Diabetes mellitus en adultos mayores costarricenses

Camacho, Gilbert Brenes; Rosero-Bixby, Luis

doi:10.15517/psm.v5i1.4546

Cited by 5 publications

(3 citation statements)

References 2 publications

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“…This is evidence of geographical barriers to healthcare that translate into a lower probability of diagnosis. A previous study by Brenes-Camacho and Rosero-Bixby (2008a) reported differential access to care in this same elderly population since individuals not living in the GMA had a lower probability of having their diabetes controlled. Inequalities in access to diabetes care can result from various factors including the geographical distribution of health services and therefore the distance needed to travel to have access to them (Whiting et al, 2010).…”

Section: Discussionmentioning

confidence: 66%

Diabetes epidemics: inequalities increase the burden on the healthcare system

Santamaría‐Ulloa

Montero-López

Rosero-Bixby

2019

Health Policy and Planning

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Diabetes is a major cause of morbidity and mortality and represents a source of demands on already constrained healthcare systems in Latin America and the Caribbean. We estimate inequalities in diabetes incidence, prevalence and mortality and assess the economic burden on the healthcare system in Costa Rica. The main source of data is the Costa Rican Longevity and Healthy Aging Study, a longitudinal nationally representative survey of the elderly population (n = 2827). Data analyses include descriptive statistics, multiple regression models and survival analysis models. More than a fifth of Costa Rican elderly experience diabetes. Incidence is estimated at 5 per 1000 person-years in the population 30+. Gender and geographical inequalities were found. Men have a significantly lower prevalence (16.51% vs 24.02%, P < 0.05) and incidence (4.3 vs 6.0 per 1000 person-years, P < 0.05), but higher mortality (hazard ratio = 1.31, P < 0.01). Longer time to the closest facility translates into a lower probability of having the condition diagnosed [odds ratio (OR) = 0.77, P < 0.05]. The diabetic as compared to the non-diabetic population imposes a larger economic burden on the healthcare system with a higher probability of using outpatient care (OR = 3.08, P < 0.01), medications (OR = 3.44, P < 0.01) and hospitalizations (OR = 1.24, P > 0.05). Individuals living in the Metro Area have a significantly lower probability of being hospitalized (OR = 0.72, P < 0.05), which may be evidence of better access to primary care that prevents hospitalization. Along the same line, women have higher utilization rates of outpatient care (OR = 2.02, P < 0.01) and medications (OR = 1.73, P < 0.01), which may contribute to lower odds of hospitalization (OR = 0.61, P < 0.01). Aligned with the aim of attaining Sustainable Development Goals, this study highlights the importance of generating health policies focused on prevention of diabetes that take into consideration gender and geographical inequalities. Strategies should booster preventive healthcare utilization by men and aim to make healthcare services accessible to all, regardless of geographical location.

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Section: Discussionmentioning

confidence: 66%

Diabetes epidemics: inequalities increase the burden on the healthcare system

Santamaría‐Ulloa

Montero-López

Rosero-Bixby

2019

Health Policy and Planning

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“…Some studies reported an inverse relationship between diabetes and socioeconomic status (SES) [33,79,103] or educational attainment [33,44,62,63,70,72,73,75,76,78,79,86,101]. Other studies reported a direct relationship between having health insurance and self-reported diabetes [42,70,97,100], implying that persons who have health insurance-proxy of access to health care services-would be aware of their health issues and report them accordingly. This interaction also poses questions about not only the access to health care but also the timeliness and quality of the care, and health literacy (or the lack of) that persons in the lowest SES-and at the highest risk of diabetes-would experience.…”

Section: Prevalence Of Diabetes Mellitus In Latin Americamentioning

confidence: 99%

“…Studies included in our review consistently reported an increased prevalence of diabetes with age. Diabetes care challenges specific to this age group include risk of obesity or undernutrition [42,56], increased risk for disability [57], economic barriers to appropriate access to health care [42], disruption in funding of health insurance [275], disparate completion of diabetes care guidelines based on health insurance coverage [276], inequalities in access to and utilization of health care services [277][278][279], complex medical care needs and frailty [280], cultural beliefs, mental health, and lack of family or social support [281], among others. Prevention of diabetes and its complications and reliable continuity of care and social support [282] need to be especially tailored for this population across the region.…”

Section: Older Adultsmentioning

confidence: 99%

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

et al. 2020

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Purpose of Review Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. Recent Findings The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. Summary The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region. Keywords Latin America. Diabetes prevalence. Diabetes treatment. Control. Diabetes complications. Interventions. Health care This article is part of the Topical Collection on Diabetes Epidemiology

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Assessing the relationship between multimorbidity, NCD configurations, frailty phenotypes, and mortality risk in older adults

Ogaz-González,

Corpeleijn,

García-Chanes

et al. 2024

BMC Geriatr

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Background Older adults are increasingly susceptible to prolonged illness, multiple chronic diseases, and disabilities, which can lead to the coexistence of multimorbidity and frailty. Multimorbidity may result in various noncommunicable disease (NCD) patterns or configurations that could be associated with frailty and death. Mortality risk may vary depending on the presence of specific chronic diseases configurations or frailty. Methods The aim was to examine the impact of NCD configurations on mortality risk among older adults with distinct frailty phenotypes. The population was analyzed from the Costa Rican Longevity and Healthy Aging Study Cohort (CRELES). A total of 2,662 adults aged 60 or older were included and followed for 5 years. Exploratory factor analysis and various clustering techniques were utilized to identify NCD configurations. The frequency of NCD accumulation was also assessed for a multimorbidity definition. Frailty phenotypes were set according to Fried et al. criteria. Kaplan‒Meier survival analyses, mortality rates, and Cox proportional hazards models were estimated. Results Four different types of patterns were identified: ‘Neuro-psychiatric’, ‘Metabolic’, ‘Cardiovascular’, and ‘Mixt’ configurations. These configurations showed a higher mortality risk than the mere accumulation of NCDs [Cardiovascular HR:1.65 (1.07–2.57); ‘Mixt’ HR:1.49 (1.00-2.22); ≥3 NCDs HR:1.31 (1.09–1.58)]. Frailty exhibited a high and constant mortality risk, irrespective of the presence of any NCD configuration or multimorbidity definition. However, HRs decreased and lost statistical significance when phenotypes were considered in the Cox models [frailty + ‘Cardiovascular’ HR:1.56 (1.00-2.42); frailty + ‘Mixt’:1.42 (0.95–2.11); and frailty + ≥ 3 NCDs HR:1.23 (1.02–1.49)]. Conclusions Frailty accompanying multimorbidity emerges as a more crucial indicator of mortality risk than multimorbidity alone. Therefore, studying NCD configurations is worthwhile as they may offer improved risk profiles for mortality as alternatives to straightforward counts.

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Diabetes mellitus en adultos mayores costarricenses

Cited by 5 publications

References 2 publications

Diabetes epidemics: inequalities increase the burden on the healthcare system

Diabetes epidemics: inequalities increase the burden on the healthcare system

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

Assessing the relationship between multimorbidity, NCD configurations, frailty phenotypes, and mortality risk in older adults

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