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Trends and disparities in diabetes care following China's healthcare reform: Evidence from the 2011-12 and 2015-16 China Health and Retirement Longitudinal Study. Prev Med 2022; 156:106982. [PMID: 35124099 DOI: 10.1016/j.ypmed.2022.106982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/19/2021] [Accepted: 01/29/2022] [Indexed: 11/20/2022]
Abstract
To address the high burden of diabetes, China has managed to strengthen diabetes care during the past decade. This study aimed to examine trends and disparities in the coverage of diabetes care among diabetes patients aged 45 years and older following China's healthcare reform. We used data from the 2011-12 baseline survey and 2015-16 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). The prevalence of three diabetes care indicators were compared between the two periods and by participants' characteristics. Logistic regressions and random-effect logit model were used to investigate the socioeconomic and geographic disparities in diabetes care indicators and assess whether there was a significant improvement in these disparities from 2011-12 to 2015-16. We found the prevalence of diabetes among adults aged 45 years and above increased from 16.37% in 2011-12 to 20.33% in 2015-16 in China. Between the 2011-12 and 2015-16 surveys, the proportions of diabetes patients who received health education increased from 31.68% to 35.63%, diabetes-related examination from 32.21% to 41.32%, and diabetes treatment from 30.8% to 36.6%. Disparities in the coverage of diabetes care still existed; while geographic disparities improved significantly during the study period, individual socioeconomic disparities persisted. To address disparities in diabetes care, more effort needs to be directed to improve the primary care system to ensure the quality and timely delivery of diabetes care. Tailored programs should be carried out with more attention given to underserved groups with less educational attainment and lower economic status.
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Alao R, Nur H, Fivian E, Shankar B, Kadiyala S, Harris-Fry H. Economic inequality in malnutrition: a global systematic review and meta-analysis. BMJ Glob Health 2021; 6:e006906. [PMID: 34887302 PMCID: PMC8663078 DOI: 10.1136/bmjgh-2021-006906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To describe the evidence on global and regional economic inequality in malnutrition, and the associations between economic inequality and malnutrition. METHODS We conducted a systematic review and meta-analysis. Between 1 November 2020 and 22 January 2021, we searched Medline, Embase, Global Health, Eldis, Web of Science and EBSCO Discovery Service. We contacted 39 experts and tracked citations. We included any study reporting a concentration index (CIX) relating economic status and nutritional status and any multilevel study reporting an association between economic inequality and nutritional status. Nutritional status was measured as stunting, wasting, anaemia, or overweight in children (<5 years), or underweight, overweight or obesity, or anaemia in adults (15-49 years). We had no study date or language restriction. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). We mapped estimates and pooled them using multilevel random-effects meta-analyses. RESULTS From 6185 results, 91 studies provided 426 CIX (>2.9 million people) and 47 associations (~3.9 million people). Stunting (CIX -0.15 (95% CI -0.19 to -0.11)) and wasting (-0.03 (95% CI -0.05 to -0.02)) are concentrated among poor households. Adult overweight and obesity is concentrated in wealthier households (0.08 (95% CI -0.00 to 0.17)), particularly in South Asia (0.26 (95% CI 0.19 to 0.34)), but not in Europe and Central Asia (-0.02 (95% CI -0.08 to 0.05)) or North America (-0.04 (95% CI -0.10 to 0.03)). We found no association between 0.1 increase in Gini coefficient and adult underweight (OR 1.03 (95% CI 0.94 to 1.12)) or overweight and obesity (0.92 (95% CI 0.80 to 1.05)). CONCLUSIONS There is good evidence that the prevalence of malnutrition varies by levels of absolute economic status. Undernutrition is concentrated in poor households, whereas concentration of overweight and obesity by economic status depends on region, and we lack information on economic inequalities in anaemia and child overweight. In contrast, links between malnutrition and relative economic status are less clear and should not be assumed; robust evidence on causal pathways is needed. PROSPERO REGISTRATION NUMBER CRD42020201572.
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Affiliation(s)
- Rotimi Alao
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hayaan Nur
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Letelier A, Madero-Cabib I, Undurraga EA, Pérez-Cruz P. Lifetime socioeconomic determinants of health trajectories among older adults. ADVANCES IN LIFE COURSE RESEARCH 2021; 49:100415. [PMID: 34733129 PMCID: PMC8562571 DOI: 10.1016/j.alcr.2021.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Drawing on life course theory and research, we explored how socioeconomic circumstances during childhood and adulthood shape self-reported health trajectories among older Mexican adults. We used data from the Mexican Health and Aging Study panel survey (2001-2015) and used sequence analysis to estimate types of self-reported health trajectories in older adulthood. We then explored the association between those health trajectories and socioeconomic determinants at different life stages, including education, occupation, employment, economic status, parental education, and adverse living conditions and illnesses during childhood. Our contributions are threefold. First, we identified four types of health trajectories for men and eight for women, representing a more nuanced longitudinal health status profile than previously shown. Second, we found that childhood and adult socioeconomic circumstances influence self-reported health trajectories at older age. Third, our results suggest there is no simple monotonic relationship between life course circumstances and self-reported health trajectories.
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Affiliation(s)
- Alejandra Letelier
- Instituto de Odontoestomatología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile; Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile
| | - Ignacio Madero-Cabib
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile; Instituto de Sociología & Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Eduardo A Undurraga
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile; Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro Pérez-Cruz
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Santiago, Chile
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Enzenbach C, Kowall B. Income in relation to obesity measures in an East German adult population: findings from the LIFE-Adult-Study. BMC Public Health 2021; 21:1313. [PMID: 34225684 PMCID: PMC8256574 DOI: 10.1186/s12889-021-11302-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Obesity has been postulated to be a consequence of economic disadvantage. However, epidemiological studies failed to demonstrate a consistent link between income and body fat indicators. We examined income as a possible cause of obesity in an East German general population, focusing on appropriate representation of study variables, as well as on confounding and modification of the income-obesity association. Methods We used data of 9599 participants in the baseline examination of the LIFE-Adult-Study, conducted in the city of Leipzig from 2011 to 2014. Body mass index (BMI) and waist circumference (WC) as obesity measures were based on standardised measurements, net equivalised income (NEI) on self-reports. We estimated adjusted means of BMI and WC within NEI categories representing the range from risk of poverty to affluence. We stratified the analyses by gender, age, and education. Results A substantial part of the age-adjusted associations of income with obesity measures was attributable to other SES indicators. Adjusted for these variables, NEI was comparably associated with BMI and WC. Among women, BMI and WC decreased across NEI categories. The inverse associations tended to be stronger at non-working age (≥ 65 years) than at working age (< 65 years). Conversely, among working-age men, BMI and WC increased with increasing NEI. Among older men, risk of poverty was related to higher values of the obesity measures. The aforementioned associations were predominantly stronger in highly educated participants compared to those with medium/low education. The differences in mean BMI and WC between persons at risk of poverty and higher income groups were rather small, ranging from 1 to 2 kg/m2 for BMI and 2 to 4 cm for WC. Conclusions Our investigation indicates an association between income and body fatness in an East German adult population that depends on the sociodemographic context of the people. However, it does not suggest that income disparities are a major driver of body fat accumulation in this population. Differential selection of study participants, error in the measurement of long-term income, and possibly reverse causality may have affected our conclusions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11302-w.
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Affiliation(s)
- Cornelia Enzenbach
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany. .,LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany. .,Institute for Community Medicine, Department SHIP-KEF, University Medicine Greifswald, Walter-Rathenau-Strasse 48, 17475, Greifswald, Germany.
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Zhao Y, Crimmins EM, Hu P, Shen Y, Smith JP, Strauss J, Wang Y, Zhang Y. Prevalence, diagnosis, and management of diabetes mellitus among older Chinese: results from the China Health and Retirement Longitudinal Study. Int J Public Health 2016; 61:347-56. [PMID: 26755457 PMCID: PMC4880519 DOI: 10.1007/s00038-015-0780-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/19/2015] [Accepted: 12/18/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To estimate prevalence of diabetes mellitus (DM), success in diagnosing, and methods of diabetes management in China. METHODS China Health and Retirement Longitudinal Study, a representative survey of the Chinese population at least 45 years old, is used to estimate diabetes and prediabetes prevalence, diagnosis, and treatment and their associations with residence, socioe-conomic, and demographic factors. RESULTS Almost 60 % of middle-aged and elderly Chinese have prediabetes or diabetes in 2011-2012. DM prevalence increases with age, but the oldest group is least likely to be diagnosed. Prevalence is higher with higher body mass index, fasting cholesterol, and larger waist circumference. Higher prevalence is found in urban areas among residents with urban registration status (the Chinese administrative registration system or hukou), especially in coastal regions. Better rates of diagnosis, management, and education regarding diabetes are strongly associated with urban hukou, living in coastal areas, and in families with higher per capita expenditures, the appropriate economic resources measure in China. CONCLUSIONS Diagnosis and management of diabetes is highly differential within China but recent efforts to improve health systems are succeeding in reducing undiagnosed disease. Current high prevalence of prediabetes suggests a more intensive effort is required in the future.
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Affiliation(s)
- Yaohui Zhao
- National School of Development, Peking University, Beijing, China.
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Peifeng Hu
- UCLA Division of Geriatric Medicine, Los Angeles, CA, USA
| | - Yang Shen
- UCLA Division of Endocrinology, Diabetes and Hypertension, Los Angeles, CA, USA
| | | | - John Strauss
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - Yafeng Wang
- Institute for Social Science Survey, Peking University, Beijing, China
| | - Yuan Zhang
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Paixão ES, Costa MDCN, Rodrigues LC, Rasella D, Cardim LL, Brasileiro AC, Teixeira MGLC. Trends and factors associated with dengue mortality and fatality in Brazil. Rev Soc Bras Med Trop 2016; 48:399-405. [PMID: 26312928 DOI: 10.1590/0037-8682-0145-2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/23/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Studies that generate information that may reduce the dengue death risk are essential. This study analyzed time trends and risk factors for dengue mortality and fatality in Brazil from 2001 to 2011. METHODS Time trends for dengue mortality and fatality rates were analyzed using simple linear regression. Associations between the dengue mortality and the case fatality rates and socioeconomic, demographic, and health care indicators at the municipality level were analyzed using negative binomial regression. RESULTS The dengue hemorrhagic fever case fatality rate increased in Brazil from 2001 to 2011 (β=0.67; p=0.036), in patients aged 0-14 years (β=0.48; p=0.030) and in those aged ≥15 years (β=1.1; p<0.01). Factors associated with the dengue case fatality rate were the average income per capita (MRR=0.99; p=0.038) and the number of basic health units per population (MRR=0.89; p<0.001). Mortality rates increased from 2001 to 2011 (β=0.350; p=0.002).Factors associated with mortality were inequality (RR=1.02; p=0.001) high income per capita (MRR=0.99; p=0.005), and higher proportions of populations living in urban areas (MRR=1.01; p<0.001). CONCLUSIONS The increases in the dengue mortality and case fatality rates and the associated socioeconomic and health care factors, suggest the need for structural and intersectoral investments to improve living conditions and to sustainably reduce these outcomes.
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Affiliation(s)
- Enny Santos Paixão
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, BR
| | | | | | - Davide Rasella
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, BR
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Siegel M, Allanson P. Longitudinal analysis of income-related health inequalities: methods, challenges and applications. Expert Rev Pharmacoecon Outcomes Res 2015; 16:41-9. [DOI: 10.1586/14737167.2016.1123096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Siegel M, Mielck A, Maier W. Individual Income, Area Deprivation, and Health: Do Income-Related Health Inequalities Vary by Small Area Deprivation? HEALTH ECONOMICS 2015; 24:1523-1530. [PMID: 25294413 DOI: 10.1002/hec.3102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 07/21/2014] [Accepted: 08/08/2014] [Indexed: 06/03/2023]
Abstract
This paper aims to explore potential associations between health inequalities related to socioeconomic deprivation at the individual and the small area level. We use German cross-sectional survey data for the years 2002 and 2006, and measure small area deprivation via the German Index of Multiple Deprivation. We test the differences between concentration indices of income-related and small area deprivation related inequalities in obesity, hypertension, and diabetes. Our results suggest that small area deprivation and individual income both yield inequalities in health favoring the better-off, where individual income-related inequalities are significantly more pronounced than those related to small area deprivation. We then apply a semiparametric extension of Wagstaff's corrected concentration index to explore how individual-level health inequalities vary with the degree of regional deprivation. We find that the concentration of obesity, hypertension, and diabetes among lower income groups also exists at the small area level. The degree of deprivation-specific income-related inequalities in the three health outcomes exhibits only little variations across different levels of multiple deprivation for both sexes.
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Affiliation(s)
- Martin Siegel
- Berlin Centre of Health Economics Research (BerlinHECOR), Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Germany
| | - Andreas Mielck
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
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Pabayo R, Kawachi I, Gilman SE. US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings. Int J Public Health 2015; 60:573-88. [PMID: 25981210 PMCID: PMC4517572 DOI: 10.1007/s00038-015-0678-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To examine prospectively the association between US state income inequality and incidence of heart attack. METHODS We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates. RESULTS In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) = 1.71, 95 % CI 1.16-2.53)], third (AOR = 1.81, 95 % CI 1.28-2.57), and fourth (AOR = 2.04, 95 % CI 1.26-3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline. CONCLUSIONS This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults.
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Affiliation(s)
- Roman Pabayo
- Department of Community Health Sciences, University of Nevada, Reno, Lombardi Building, 203, MS 0274, 1664 North Virginia Street, Reno, NV, 89557, USA,
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Grundmann N, Mielck A, Siegel M, Maier W. Area deprivation and the prevalence of type 2 diabetes and obesity: analysis at the municipality level in Germany. BMC Public Health 2014; 14:1264. [PMID: 25495106 PMCID: PMC4301883 DOI: 10.1186/1471-2458-14-1264] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/04/2014] [Indexed: 02/06/2023] Open
Abstract
Background The objective of this study was to analyse the association between area deprivation at municipality level and the prevalence of type 2 diabetes (T2D) and obesity across Germany, controlling for individual socioeconomic status (SES). Methods The analyses are based on a large survey conducted in 2006. Information was included from 39,908 adults aged 20 years or above. Area deprivation was assessed using the German Index of Multiple Deprivation (GIMD) at municipality level. About 4,700 municipalities could be included and assigned to a deprivation quintile. Individual SES was assessed by income and educational level. Multilevel logistic models were used to control for individual SES and other potential confounders such as age, sex and physical activity. Results We found a positive association of area deprivation with T2D and obesity. Controlling for all individual-level variables, the odds ratios for municipalities in the most deprived quintile were significantly increased for T2D (OR 1.35; 95% CI 1.12–1.64) as well as for obesity (OR 1.14; 95% CI 1.02–1.26). Further analyses showed that these associations were relatively similar for both men and women. Conclusions Based on a nationwide dataset, we were able to show that area deprivation at municipality level is significantly associated with the prevalence of T2D and obesity. It will be important to focus preventive efforts on very deprived municipalities.
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Affiliation(s)
| | | | | | - Werner Maier
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
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Estimating diabetes prevalence in Turkey in 2025 with and without possible interventions to reduce obesity and smoking prevalence, using a modelling approach. Int J Public Health 2014; 60 Suppl 1:S13-21. [PMID: 25471076 DOI: 10.1007/s00038-014-0622-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 11/06/2014] [Accepted: 11/13/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The purpose of this study is to estimate the prevalence and the number of people with type 2 diabetes (T2DM) in 2025 in Turkey and to evaluate the impact of possible policy options on T2DM prevalence. METHODS We developed a model to predict future prevalence of T2DM using trend data for adults aged 25-74 in Turkey from 1997 to 2025. The model integrates population, obesity and smoking trends to estimate the future T2DM prevalence using a Markov approach. RESULTS T2DM prevalence was 7.5% (95% CI: 6.0-9.0%) in 1997 increasing to 16.2% (95% CI: 15.5-21.1%) in 2010. The forecasted prevalence for 2025 was 31.5% (28.6% in men and 35.1% in women). If obesity prevalence declines by 10% and smoking decreases by 20% in 10 years from 2010, a 10% relative reduction in diabetes prevalence (1,655,213 individuals) could be achieved by 2025. CONCLUSIONS Diabetes burden is now a significant public health challenge, and our model predicts that its burden will increase significantly over the next two decades. Tackling obesity and other diabetes risk factors needs urgent action.
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