Predictors of Undiagnosed Diabetes among Middle-Aged and Seniors in China: Application of Andersen’s Behavioral Model

Abstract

Undiagnosed diabetes is a threat to public health. This study aims to identify potential variables related to undiagnosed diabetes using Andersen’s behavioral model. Baseline data including blood test data from the China Health and Retirement Longitudinal Study (CHARLS) were adopted. First, we constructed health service related variables based on Andersen model. Second, univariate analysis and multiple logistic regression were used to analyze the relations of variables to undiagnosed diabetes. The strength of relationships was presented by odds ratios (ORs) and 95% confidence intervals (CIs). Finally, the prediction of multiple logistic regression model was assessed using the Receiver Operating Characteristic (ROC) curve and the area under the ROC curve (AUC). According to diagnosis standards, 1234 respondents had diabetes, among which 560 were undiagnosed and 674 were previously diagnosed. Further analysis showed that the following variables were significantly associated with undiagnosed diabetes: age as the predisposing factor; medical insurance, residential places and geographical regions as enabling factors; having other chronic diseases and self-perceived health status as need factors. Moreover, the prediction of regression model was assessed well in the form of ROC and AUC. Andersen model provided a theoretical framework for detecting variables of health service utilization, which may not only explain the undiagnosed reasons but also provide clues for policy-makers to balance health services among diverse social groups in China.

Prevalence and correlates of undiagnosed, diagnosed, and total type 2 diabetes among adults in Morocco, 2017

“…Consistent with some previous research 14 – 19 , some predisposing factors (older age) were associated with undiagnosed T2D versus no T2D. According to some previous studies 15 , 16 , 26 , enabling / disabling factors associated with undiagnosed T2D versus diagnosed T2D included no receipt of health care advice (to lose weight) in the past three years, and had never been screened for cholesterol. People with receipt of health care advice and cholesterol screening are more likely to use health services and may consequently reduce the odds of undiagnosed T2D 16 .…”

“…Predisposing factors associated with undiagnosed T2D included in some studies younger adults 13 – 15 , older adults 16 – 19 , male sex 15 , 17 , living alone 15 , 20 , and family history of diabetes 21 , 22 . Enabling/disabling factors associated with undiagnosed T2D include rural residence 13 , 16 , in some studies lower economic status 13 , 23 , food insecurity 24 , and lower education 14 , 25 , and in other studies higher economic status 17 , and higher education 23 . Other enabling/disabling factors associated with undiagnosed T2D include knowing symptoms of diabetes 21 , no health care visit in the past 12 months 15 , health insurance status (having medical insurance 16 , and not having private insurance 26 and health risk behaviours (high sedentary behaviour 27 , heavy alcohol use 28 , and high level of physical activity 23 .…”

“…Enabling/disabling factors associated with undiagnosed T2D include rural residence 13 , 16 , in some studies lower economic status 13 , 23 , food insecurity 24 , and lower education 14 , 25 , and in other studies higher economic status 17 , and higher education 23 . Other enabling/disabling factors associated with undiagnosed T2D include knowing symptoms of diabetes 21 , no health care visit in the past 12 months 15 , health insurance status (having medical insurance 16 , and not having private insurance 26 and health risk behaviours (high sedentary behaviour 27 , heavy alcohol use 28 , and high level of physical activity 23 .…”

“…The need factors associated with undiagnosed T2D include other chronic diseases 16 , hypertension status (not hypertension 13 , 14 , hypertension 17 , 18 , 29 , 30 ), obesity 17 – 19 , 21 , 22 , 28 , 31 , low HDL-C 31 , 32 , high triglycerides 31 , 32 , dyslipidaemia 22 , cardiovascular disease status (not heart disease 14 , cardiovascular disease 18 ), and perceived poor health 16 . The study aimed to estimate the prevalence and associated factors of undiagnosed T2D among people 18 years and older in Morocco.…”

Inequalities in access to community-based diabetes examination and its impact on healthcare utilization among middle-aged and older adults with diabetes in China

“…The level of education was classified into three groups: uneducated, primary school or below, and secondary school or above. The classification of reimbursement rates of medical insurance into high, low, and no insurance was according to the fact that of the listed medical insurance, government medical insurance, urban employee medical insurance, and private medical insurance reimburse at a significantly higher rate than other insurances (29).…”