Prevalence, correlates, and description of self-reported diabetes in brazilian capitals - results from a telephone survey

Knowledge, attitude and practice toward diabetes among the public in the Kingdom of Saudi Arabia: a cross-sectional study

Background

The increasing adoption of sedentary lifestyles and cultural shifts has fostered unhealthy habits and decreased physical activity, consequently exacerbating the prevalence of diabetes. Diabetes is currently one of the top 10 diseases worldwide, contributing significantly to both mortality and morbidity. Since diabetes hinges on self-care, possessing the right knowledge, attitude, and habits related to the disease is paramount. This study, therefore, aims to examine the knowledge, attitude, and practice of diabetes among the population of Saudi Arabia.

Methods

The study utilized data from a cross-sectional study conducted via an online self-reported questionnaire among the general population of Saudi Arabia. The study primarily used univariate and multivariable regression data analyses. Univariate analysis was employed to compile social and demographic statistics frequencies, while One-way analysis of variance (ANOVA) was used to assess mean differences in knowledge, attitudes, and practices scores. Furthermore, a multivariable linear regression analysis was executed to identify factors associated with knowledge, attitudes, and practices.

Results

The mean score for diabetes knowledge was 17.79 (SD = 5.39, range: 0-29), with an overall accuracy rate of 61.34%. The mean attitude score for diabetes was 2.33 (SD = 1.91, range: 0-7), while the mean score for diabetes practices was 2.58 (SD = 1.28, range: 0-4). The multivariate analyses reveal distinct variations in knowledge, attitudes, and practices of diabetes among participants based on their gender, education, marital status, income, diabetes patient status, and having a medical field-related education.

Conclusion

High knowledge scores do not necessarily equate to positive attitudes and practices related to diabetes. There is need for intensified care and the implementation of specialized educational programs that emphasize the importance of having the right attitude and engaging in the good diabetes practices.

Patient activation levels and socioeconomic factors among the Amazonas population with diabetes: a cross-sectional study

BACKGROUND

The presence of chronic conditions such as type 2 diabetes mellitus (T2DM) requires behavioral lifestyle changes mediated by individuals' motivation for change and adherence to treatment. This study aims to explore activation levels in individuals with T2DM treated in primary care facilities and to identify the association between demographic, clinical, psychosocial factors, and patient activation amongst populations in the Brazilian state of Amazonas.

METHODS

SAPPA is a cross-sectional study conducted in Amazonas, approved by the Universidade Federal do Amazona's IRB in Brazil. Individuals with T2DM were evaluated in their homes (n = 4,318,325). The variables were sex, age, skin color, education level; health-related variables such as body mass index, nutritional behavior, and frequency of physical activity. Measures related to patient self-management behaviors over the past 6 months (Patient Activation Measure - PAM-13) were included in the survey. Descriptive and frequency data are presented as mean (standard deviation (SD)) or numeric percentage). Statistical testing was performed using IBM SPSS V.26, and a p-value of < 0.050 showed significance. Activation levels were dichotomized into low activation (Levels 1 and 2) and high activation (Levels 3 and 4). A multivariate linear model assessed the association between the PAM-13 score and the following variables: age, sex, BMI, skin color, number of comorbidities, burden of symptoms, and number of medications.

RESULTS

Logistic regression analyses indicated a statistically significant association between sex, age, education, self-rated health, and general satisfaction with life. men were 43% more likely to score lower levels (p < 0.001). The results also indicated that advanced age had lower PAM levels (p < 0.001). Participants with fewer years of education were 44% more likely to have lower levels of PAM (p = 0.03). Worse self-rated health (p < 0.001) and lower general life satisfaction (p = 0.014) were associated with lower PAM levels.

CONCLUSIONS

Low patient activation was associated with worse sociodemographic, health, and psychological conditions in the Amazon population. The low level of patient activation observed in this sample highlights an important impediment to diabetes disease management/self-management in disadvantaged populations.

Access to diabetes diagnosis in Brazil based on recent testing and consultation: The Brazilian national health survey, 2013 and 2019

BACKGROUND

Screening for undiagnosed diabetes using glucose testing is recommended globally to allow preventive action among those detected. Our aim was to evaluate the access to glucose testing to screen for diabetes in Brazil using self-reported information on recent testing and medical consultation from national surveys of Brazilian adults.

METHODS

The Pesquisa Nacional de Saúde (PNS) was conducted in 2013 and 2019 drawing probabilistic samples of Brazilians aged 18 years and above. To evaluate glucose testing among those undiagnosed, we excluded those self-reporting a previous diagnosis of diabetes. We then defined recent access to diabetes diagnosis by considering the previous two years and choosing the last blood glucose test and the proximal medical consultation reported. We used Poisson regression with robust variance to assess correlates of access, expressing them with adjusted prevalence ratios (PR) and their 95% confidence intervals.

RESULTS

Access to recent glucose testing documented that over 70% reported a recent glycemic test, 71% in 2013, and 77% in 2019. These findings are consistent with a wide recent access to medical consultation, 86% and 89% in 2013 and 2019, respectively. Reporting recent glucose testing and medical consultation may better reflect the actual access to medical diagnostic testing. When analyzing this joint outcome, diagnostic access was still wide, 67% and 74%, respectively. Greater access (p< 0.001) was seen for women (PR=1.16; 1.15-1.17), older individuals (PR=1.25; 1.22-1.28), and those with higher education (PR=1.17; 1.15-1.18), obesity (PR=1.06; 1.05-1.08), and hypertension (PR=1.12; 1.11-1.13). In contrast, lower access (p<0.001) was seen for those declaring being Black (PR=0.97; 0.95-0.99) or of mixed-race (PR=0.97; 0.96-0.98), those residing in rural areas (PR=0.89; 0.87-0.90), and not having a private health insurance plan (PR=0.85; 0.84-0.86).

CONCLUSIONS

Although access to diagnostic testing for diabetes is high in Brazil, partly due to its universal health system, social inequities are still present, demanding specific actions, particularly in rural areas and among those self-declaring as being Black or mixed-race.

Study of Health in Primary Care of the Amazonas Population: Protocol for an Observational Study on Diabetes Management in Brazil

Background

Changes in the profiles of patients have significant impacts on the health care system. Diabetes mellitus type 2 (T2DM) prevention and management should be studied in different contexts.

Objective

The Study of Health in Primary Care for the Amazonas Population (SAPPA) primarily aims to describe T2DM prevention and management actions offered by primary health care settings in Brazil and whether the care delivered is consistent with the chronic care model (CCM). Second, the study aims to examine the impact of T2DM management actions on health and lifestyle, and third, to understand how sociodemographic characteristics, health, and subjective outcomes impact diabetes management.

Methods

As part of this observational study, managers and health professionals complete a questionnaire containing information about T2DM prevention and management actions and CCM dimensions. During in-home visits, patients are asked about their health, lifestyle, sociodemographics, diabetes care, and subjective variables.

Results

A total of 34 managers, 1560 professional health workers, and 955 patients will be recruited. The data collection will be completed in October 2022.

Conclusions

The SAPPA is an observational study that intends to understand the T2DM management process in primary health care, including planning, execution, reach, and impact on patient motivation and adherence.

International Registered Report Identifier (IRRID)

DERR1-10.2196/37572

The Health State of Women in Serbia in the Period 2006-2016

Women’s health is of particular importance because of the large and specific sensitivity of this population group and the fact that women are consistently concerned about their own health, but also about the health of their children, parents and other family members. The aim of this study was to considering the health of women in Serbia in the period from 2006 to 2016, in order to highlight the priority problems, which would serve to create preventive programs and measures aimed at improving the health of this population group. Chronic non-communicable diseases (malignancies, acute coronary syndrome, diabetes mellitus, etc) are the leading causes of morbidity and mortality, and one of the main reasons for the use of health care in the population of women in our country in the period from 2006 to 2016. How it comes to preventable diseases, actions in the field of health promotion should be directed at preventing or modifying risk factors that are responsible for the occurrence of these diseases, as well as the creation of national strategies for the prevention and control, monitoring the performance of screening and other preventive programs, planning and organization of health care. By promoting healthy lifestyles, empowering women and their active participation in the community can have significant positive effects on raising the health potential of this population.

Obesity in people with diabetes in COVID-19 times: Important considerations and precautions to be taken

At the end of 2019, a new disease with pandemic potential appeared in China. It was a novel coronavirus called coronavirus disease 2019 (COVID-19). Later, in the first quarter of 2020, the World Health Organization declared the outbreak of this disease a pandemic. Elderly people, people with comorbidities, and health care professionals are more vulnerable to COVID-19. Obesity has been growing exponentially worldwide, affecting several age groups. It is a morbidity that is associated with genetic, epigenetic, environment factors and/or interaction between them. Obesity is associated with the development of several diseases including diabetes mellitus, mainly type 2. Diabetes affects a significant portion of the global population. Obesity and diabetes are among the main risk factors for the development of severe symptoms of COVID-19, and individuals with these conditions constitute a risk group. Based on a literature review on obesity in people with diabetes in the framework of the COVID-19 pandemic, this study presents updated important considerations and care to be taken with this population.

Association between type 2 diabetes and non-exercise estimated cardiorespiratory fitness among adults: evidences from a middle-income country

OBJECTIVE

The objective of this study is to assess the association between type 2 diabetes (T2D) and cardiorespiratory fitness (CRF) estimated through a non-exercise model in a large representative group of Brazilian adults.

STUDY DESIGN

The study design of this study is a cross-sectional population-based study.

METHODS

The presence of T2D was assessed through self-report in 42,631 individuals aged 20-59 years. The CRF was predicted from a non-exercise equation containing the following data: sex, age, body mass index, and physical activity level. The corresponding metabolic equivalent (MET) value was used to classify participants into the following four groups based on the cutpoints: <6, 6-9, 10-11, and ≥12 METs. Crude and multivariable-adjusted logistic regressions were carried out to determine the association between CRF and the presence of diabetes.

RESULTS

Significant linear trends were observed in diabetes across different categories of CRF in men. In women, however, linear trends were not observed in T2D across '10-11' and '≥12' categories. A 1-MET increase in estimated CRF was associated with 29% lower odds of diabetes in men and 14% in women after adjusting all the potential confounders (P < 0.001).

CONCLUSIONS

The presence of T2D was inversely associated with every CRF level in men and with 6-9 METs when comparing with <6 METs in women, through a non-exercise model in Brazilian adults. This finding suggests that a practical, viable, and low-cost measurement of CRF could be applied in lower income countries to assess the relationship between CRF and T2D. However, new non-exercise models are needed to better detect T2D in women.

Relationship between marital status and incidence of type 2 diabetes mellitus in a Brazilian rural population: The Baependi Heart Study

Many factors influence the incidence of type 2 diabetes mellitus (T2DM). Here, we investigated the associations between socio-demographic characteristics and familial history with the 5-year incidence of T2DM in a family-based study conducted in Brazil. T2DM was defined as baseline fasting blood glucose ≥ 126 mg/dL or the use of any hypoglycaemic drug. We excluded individuals with T2DM at baseline or if they did not attend two examination cycles. After exclusions, we evaluated a sample of 1,125 participants, part of the Baependi Heart Study (BHS). Mixed-effects logistic regression models were used to assess T2DM incident given different characteristics. At the 5-year follow-up, the incidence of T2DM was 6.7% (7.2% men and 6.3% women). After adjusting for age, sex, and education status, the model that combined marital and occupation status, skin color, and familial history of T2DM provided the best prediction for T2DM incidence. Only marital status was independently associated with T2DM incidence. Individuals that remained married, despite having significantly increased their weight, were significantly less likely to develop diabetes than their divorced counterparts.

Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses

Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG).Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications.Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications.Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.

Morbidades autorreferidas por usuários de espaços comunitários de atividade física

Objetivo: analisar as morbidades autorreferidas relacionadas com as condições sociodemográficas dos usuários de espaços comunitários de atividade física.Materiais e métodos: estudo transversal, com abordagem quantitativa, realizado com 433 usuários do Sistema Único de Saúde, na macrorregião Cariri, Ceará, Brasil. A coleta ocorreu por meio de formulário estruturado a partir do modelo de questionário da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico, operacionalizada pelo Ministério da Saúde do Brasil.Resultados: a média de idade dos participantes do estudo foi de 42,92 anos (DP ± 17,4); a de renda familiar foi de R$ 1.486,30 (DP ± 1.015,0). Verificou-se predomínio do sexo feminino associado à maior prevalência de hipertensão (p = 0,001) e de dislipidemia (p = 0,003). A idade mais elevada relacionou-se aos diagnósticos médicos de hipertensão (53,85 anos, DP ± 15,64), dislipidemia (59,54 anos, DP ± 15,25) e diabetes (52,42 anos, DP ± 16,66).Conclusão: a análise das características sociais e econômicas permitiu verificar a associação de morbidades como hipertensão, diabetes e dislipidemia com o sexo, a idade, a renda e a escolaridade; esses fatores são causais para o desenvolvimento das doenças crônicas não transmissíveis.

Diabetes Care in Brazil

BACKGROUND

The diabetes epidemic affects most countries across the world and is increasing at alarming rates in Latin America. Nearly 12 million individuals have diabetes in Brazil, and the current prevalence ranges from 6.3% to 13.5%, depending on the region and the diagnostic criteria adopted in each study.

OBJECTIVE

To provide an overview of diabetes care in Brazil, focusing on studies of diabetes epidemiology, prevalence of patients within the standard targets of care, and economic burden of diabetes and its complications.

METHODS

SciELO and PubMed searches were performed for the terms "diabetes," "Brazil," "Brazilian," and "health system"; relevant literature from 1990 to 2015 was selected. Additional articles identified from reference list searches were also included. All articles selected were published in Portuguese and/or English.

FINDINGS

Recent studies detected a prevalence of gestational diabetes mellitus of nearly 20%. Among patients with type 1 diabetes, almost 90% fail to reach target of glycemic control, with less than 30% receiving treatment for both hypertension and dyslipidemia. More than 75% of patients with type 2 diabetes are either overweight or obese. Most of these patients fail to reach glycemic targets (42.1%) and less than 30% reached the target for systolic and diastolic blood pressure, body mass index, or low-density lipoprotein cholesterol. Only 0.2% of patients reach all these anthropometric and metabolic targets.

CONCLUSIONS

Brazil is the fourth country in the world in number of patients with diabetes. Regardless of the diabetes type, the majority of patients do not meet other metabolic control goals. The economic burden of diabetes and its complications in Brazil is extremely high, and more effective approaches for preventions and management are urgently needed.

Potential use of telephone-based survey for non-communicable disease surveillance in Sri Lanka

BACKGROUND

Telephone survey (TS) has been a popular tool for conducting health surveys, particularly in developed countries. However, the feasibility, and reliability of TS are not adequately explored in Sri Lanka. The main aim of this study is to assess the effectiveness of telephone-based survey in estimating the prevalence of common non-communicable diseases (NCDs) in Sri Lanka.

METHODS

We carried out an observational cross-sectional study using telephone interview method in Galle district, Sri Lanka. The study participants were selected randomly from the residents living in the households with fixed land telephone lines. The prevalence of the main NCDs was estimated using descriptive statistics.

RESULTS

Overall, 975 telephone numbers belonging to six main areas of Galle district were called, and 48% agreed to participate in the study. Of the non-respondents, 22% actively declined to participate. Data on NCDs were gathered from 1470 individuals. The most common self-reported NCD was hypertension (17.%), followed by diabetes (16.3%) and dyslipidaemia (15.6%). Smoking was exclusively seen in males (7.4%), and regular alcohol use was significantly more common in males (19.2%) than females (0.4%, P < .001).

CONCLUSIONS

Our study revealed average response rate for telephone based interview in Sri Lankan setting. Overall prevalence of main NCDs in this study showed a comparable prevalence to studies used face to face interview method. This study supports the potential use of telephone-based survey to assess heath related information in Sri Lanka.

Factors associated with self-reported diabetes according to the 2013 National Health Survey

OBJECTIVES

To analyze the factors associated with self-reported diabetes among adult participants of the National Health Survey (PNS).

METHODS

Cross-sectional study using data of the PNS carried out in 2013, from interviews with adults (≥ 18 years) of 64,348 Brazilian households. The prevalence of self-reported diabetes, assessed by the question "Has a doctor ever told you that you have diabetes?," was related to sociodemographic characteristics, lifestyle, self-reported chronic disease, and self-evaluation of the health condition. Prevalence ratios were adjusted according to age, sex, and schooling by Poisson regression with robust variance.

RESULTS

The diagnosis of diabetes was reported by 6.2% of respondents. Its crude prevalence was higher in women (7.0% vs. 5.4%), and among older adults, reaching 19.8% in the elderly. Black adults who received less schooling showed higher prevalence. Among those classified as obese, 11.8% reported having diabetes. Ex-smokers, those insufficiently active and those who consume alcohol abusively reported diabetes more often. Differences were not verified in eating habits among adults who reported, or did not, diabetes. A relation between diabetes and hypertension was found.

CONCLUSIONS

After adjustment according to age, schooling and sex, diabetes was shown to be associated with higher age, lower schooling, past smoking, overweight and obesity, and hypertension, as well as with a self-declared poor state of health, indicating a pattern of risk factors common to many chronic non-communicable diseases and the association of the disease with morbidity.

Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review

Background

National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys.

Objective

The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs).

Methods

Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results

A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times.

Conclusions

Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey.

Family history of cardiovascular disease and parental lifestyle behaviors are associated with offspring cardiovascular disease risk markers in childhood

INTRODUCTION

Cardiovascular disease risk markers have become more prevalent in childhood. To provide increased understanding of the etiology of this public health issue, we investigated associations between family characteristics with cardiovascular disease risk markers in adolescents from a developing nation.

METHODS

In this cross-sectional study data for fasting glucose, lipoproteins (LDL-C and HDL-C), triglycerides, and total cholesterol were collected from 991 adolescents aged 10-17 who were recruited from public schools in Londrina city, Southern Brazil. Family history of cardiovascular disease and parental engagement in risk behavior (alcohol consumption and tobacco smoking) were collected using a self-reported parental questionnaire. Socioeconomic status, adolescent physical activity (estimated by Baecke questionnaire), self-reported tobacco and alcohol intake, and somatic maturation (age at peak height velocity) were used as covariates. Logistic regression was used for the main analyses.

RESULTS

Independent of adolescent lifestyle behaviors, associations (OR_adj [95% CI]) were found between: (1) paternal family history of cardiovascular disease with increased likelihood of high adolescent offspring BMI (1.53 [1.01 to 2.32]) and high triglycerides (2.93 [1.04 to 8.27]); (2) maternal family history of cardiovascular disease with heightened odds of high adolescent offspring triglycerides (2.84 [1.02 to 7.91]); (3) maternal cardiovascular disease with higher odds of high fasting glucose (2.16 [1.13 to 4.14]), and (4) maternal smoking with increased odds of high LDL-C (1.78 [1.14 to 2.79]) and high total cholesterol (1.77 [1.01 to 3.10]) in adolescent offspring.

CONCLUSION

Family history of cardiovascular disease and maternal tobacco smoking are related to increased cardiovascular risk in adolescents, potentially independent of their own lifestyle behaviors.

Common mental disorders and sociodemographic characteristics: baseline findings of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

OBJECTIVE

To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.

METHODS

We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score ≥ 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression.

RESULTS

CMD (CIS-R score ≥ 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%CI 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%).

CONCLUSION

The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders.

Trends in the prevalence of self-reported diabetes in Brazilian capital cities and the Federal District, 2006-2014

BACKGROUND

Diabetes is increasing globally, particularly in low and middle income countries, posing a great challenge to health systems. Brazil is currently ranked 4th in the world in terms of the absolute number of persons with diabetes. Our aim was to analyze the trend in self-reported diabetes prevalence between 2006 and 2014 in Brazilian adults.

METHODS

We used data from the national telephone survey-VIGITEL. Over 40,000 individuals from probabilistic sample of subjects ≥18 years old residing in 26 state capitals and the Federal District were interviewed per year in each location. Estimates were weighted to represent the surveyed population. We analyzed trends with a linear regression model. We adjusted prevalence with a probability predictive margins model, using as reference categories: men, 18-24 years, ≥12 years of schooling and lean/normal weight.

RESULTS

From 2006 to 2014, the overall prevalence increased from 5.5 to 8.0 %, a net rise of 0.26 %/year (P = 0.001). After adjustment for sex, age, schooling and BMI categories, the trend decreased only slightly to 0.25 %/year. Relatively greater adjusted increases were present in men (0.28 %/year), in those ≥65 years (0.52 %/year), with ≤8 years of schooling (0.33 %/year) and in those overweight (0.24 %/year). The most consistent upward trends were observed among men (coefficient of determination, R² = 0.93), those with educational attainment of 0-8 years (R² = 0.81), those > 65 years (R² = 0.79) and those who were overweight (R² = 0.75). There was no significant trend in diabetes prevalence for the obese. As expected, the prevalence of self-reported diabetes was always higher among those with greater age, less schooling, in women, and in those with obesity. Being obese was associated with having more than twice the prevalence of diabetes of those normal/underweight.

CONCLUSIONS

Prevalence of self-reported diabetes in Brazilian adults has risen between 2006 and 2014, especially among those 65 years or older, even after taking into account the sociodemographic and nutritional changes during the period. Regardless of possible causes (higher incidence, increased diagnosis or decreased mortality), this increase in prevalence has enormous implications for the health system, representing >300,000 newly diagnosed cases of diabetes yearly requiring health care.

Validity assessment of self-reported medication use by comparing to pharmacy insurance claims

OBJECTIVES

In Japan, an annual health check-up and health promotion guidance programme was established in 2008 in accordance with the Act on Assurance of Medical Care for the Elderly. A self-reported questionnaire on medication use is a required item in this programme and has been used widely, but its validity has not been assessed. The aim of this study was to evaluate the validity of this questionnaire by comparing self-reported usage to pharmacy insurance claims.

SETTING

This is a population-based validation study. Self-reported medication use for hypertension, diabetes and dyslipidaemia is the evaluated measurement. Data on pharmacy insurance claims are used as a reference standard.

PARTICIPANTS

Participants were 54,712 beneficiaries of the National Health Insurance of Chiba City.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sensitivity, specificity and κ statistics of the self-reported medication-use questionnaire for predicting actual prescriptions during 1 month (that of the check-up) and 3 months (that of the check-up and the previous 2 months) were calculated.

RESULTS

Sensitivity and specificity scores of questionnaire data for predicting insurance claims covering 3 months were, respectively, 92.4% (95% CI 91.9 to 92.8) and 86.4% (95% CI 86.0 to 86.7) for hypertension, 82.6% (95% CI 81.1 to 84.0) and 98.5% (95% CI 98.4 to 98.6) for diabetes, and 86.2% (95% CI 85.5 to 86.8) and 91.0% (95% CI 90.8 to 91.3) for dyslipidaemia. Corresponding κ statistics were 70.9% (95% CI 70.1 to 71.7), 77.1% (95% CI 76.2 to 77.9) and 69.8% (95% CI 68.9 to 70.6). The specificity was significantly higher for questionnaire data covering 3 months compared with data covering 1 month for all 3 conditions.

CONCLUSIONS

Self-reported questionnaire data on medication use had sufficiently high validity for further analyses. Item responses showed close agreement with actual prescriptions, particularly those covering 3 months.

Diabetes, hypertension and mobility among Brazilian older adults: findings from the Brazilian National Household Sample Survey (1998, 2003 and 2008)

Background

The rapid population ageing has been accompanied by a growing number of older adults experiencing chronic conditions, especially diabetes and hypertension, which are conditions associated to the decline in physical functioning. The aim of this study was to investigate changes in the strength of the association between mobility and two chronic conditions (hypertension and diabetes) in a large representative sample of Brazilian older adults over a ten year period.

Methods

The data came from the Brazilian National Household Sample Survey (PNAD) of 1998, 2003 and 2008. The sample comprised 28,943 participants aged 60 years and older investigated in 1998, 35,042 in 2003 and 41,269 in 2008, totalling 105,254 older adults. The dependent variable was the physical mobility index (PMI) constructed based on the Item Response Theory (IRT) using five physical mobility indicators. The chronic conditions were self-reported and the confounders included: age, sex, schooling, ethnicity, family income, household composition, other co-morbidities and use of health services. The association between physical mobility (three different groups) and chronic conditions (hypertension and diabetes) was performed using multinomial logistic regression.

Results

Over the ten year period the prevalence of hypertension increased from 44 % (1998), 49 % (2003) to 53 % (2008) (p < 0.001). Similar pattern was observed for the prevalence of diabetes: 10 % in 1998, 13 % in 2003 and 16 % in 2008 (p < 0.001). Overall, physical mobility showed a statistical significant association with both chronic diseases studied even after adjusting for potential confounders. The time-disease interaction term was significant (p < 0.05) for the two chronic conditions studied, and the strength of the associations decreased over the first five years, but it was not sustained between 2003 and 2008.

Conclusions

Despite the increases observed in the prevalence of the hypertension and diabetes over the ten year period, the decrease in strength of the association with physical mobility during the first period could be explained by improvements in health services and treatment of older adults. Special attention should be given to the treatment and management of diabetes in order to avoid declines in physical mobility levels.