Variation in health system performance for managing diabetes among states in India: a cross-sectional study of individuals aged 15 to 49 years.

Autor: Prenissl J; Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany. jonas.prenissl@gmail.com.; Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. jonas.prenissl@gmail.com., Jaacks LM; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Public Health Foundation of India, New Delhi, Delhi NCR, India., Mohan V; Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India., Manne-Goehler J; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Davies JI; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Johannesburg, Gauteng, South Africa.; Institute of Applied Health Research, University of Birmingham, Birmingham, UK., Awasthi A; Indian Institute of Public Health, Gandhinagar, Gujarat, India., Bischops AC; Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany., Atun R; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Harvard Medical School, Harvard University, Boston, MA, USA., Bärnighausen T; Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany.; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa., Vollmer S; Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany., Geldsetzer P; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2019 May 13; Vol. 17 (1), pp. 92. Date of Electronic Publication: 2019 May 13.
DOI: 10.1186/s12916-019-1325-6
Abstrakt: Background: Understanding where adults with diabetes in India are lost in the diabetes care cascade is essential for the design of targeted health interventions and to monitor progress in health system performance for managing diabetes over time. This study aimed to determine (i) the proportion of adults with diabetes in India who have reached each step of the care cascade and (ii) the variation of these cascade indicators among states and socio-demographic groups.
Methods: We used data from a population-based household survey carried out in 2015 and 2016 among women and men aged 15-49 years in all states of India. Diabetes was defined as a random blood glucose (RBG) ≥ 200 mg/dL or reporting to have diabetes. The care cascade-constructed among those with diabetes-consisted of the proportion who (i) reported having diabetes ("aware"), (ii) had sought treatment ("treated"), and (iii) had sought treatment and had a RBG < 200 mg/dL ("controlled"). The care cascade was disaggregated by state, rural-urban location, age, sex, household wealth quintile, education, and marital status.
Results: This analysis included 729,829 participants. Among those with diabetes (19,453 participants), 52.5% (95% CI, 50.6-54.4%) were "aware", 40.5% (95% CI, 38.6-42.3%) "treated", and 24.8% (95% CI, 23.1-26.4%) "controlled". Living in a rural area, male sex, less household wealth, and lower education were associated with worse care cascade indicators. Adults with untreated diabetes constituted the highest percentage of the adult population (irrespective of diabetes status) aged 15 to 49 years in Goa (4.2%; 95% CI, 3.2-5.2%) and Tamil Nadu (3.8%; 95% CI, 3.4-4.1%). The highest absolute number of adults with untreated diabetes lived in Tamil Nadu (1,670,035; 95% CI, 1,519,130-1,812,278) and Uttar Pradesh (1,506,638; 95% CI, 1,419,466-1,589,832).
Conclusions: There are large losses to diabetes care at each step of the care cascade in India, with the greatest loss occurring at the awareness stage. While health system performance for managing diabetes varies greatly among India's states, improvements are particularly needed for rural areas, those with less household wealth and education, and men. Although such improvements will likely have the greatest benefits for population health in Goa and Tamil Nadu, large states with a low diabetes prevalence but a high absolute number of adults with untreated diabetes, such as Uttar Pradesh, should not be neglected.
Databáze: MEDLINE
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