quality and outcomes, while reducing costs.


Assuntos
Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/epidemiologia , Nefropatias/epidemiologia , Medicare/economia , Múltiplas Afecções Crônicas/epidemiologia , Organizações de Assistência Responsáveis/economia , Idoso , Diabetes Mellitus/economia , Feminino , Custos de Cuidados de Saúde , Insuficiência Cardíaca/economia , Humanos , Nefropatias/economia , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/economia , Estados Unidos
9.
Diabetes Metab Syndr ; 13(3): 2025-2031, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235131

RESUMO

The objective of this study was to assess the affordability effect of diabetic medicine on patient's treatment adherence among patients aged 18 and above who sought treatment at IH diabetic clinic. The source of data was primary which was collected by the researcher from IH. The independent variable was considered as affordability of the diabetic medicine and adherence was the dependent variable in this study. Findings showed that Sex, marital status, education level, estimated monthly income were significantly associated with treatment adherence at the bivariate level. The objectives of the study were looking at the affordability effect of diabetic medicine and awareness among the patients. It was found out that there is a statistically significant relationship between the two variables. Basing on the findings of the study, it is recommended that more sensitization should be put in place to help patients be informed about their health, to be educated and also made aware of how to take good care of themselves especially on the side of females as well as be trained on how to have a strong financial base as this can help improve on affordability of medicine.


Assuntos
Custos e Análise de Custo/economia , Diabetes Mellitus/economia , Diabetes Mellitus/prevenção & controle , Gastos em Saúde , Cooperação do Paciente/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores Socioeconômicos , Uganda/epidemiologia , Adulto Jovem
10.
Int J Equity Health ; 18(1): 73, 2019 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118033

RESUMO

BACKGROUND: Direct out of pocket (OOP) payments for healthcare may cause financial hardship. For diabetic patients who require frequent visits to health centres, this is of concern as OOP payments may limit access to healthcare. This study assesses the incidence, socio-economic inequalities and determinants of catastrophic health expenditure and impoverishment amongst diabetic patients in South Africa. METHODS: Data were taken from a cross-sectional survey conducted in 2017 at two public hospitals in Tshwane, South Africa (N = 396). Healthcare costs and transport costs related to diabetes care were classified as catastrophic if they exceeded the 10% threshold of household's capacity to pay (WHO standard method) or if they exceeded a variable threshold of total household expenditure (Ataguba method). Erreygers concentration indices (CIs) were used to assess socio-economic inequalities. A multivariate logistic regression was applied to identify the determinants of catastrophic health expenditure and impoverishment. RESULTS: Transport costs contributed to over 50% of total healthcare costs. The incidence of catastrophic health expenditure was 25% when measured at a 10% threshold of capacity to pay and 13% when measured at a variable threshold of total household expenditure. Depending on the method used, the incidence of impoverishment varied from 2 to 4% and the concentration index for catastrophic health expenditure varied from - 0.2299 to - 0.1026. When measured at a 10% threshold of capacity to pay factors associated with catastrophic health expenditure were being female (Odds Ratio 1.73; Standard Error 0.51), being within the 3rd (0.49; 0.20), 4th (0.31; 0.15) and 5th wealth quintile (0.30; 0.17). When measured using a variable threshold of total household expenditure factors associated with catastrophic health expenditure were not having children (3.35; 1.82) and the 4th wealth quintile (0.32; 0.21). CONCLUSION: Financial protection of diabetic patients in public hospitals is limited. This observation suggests that health financing interventions amongst diabetic patients should target the poor and poor women in particular. There is also a need for targeted interventions to improve access to healthcare facilities for diabetic patients and to reduce the financial impact of transport costs when seeking healthcare. This is particularly important for the achievement of universal health coverage in South Africa.


Assuntos
Doença Catastrófica/economia , Diabetes Mellitus/economia , Gastos em Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus/terapia , Feminino , Hospitais Públicos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , África do Sul
11.
BMC Health Serv Res ; 19(1): 313, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096989

RESUMO

BACKGROUND: Most studies that examine comorbidity and its impact on health service utilization focus on a single index-condition and are published in disease-specific journals, which limit opportunities to identify patterns across conditions/disciplines. These comparisons are further complicated by the impact of using different study designs, multimorbidity definitions and data sources. The aim of this paper is to share insights on multimorbidity and associated health services use and costs by reflecting on the common patterns across 3 parallel studies in distinct disease cohorts (diabetes, dementia, and stroke) that used the same study design and were conducted in the same health jurisdiction over the same time period. METHODS: We present findings that lend to broader Insights regarding multimorbidity based on the relationship between comorbidity and health service use and costs seen across three distinct disease cohorts. These cohorts were originally created using multiple linked administrative databases to identify community-dwelling residents of Ontario, Canada with one of diabetes, dementia, or stroke in 2008 and each was followed for health service use and associated costs. RESULTS: We identified 376,434 indviduals wtih diabetes, 95,399 wtih dementia, and 29,671 with stroke. Four broad insights were identified from considering the similarity in comorbidity, utilization and cost patterns across the three cohorts: 1) the most prevalent comorbidity types were hypertension and arthritis, which accounted for over 75% of comorbidity in each cohort; 2) overall utilization increased consistently with the number of comorbidities, with the vast majority of services attributed to comorbidity rather than the index conditions; 3) the biggest driver of costs for those with lower levels of comorbidity was community-based care, e.g., home care, GP visits, but at higher levels of comorbidity the driver was acute care services; 4) service-specific comorbidity and age patterns were consistent across the three cohorts. CONCLUSIONS: Despite the differences in population demographics and prevalence of the three index conditions, there are common patterns with respect to comorbidity, utilization, and costs. These common patterns may illustrate underlying needs of people with multimorbidity that are often obscured in literature that is still single disease-focused.


Assuntos
Demência/epidemiologia , Diabetes Mellitus/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Multimorbidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artrite/epidemiologia , Comorbidade , Demência/economia , Diabetes Mellitus/economia , Feminino , Serviços de Saúde/economia , Humanos , Hipertensão/epidemiologia , Masculino , Ontário/epidemiologia , Prevalência , Projetos de Pesquisa , Acidente Vascular Cerebral/economia
12.
Clin Podiatr Med Surg ; 36(3): 355-359, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079602

RESUMO

Diabetes mellitus is an international epidemic. In the United States, the prevalence of diabetes has increased from estimates in 1990 when 6.5% of the population was affected and 6.2 million people had diabetes compared with the estimates in 2017 with 24.7 million people with diabetes or accounting 9.6% of the adult population. The diabetic foot syndrome manifests as a combination of diabetes-related diseases including diabetic sensory neuropathy, limited joint mobility, immunopathy, peripheral arterial disease, foot ulceration, and Charcot arthropathy. The culmination of these provides an ideal environment for unrecognized tissue injury that leads to ulceration, infection, infection, and amputation.


Assuntos
Diabetes Mellitus/epidemiologia , Pé Diabético/prevenção & controle , Amputação/estatística & dados numéricos , Diabetes Mellitus/economia , Pé Diabético/complicações , Neuropatias Diabéticas/complicações , Humanos , Equipe de Assistência ao Paciente , Prevalência , Estados Unidos/epidemiologia
13.
PLoS One ; 14(4): e0215663, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30998763

RESUMO

BACKGROUND: While a few studies have tried to estimate the economic burden of noncommunicable diseases (NCDs) associated with air pollution, most previous studies have methodological limitations. For example, neither the cost of illness approach nor the value of a statistical life approach accounts for economic adjustment mechanisms (i.e., they do not include substitution of labor lost due to an illness with capital or other workers), and neither approach considers disease impact on physical and human capital. Furthermore, since new evidence shows that air pollution is also linked to diabetes, previous studies did not estimate the economic costs of diabetes associated with air pollution. The total economic costs of NCDs associated with air pollution under a comprehensive framework therefore remained unexplored. OBJECTIVES: This study uses a human capital-augmented production function framework to analyze and estimate the macroeconomic impact of NCDs associated with air pollution in China in 1990-2030 and in 2015-2030. It makes several contributions-beyond those of the extant literature-to understanding the economic burden of NCDs associated with air pollution. It does this by accounting for economic adjustment mechanisms and by incorporating human capital into the model. METHODS: In our framework, aggregate output is produced according to a human capital-augmented production function that accounts for the effects of projected disease prevalence. NCDs associated with air pollution affect the aggregate output through three pathways: 1) Mortality effect-when working-age individuals die from a disease, aggregate output decreases because physical capital is an imperfect substitute for the loss of human capital in the production process. 2) Morbidity effect-when working-age individuals suffer from a disease but do not die from it, their contribution to overall output also decreases depending on disease severity; for example, they might work fewer hours or with lower productivity, or they might retire earlier. We also incorporate age-specific human capital to account for education-related productivity differences between members of different cohorts who are differentially affected by NCDs. 3) Treatment cost effect-when households in which members suffer from a disease use part of their savings to cover the out-of-pocket share of their treatment costs, physical capital accumulation diminishes. Our estimates are based on the recently updated Global Burden of Disease epidemiology data, which identify four pathways through which air pollution affects health: cardiovascular diseases, respiratory diseases, cancer, and diabetes. RESULTS: Total losses from NCDs associated with air pollution in China in 1990-2030 are estimated to be $1,137 billion (constant 2010 USD) and in 2015-2030 are estimated to be $499 billion (constant 2010 USD). Cardiovascular diseases account for the highest burden, followed by chronic respiratory diseases, diabetes, and cancer. Treatment costs account for nearly 30% of the total economic burden of NCDs associated with air pollution. We also find that the share of economic burden associated with treatment costs is highest for diabetes. This is mainly driven by the fact that, on a per case basis, diabetes has a lower health burden than other diseases associated with air pollution. DISCUSSION: The NCDs associated with air pollution impose a large economic burden on China.


Assuntos
Poluição do Ar/efeitos adversos , Doenças Cardiovasculares , Efeitos Psicossociais da Doença , Diabetes Mellitus , Doenças não Transmissíveis , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Doenças não Transmissíveis/economia , Doenças não Transmissíveis/epidemiologia , Prevalência
14.
Rev. enferm. UFPE on line ; 13(4): 981-988, abr. 2019. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1017308

RESUMO

Objetivo: descrever os casos de morbidade hospitalar e os impactos financeiros por diabetes mellitus. Método: trata-se de estudo quantitativo, ecológico e descritivo, com dados do Departamento de Informática do Sistema Único de Saúde no estado da Bahia, Brasil, entre 2013 e 2017. Selecionou-se as variáveis: internações, óbitos, sexo, faixa etária, média de permanência, custos hospitalares e raça/cor. Tabulou-se e analisou-se os dados por meio de estatística descritiva simples no programa Excel. Resultados: registrou-se 52.267 internações e a maior prevalência ocorreu na macrorregião Leste (23,08%), no sexo feminino (55,82%), com idade ≥80 anos (14,02%) e pardas (50,74%). Prevaleceu-se as instituições com regime ignorado (47,38%) e registrou-se média de permanência de 5,8 dias. Notificou-se ainda, um impacto financeiro superior a 25,5 milhões de reais e a macrorregião Leste responsabilizou-se por 36,74%. Conclusão: constata-se a imprescindibilidade de ações de controle e prevenção da patologia, prioritariamente, na macrorregião Leste, por evidenciar maior prevalência de internações, e consequentemente, implicar no incremento dos gastos públicos hospitalares. Ressalta-se, ainda, que esse estudo pode orientar estratégias preventivas no intuito de evitar as internações e onerações por complicações diabéticas.(AU)


Objective: to describe the cases of hospital morbidity and the financial impacts of diabetes mellitus. Method: this is a quantitative, ecological and descriptive study, with data from the Department of Informatics of the Unified Health System in the state of Bahia, Brazil, between 2013 and 2017. The following variables were selected: hospitalizations, deaths, gender, age, average stay length, hospital costs and race/color. Data were tabulated and analyzed through simple descriptive statistics in Excel program. Results: there were 52,267 hospitalizations, with greater prevalence in the East Macroregion (23.08%), in women (55.82%), aged ≥80 years (14.02%) and pardo race (50.74%). Institutions with ignored administration prevailed (47.38%), and an average stay length of 5.8 days. Moreoverm there was a financial impact exceeding R$ 25.5 million, with the East Macroregion responsible for 36.74%. Conclusion: there is the absolute need for actions of control and prevention of the disease, primarily in the East Macroregion, which demonstrated higher prevalence of hospitalizations and, consequently, increased public spending in hospitals. This study can be used to guide preventive strategies in order to avoid hospitalizations and burdens from diabetic complications.(AU)


Objetivo: describir los casos de morbilidad hospitalaria y el impacto financiero debido a la diabetes mellitus. Método: se trata de un estudio cuantitativo, ecológico y descriptivo, con datos del Departamento de Informática del Sistema Único de Salud en el estado de Bahía, Brasil, entre 2013 y 2017. Fueron seleccionadas las siguientes variables: hospitalizaciones, muertes, sexo, edad, duración media de la estancia, gastos hospitalarios y raza/color. Los datos fueron tabulados y analizados por medio de estadística descriptiva simple en el programa Excel. Resultados: se registraron 52,267 hospitalizaciones y mayor prevalencia en la Macroregión Este (23,08%), en el sexo femenino (55.82%), con edad ≥ 80 años (14,02%) y pardas (50.74%). Si prevalecen las instituciones con esquema ignorado (47.38%) y se registró el promedio de estadía de 5,8 días. Se observó un impacto superior a los 25,5 millones de reales, con la Macroregión Este teniendo 36.74%. Conclusión: existe la necesidad absoluta de medidas de control y prevención de la enfermedad, sobre todo en la Macroregión Este, que demonstró una mayor prevalencia de hospitalizaciones y, por consiguiente, un aumento en el gasto público en los hospitales. Cabe destacar que este estudio puede ser utilizado para guiar las estrategias preventivas a fin de evitar hospitalizaciones y costos debido a las complicaciones de la diabetes.(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Sistema Único de Saúde , Gastos em Saúde , Complicações do Diabetes , Diabetes Mellitus , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Hospitalização , Epidemiologia Descritiva , Estudos Ecológicos , Sistemas de Informação em Saúde
15.
BMC Public Health ; 19(1): 269, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30841928

RESUMO

BACKGROUND: The prevalence of diabetes and diabetic complications increased alarmingly which also brought heavy burden to patients and health system. METHODS: We used mix approaches to summarize evidence from published articles and policy documents on the extent and trends of diabetic complications, potential causes, and awareness and services utilization of diabetes in China. RESULTS: The annual direct medical expense per patient varied among different types of complications and increased dramatically with the number of diabetic complication and patients were exposed to great financial risk. The number of health policies and strategies on diabetes and its complications at the national level is limited. Primary and secondary preventions such as health education and early diagnosis are necessary. CONCLUSIONS: With an increasingly burden of non-communicable diseases such as diabetes and its complications, efforts should be invested in education, early screening mechanism and patient management programs to improve the primary and secondary prevention of diabetes and its complications. An integrated services delivery system centered on primary level is recommended to promote education, early case-detection and screening, patient management, referral and care-coordination between primary, secondary and tertiary health care providers.


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Efeitos Psicossociais da Doença , Complicações do Diabetes/economia , Diabetes Mellitus/economia , Feminino , Programas Governamentais , Educação em Saúde , Política de Saúde , Serviços de Saúde/economia , Humanos , Assistência Médica , Pessoa de Meia-Idade , Prevalência , Encaminhamento e Consulta , Fatores de Risco , Fatores Sexuais
16.
PLoS Med ; 16(3): e1002751, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30822339

RESUMO

BACKGROUND: The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. METHODS AND FINDINGS: We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. CONCLUSIONS: The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.


Assuntos
Assistência à Saúde/economia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/economia , Inquéritos Epidemiológicos/economia , Pobreza/economia , Adolescente , Adulto , Estudos Transversais , Assistência à Saúde/tendências , Diabetes Mellitus/terapia , Feminino , Necessidades e Demandas de Serviços de Saúde/tendências , Inquéritos Epidemiológicos/tendências , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Pobreza/tendências , Adulto Jovem
17.
J Diabetes Investig ; 10(5): 1372-1381, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30758145

RESUMO

AIMS/INTRODUCTION: The present study aimed to evaluate the effects of income levels on physician visit patterns and to quantify the consequent impact of irregular physician visits on glycemic control among employees' health insurance beneficiaries in Japan. MATERIALS AND METHODS: We obtained specific health checkup data of untreated diabetes patients from the Fukuoka branch of the Japanese Health Insurance Association. We selected 2,981 insurance beneficiaries and classified 650 and 2,331 patients into, respectively, the regular visit and irregular visit group. We implemented propensity score matching to select an adequate control group. RESULTS: Compared with those with a standard monthly income <$2,000 (US$1 = ¥100), those with a higher monthly income were less likely to have irregular visits; $2,000-2,999: odds ratio 0.74 (95% confidence interval 0.56-0.98), $3,000-3,999: odds ratio 0.63 (95% confidence interval 0.46-0.87) and ≥$5,000: odds ratio 0.58 (95% confidence interval 0.39-0.86). After propensity score matching and adjusting for covariates, the irregular visit group tended to have poor glycemic control; increased glycated hemoglobin ≥0.5: odds ratio 1.90 (95% confidence interval 1.30-2.77), ≥1.0: odds ratio 2.75 (95% confidence interval 1.56-4.82) and ≥20% relatively: odds ratio 3.18 (95% confidence interval 1.46-6.92). CONCLUSIONS: We clarified that there was a significant relationship between income and irregular visits, and this consequently resulted in poor glycemic control. These findings would be useful for more effective disease management.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus/economia , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Renda/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Consultórios Médicos/estatística & dados numéricos , Adulto , Idoso , Biomarcadores/análise , Estudos de Coortes , Diabetes Mellitus/sangue , Diabetes Mellitus/tratamento farmacológico , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/economia , Hipoglicemia/economia , Hipoglicemiantes/uso terapêutico , Incidência , Seguro Saúde , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/economia , Prognóstico , Pontuação de Propensão
18.
Sci Total Environ ; 662: 615-621, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-30699382

RESUMO

While it has been acknowledged that exposure to endocrine-disrupting chemicals (EDCs) is associated with human diseases, the overall disease burden attributable to the exposure to a specific EDC has rarely been evaluated. Based on existing models for assessing probabilities of causation and a comprehensive review of available data, we analyzed the burden of three diseases, i.e., male infertility, adult obesity, and diabetes, among the general Chinese population resulting from exposure to phthalates. Our estimation indicates that exposure to phthalates is associated with ~2.50 million cases of the three diseases across China in 2010, causing ~57.2 billion Chinese Yuan (equivalent to ~9 billion US dollars) of health care costs in a year. Male infertility has the largest number of cases, followed by adult obesity and diabetes. Based on these phthalate-specific estimates, we further estimated that the total disease cost due to exposure to the overall EDCs amounted to ~429.43 billion Chinese Yuan in China in 2010, accounting for 1.07% of nationwide gross domestic product (GDP). When comparing our results with an earlier estimate for the European Union (EU) member countries, we find that exposure to phthalates leads to quite a similar disease burden per unit of GDP in both regions. Our study illustrates the considerable socio-economic impact of EDC exposure on human society, implying the imperative need for global risk reduction actions on EDCs, especially in view of the 2030 Sustainable Development Goals.


Assuntos
Diabetes Mellitus/economia , Disruptores Endócrinos/efeitos adversos , Exposição Ambiental/efeitos adversos , Infertilidade Masculina/economia , Obesidade/economia , Ácidos Ftálicos/efeitos adversos , China , Efeitos Psicossociais da Doença , Diabetes Mellitus/induzido quimicamente , Poluentes Ambientais/efeitos adversos , Humanos , Infertilidade Masculina/induzido quimicamente , Masculino , Obesidade/induzido quimicamente
19.
Int J Equity Health ; 18(1): 9, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30646905

RESUMO

BACKGROUND: Treatment of non-communicable diseases (NCDs) in low-and-middle-income countries (LMICs) is costly and could expose households to financial hardship and vulnerability. This paper examines the association between medication costs of two major NCDs - hypertension (blood pressure) and diabetes, and household-level incidences of catastrophic health expenditure (CHE) in a South Asian LMIC, Pakistan. METHODS: The study analyzes self-reported blood pressure and diabetes (BPD) medication expenditure from the latest version (2015-16) of the Household Integrated Economic Survey (HIES) of Pakistan, a nationally representative survey of 24,238 households. The incidence of CHE is defined as households' out-of-pocket (OOP) medical expenditure exceeding 10% of the total household expenditure. Using a linear probability model, we estimate the adjusted differences in CHE incidence between households that are spending and 'not' spending on BPD medication. We also analyze several hypothetical scenarios of BPD medication cost coverage, and compare the estimated CHE incidences of respective scenarios with the status quo. RESULTS: We find that the average monthly medical expenditure, and average medical expenditure share are significantly higher for households spending on BPD medication, compared to households 'not' spending. The incidence of CHE is found 6.7 percentage point higher for the households consuming BPD medication, after controlling for relevant socioeconomic attributes. If 25, 50, and 100% of the BPD medication OOP cost is covered, then the CHE incidence would reduce respectively by 5.9, 12.7, and 21.4% compared to the status quo. CONCLUSION: Medication cost for managing two major NCDs and household catastrophic health expenditure have strong associations. The findings inform policies toward ensuring access to necessary healthcare services, and protecting households from NCD treatment related financial hardship.


Assuntos
Doença Catastrófica/economia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/economia , Custos de Medicamentos/estatística & dados numéricos , Serviços de Saúde/economia , Hipertensão/tratamento farmacológico , Hipertensão/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Pobreza/estatística & dados numéricos
20.
PLoS Med ; 16(1): e1002716, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30620729

RESUMO

BACKGROUND: There is little systematic assessment of how total health expenditure is distributed across diseases and comorbidities. The objective of this study was to use statistical methods to disaggregate all publicly funded health expenditure by disease and comorbidities in order to answer three research questions: (1) What is health expenditure by disease phase for noncommunicable diseases (NCDs) in New Zealand? (2) Is the cost of having two NCDs more or less than that expected given the independent costs of each NCD? (3) How is total health spending disaggregated by NCDs across age and by sex? METHODS AND FINDINGS: We used linked data for all adult New Zealanders for publicly funded events, including hospitalisation, outpatient, pharmaceutical, laboratory testing, and primary care from 1 July 2007 to 30 June 2014. These data include 18.9 million person-years and $26.4 billion in spending (US$ 2016). We used case definition algorithms to identify if a person had any of six NCDs (cancer, cardiovascular disease [CVD], diabetes, musculoskeletal, neurological, and a chronic lung/liver/kidney [LLK] disease). Indicator variables were used to identify the presence of any of the 15 possible comorbidity pairings of these six NCDs. Regression was used to estimate excess annual health expenditure per person. Cause deletion methods were used to estimate total population expenditure by disease. A majority (59%) of health expenditure was attributable to NCDs. Expenditure due to diseases was generally highest in the year of diagnosis and year of death. A person having two diseases simultaneously generally had greater health expenditure than the expected sum of having the diseases separately, for all 15 comorbidity pairs except the CVD-cancer pair. For example, a 60-64-year-old female with none of the six NCDs had $633 per annum expenditure. If she had both CVD and chronic LLK, additional expenditure for CVD separately was $6,443/$839/$9,225 for the first year of diagnosis/prevalent years/last year of life if dying of CVD; additional expenditure for chronic LLK separately was $6,443/$1,291/$9,051; and the additional comorbidity expenditure of having both CVD and LLK was $2,456 (95% confidence interval [CI] $2,238-$2,674). The pattern was similar for males (e.g., additional comorbidity expenditure for a 60-64-year-old male with CVD and chronic LLK was $2,498 [95% CI $2,264-$2,632]). In addition to this, the excess comorbidity costs for a person with two diseases was greater at younger ages, e.g., excess expenditure for 45-49-year-old males with CVD and chronic LLK was 10 times higher than for 75-79-year-old males and six times higher for females. At the population level, 23.8% of total health expenditure was attributable to higher costs of having one of the 15 comorbidity pairs over and above the six NCDs separately; of the remaining expenditure, CVD accounted for 18.7%, followed by musculoskeletal (16.2%), neurological (14.4%), cancer (14.1%), chronic LLK disease (7.4%), and diabetes (5.5%). Major limitations included incomplete linkage to all costed events (although these were largely non-NCD events) and missing private expenditure. CONCLUSIONS: The costs of having two NCDs simultaneously is typically superadditive, and more so for younger adults. Neurological and musculoskeletal diseases contributed the largest health system costs, in accord with burden of disease studies finding that they contribute large morbidity. Just as burden of disease methodology has advanced the understanding of disease burden, there is a need to create disease-based costing studies that facilitate the disaggregation of health budgets at a national level.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Doenças não Transmissíveis/economia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Assistência Ambulatorial/economia , Animais , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Doença Crônica/economia , Doença Crônica/epidemiologia , Técnicas de Laboratório Clínico/economia , Comorbidade , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Custos de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/economia , Doenças Musculoesqueléticas/epidemiologia , Neoplasias/economia , Neoplasias/epidemiologia , Doenças do Sistema Nervoso/economia , Doenças do Sistema Nervoso/epidemiologia , Nova Zelândia/epidemiologia , Doenças não Transmissíveis/epidemiologia , Pitheciidae , Fatores Sexuais
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