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Basto-Abreu A, Barrientos-Gutiérrez T, Vidaña-Pérez D, Colchero MA, Hernández-F M, Hernández-Ávila M, Ward ZJ, Long MW, Gortmaker SL. Cost-Effectiveness Of The Sugar-Sweetened Beverage Excise Tax In Mexico. Health Aff (Millwood) 2020; 38:1824-1831. [PMID: 31682510 DOI: 10.1377/hlthaff.2018.05469] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
An excise tax of 1 peso per liter on sugar-sweetened beverages was implemented in Mexico in 2014. We estimated the cost-effectiveness of this tax and an alternative tax scenario of 2 pesos per liter. We developed a cohort simulation model calibrated for Mexico to project the impact of the tax over ten years. The current tax is projected to prevent 239,900 cases of obesity, 39 percent of which would be among children. It could also prevent 61,340 cases of diabetes, lead to gains of 55,300 quality-adjusted life-years, and avert 5,840 disability-adjusted life-years. The tax is estimated to save $3.98 per dollar spent on its implementation. Doubling the tax to 2 pesos per liter would nearly double the cost savings and health impact. Countries with comparable conditions could benefit from implementing a similar tax.
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Affiliation(s)
- Ana Basto-Abreu
- Ana Basto-Abreu is an assistant professor at the Center for Population Health Research, National Institute of Public Health, in Cuernavaca, Mexico
| | - Tonatiuh Barrientos-Gutiérrez
- Tonatiuh Barrientos-Gutiérrez ( tbarrientos@insp. mx ) is the director of the Center for Population Health Research, National Institute of Public Health
| | - Dèsirée Vidaña-Pérez
- Dèsirée Vidaña-Pérez is a researcher at the Center for Population Health Research, National Institute of Public Health
| | - M Arantxa Colchero
- M. Arantxa Colchero is an associate professor of health economics at the Center for Health Systems Research, National Institute of Public Health
| | - Mauricio Hernández-F
- Mauricio Hernández-F. is a research assistant at the Center for Research and Nutrition Health, National Institute of Public Health
| | - Mauricio Hernández-Ávila
- Mauricio Hernández-Ávila is director of economic and social benefits, Mexican Institute of Social Security, in Mexico City
| | - Zachary J Ward
- Zachary J. Ward is a programmer analyst at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Michael W Long
- Michael W. Long is an assistant professor in the Milken Institute School of Public Health, George Washington University, in Washington, D.C
| | - Steven L Gortmaker
- Steven L. Gortmaker is a professor of the practice of health sociology at the Harvard T. H. Chan School of Public Health
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Meitei WB, Ladusingh L. Transition Specific Risk Factors Affecting the Lifestyle Disease Progression from Diabetes to Hypertension in India. Health (London) 2019. [DOI: 10.4236/health.2019.118083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bustamante AV, Vilar-Compte M, Ochoa Lagunas A. Social support and chronic disease management among older adults of Mexican heritage: A U.S.-Mexico perspective. Soc Sci Med 2018; 216:107-113. [PMID: 30292581 DOI: 10.1016/j.socscimed.2018.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/02/2018] [Accepted: 09/14/2018] [Indexed: 01/16/2023]
Abstract
This study explores the association between social support and chronic disease self-management among older adults of Mexican heritage who live in the U.S. and Mexico. We hypothesize that social support increases the ability to manage hypertension and Type 2 (T2) diabetes, regardless of place of residence. We also investigate if differences in country of residence and health system factors influence the ability to manage chronic conditions. Older adults 65 years or older from Los Angeles (LA) and Mexico City (CDMX), with diagnosed hypertension or T2 diabetes (self-reported), attending government agencies, participated in the study. The statistical analyses investigate differences between older adults in LA and CDMX; identify the association between social support and chronic disease self-management; and examine the role of T2 diabetes treatment, testing and complications on self-management. Our study findings show that social support was a statistically significant predictor of improved T2 diabetes self-management (37%-51%, p < 0.05). The association between social support and hypertension self-management was only significant (90% confidence level) for adherence to weight management and increased alcohol consumption. Our study did not identify statistically significant differences in social support between LA and CDMX. However, almost 40% of sampled older adults were at risk of social isolation, signaling a vulnerable population that needs to be targeted by health and social systems in the U.S. and Mexico. Our study also shows that social support is a strong predictor of improved T2 diabetes management in the U.S. and Mexico. While older adults in the U.S. and Mexico reported similar access to care and health insurance coverage, higher adherence to low salt diets in LA and reduced coverage of glucose testing in CDMX could signal areas of opportunity for policymakers. Health care providers in both countries need to identify ways of improving adherence to physical activity and weight management.
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Affiliation(s)
- Arturo Vargas Bustamante
- Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South Room 31-299C, Box 951772, Los Angeles, CA, 90095, USA.
| | - Mireya Vilar-Compte
- Department of Health Studies, Universidad Iberoamricana, Prolongación Paseo de Reforma 880, Lomas de Santa Fe, CP 01219, CDMX, Mexico.
| | - Adriana Ochoa Lagunas
- University of Sussex in Brighton, Guillermo Prieto 25 Bis, Lomas Quebradas Magdalena Contreras, CP 10000, CDMX, Mexico.
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Lin J, Weng Y, Li M, Mo Y, Zhao J. Hydration prevents chronic hyperglycaemic patients from neurological deterioration post-ischaemic stroke. Acta Neurol Scand 2018; 137:557-565. [PMID: 29363095 DOI: 10.1111/ane.12900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine whether chronic hyperglycaemia predisposes patients to dehydration, which may promote neurological deterioration, and to investigate whether dehydration control improves functional outcome. PATIENTS AND METHODS This study included 355 patients hospitalized with acute ischaemic stroke and diabetes mellitus who fulfilled the glycaemic gap ≤0. We used the following cut-offs: (i) no chronic hyperglycaemia (glycated haemoglobin A1c [HbA1c] < 7%) and (ii) chronic hyperglycaemia (HbA1c ≥ 7%). The chronic hyperglycaemic patients were randomly divided into the control group and the hydration group. Hydration therapy was only initiated in the hydration group. The blood urea nitrogen (BUN)/creatinine (Cr) ratio was used as an indicator of dehydration. Stroke severity on admission and discharge was assessed by means of National Institutes of Health Stroke Scale (NIHSS). RESULTS The mean baseline BUN/Cr ratios were higher in the control group and hydration group than in the no chronic hyperglycaemia group. The mean BUN/Cr ratio decreased from 91.22 ± 29.95 on the first day to 77.03 ± 18.23 on the third day (P < .001) in the hydration group. On the third day after admission, there was no significant difference in the BUN/Cr ratio between the hydration group and the no chronic hyperglycaemia group (P = .831). Moreover, neurological deterioration was highest in the control group (33.6%, 36/107), followed by the hydration group (10.5%, 11/105) and the no chronic hyperglycaemia group (5.6%, 8/143). CONCLUSIONS Chronic hyperglycaemia was associated with the admission NIHSS score and neurological deterioration after excluding the effect of stress hyperglycaemia. Furthermore, hydration therapy may help prevent neurological deterioration.
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Affiliation(s)
- J. Lin
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
| | - Y. Weng
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
| | - M. Li
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
| | - Y. Mo
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
| | - J. Zhao
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
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Salas-Zapata L, Palacio-Mejía LS, Aracena-Genao B, Hernández-Ávila JE, Nieto-López ES. Costos directos de las hospitalizaciones por diabetes mellitus en el Instituto Mexicano del Seguro Social. GACETA SANITARIA 2018; 32:209-215. [PMID: 27495830 DOI: 10.1016/j.gaceta.2016.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/04/2016] [Accepted: 06/14/2016] [Indexed: 11/25/2022]
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Arredondo A, Azar A. Challenges of the economic and social effects of diabetes in low- and middle-income countries. J Diabetes 2018; 10:344-345. [PMID: 29206347 DOI: 10.1111/1753-0407.12633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Armando Arredondo
- Health System Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | - Alejandra Azar
- Health System Research Department, National Institute of Public Health, Cuernavaca, Mexico
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Arredondo A. Changing paradigms and challenges: evidence on the epidemiological and economic burden of diabetes in Latin America. Diabet Med 2017; 34:1009-1010. [PMID: 28004431 DOI: 10.1111/dme.13311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/02/2016] [Accepted: 12/19/2016] [Indexed: 12/12/2022]
Affiliation(s)
- A Arredondo
- National Institute of Public Health, Cuernavaca, Mexico
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Arredondo A. Universal coverage and economic burden from epidemiological changes of diabetes in Latin America. J Glob Health 2017; 6:020309. [PMID: 28028433 PMCID: PMC5140078 DOI: 10.7189/jogh.06.020309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Arredondo A, Azar A, Recamán AL. Diabetes, a global public health challenge with a high epidemiological and economic burden on health systems in Latin America. Glob Public Health 2017; 13:780-787. [PMID: 28447537 DOI: 10.1080/17441692.2017.1316414] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This manuscript presents the results of an analysis that highlights the challenges of diabetes as a global public health problem. The analysis was conducted in two phases: the first phase deals with primary data and results of a longitudinal study to provide evidence on the Mexican case. Regarding epidemiological changes between 2014 and 2016, there is an increase of 9-13% (p < .001). Comparing the economic burden from epidemiological changes in 2014 versus 2016 (p < .05), there is a 26% increase. The total amount spent on diabetes in 2015 (US dollars) was $ 8,974,662,570. This includes $ 3,981,426,810 in direct costs and $ 4993,235,752 in indirect costs. The second phase emphasises the analysis of diabetes as a major global public health challenge in the Americas. For this purpose a comparative analysis of epidemiological trends was carried out in seven selected Latin American countries (LACs). The results of both phases showed evidence leading to the conclusion that if the risk factors and models of health care remain as they currently are in LACs, there will be a high economic impact to patients' pockets and to health systems, which could lead to financial collapse.
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Affiliation(s)
| | - Alejandra Azar
- a National Institute of Public Health , Cuernavaca , Mexico
| | - Ana Lucía Recamán
- b Department of Management and Marketing , La Salle University , Cuernavaca , Mexico
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Murillo-Zamora E, García-Ceballos R, Delgado-Enciso I, Garza-Guajardo R, Barboza-Quintana O, Rodríguez-Sánchez IP, Mendoza-Cano O. Regional-level estimation of expected years of life lost attributable to overweight and obesity among Mexican adults. Glob Health Action 2016; 9:31642. [PMID: 27606969 PMCID: PMC5015640 DOI: 10.3402/gha.v9.31642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/07/2016] [Accepted: 07/15/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excess body weight has become a major public health problem worldwide, and the burden of overweight and obesity was calculated in this work from a health economics perspective. OBJECTIVE To estimate the burden of disease attributable to overweight and obesity among males and females aged 20 years and older using years of life lost (YLL) and age-standardized YLL rates (ASYLL), and to rank the leading causes of premature death. DESIGN A cross-sectional study took place (2010-2014) and 6,054 deaths were analyzed. Thirteen basic causes of death associated with overweight or obesity were included. The population attributable fraction (PAF), YLL, and ASYLL were calculated. RESULTS The overall burden attributable to overweight and obesity was 36,087 YLL, and the estimated ASYLL per 10,000 persons was 1,098 and 1,029 in males and females, respectively. Type 2 diabetes mellitus was the main cause of premature death (males, 968 ASYLL; females, 772 ASYLL). CONCLUSIONS Overweight and obesity are major risk factors of chronic diseases that are main causes of premature death in the study population. Strategies for preventing overweight and obesity may decrease the incidence and mortality associated with these non-communicable diseases. ASYLL seems to be an indicator that is particularly well adapted to decision-making in public health.
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Affiliation(s)
- Efrén Murillo-Zamora
- Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, México
| | - Raúl García-Ceballos
- Coordinación de Vigilancia Epidemiológica, Servicios de Salud del Estado de Colima, Colima, México
| | - Iván Delgado-Enciso
- Facultad de Medicina, Universidad de Colima, Colima, México
- Instituto Estatal de Cancerología, Servicios de Salud del Estado de Colima, Colima, México
| | - Raquel Garza-Guajardo
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "José Eleuterio González", Servicio de Anatomía Patológica y Citopatología, Monterrey, Nuevo León, México
| | - Oralia Barboza-Quintana
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "José Eleuterio González", Servicio de Anatomía Patológica y Citopatología, Monterrey, Nuevo León, México
| | - Irám P Rodríguez-Sánchez
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "José Eleuterio González", Departamento de Genética, Monterrey, Nuevo León, México
| | - Oliver Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, Colima, México
- Center for Health and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA, USA; ,
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Ascencio-Montiel IDJ, Kumate-Rodríguez J, Borja-Aburto VH, Fernández-Garate JE, Konik-Comonfort S, Macías-Pérez O, Campos-Hernández Á, Rodríguez-Vázquez H, López-Roldán VM, Zitle-García EJ, Solís-Cruz MDC, Velázquez-Ramírez I, Aguilar-Jiménez M, Villa-Caballero L, Cisneros-González N. Survival rates and worker compensation expenses in a national cohort of Mexican workers with permanent occupational disability caused by diabetes. BMC Public Health 2016; 16:921. [PMID: 27587061 PMCID: PMC5009674 DOI: 10.1186/s12889-016-3598-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/25/2016] [Indexed: 11/25/2022] Open
Abstract
Background Permanent occupational disability is one of the most severe consequences of diabetes that impedes the performance of usual working activities among economically active individuals. Survival rates and worker compensation expenses have not previously been examined among Mexican workers. We aimed to describe the worker compensation expenses derived from pension payments and also to examine the survival rates and characteristics associated with all-cause mortality, in a cohort of 34,014 Mexican workers with permanent occupational disability caused by diabetes during the years 2000–2013 at the Mexican Institute of Social Security. Methods A cross-sectional analysis study was conducted using national administrative records data from the entire country, regarding permanent occupational disability medical certification, pension payment and vital status. Survival rates were estimated using the Kaplan–Meier method. Multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (95 % CI) in order to assess the cohort characteristics and all-cause mortality risk. Total expenses derived from pension payments for the period were accounted for in U.S. dollars (USD, 2013). Results There were 12,917 deaths in 142,725.1 person-years. Median survival time was 7.26 years. After multivariate adjusted analysis, males (HR, 1.39; 95 % CI, 1.29–1.50), agricultural, forestry, and fishery workers (HR, 1.41; 95 % CI, 1.15–1.73) and renal complications (HR, 3.49; 95 % CI, 3.18–3.83) had the highest association with all-cause mortality. The all-period expenses derived from pension payments amounted to $777.78 million USD (2013), and showed a sustained increment: from $58.28 million USD in 2000 to $111.62 million USD in 2013 (percentage increase of 91.5 %). Conclusions Mexican workers with permanent occupational disability caused by diabetes had a median survival of 7.26 years, and those with renal complications showed the lowest survival in the cohort. Expenses derived from pension payments amounted to $ 777 million USD and showed an important increase from 2000 to 2013.
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Affiliation(s)
- Iván de Jesús Ascencio-Montiel
- Epidemiological Surveillance Coordination, Mexican Institute of Social Security, Mier y Pesado 120, Col. del Valle, Benito Juárez, 03100, Mexico City, Mexico
| | - Jesús Kumate-Rodríguez
- Fundación IMSS, A.C., Av. Paseo de la Reforma 476, Col. Juárez, Cuauhtémoc, 06600, Mexico City, Mexico
| | - Víctor Hugo Borja-Aburto
- Primary Health Care Unit, Mexican Institute of Social Security, Hamburgo 18, Col. Juárez, Cuauhtémoc, 06600, Mexico City, Mexico
| | - José Esteban Fernández-Garate
- Epidemiological Surveillance Coordination, Mexican Institute of Social Security, Mier y Pesado 120, Col. del Valle, Benito Juárez, 03100, Mexico City, Mexico
| | - Selene Konik-Comonfort
- Division of Technical Studies, Coordination of Economic Benefits, Mexican Institute of Social Security, Toledo 21, Col. Juárez, Cuauhtémoc, 06600, Mexico City, Mexico
| | - Oliver Macías-Pérez
- Division of Technical Studies, Coordination of Economic Benefits, Mexican Institute of Social Security, Toledo 21, Col. Juárez, Cuauhtémoc, 06600, Mexico City, Mexico
| | - Ángel Campos-Hernández
- Health Information Division, Mexican Institute of Social Security, Durango 289, Col. Roma Norte, Cuauhtémoc, 06700, Mexico City, Mexico
| | - Héctor Rodríguez-Vázquez
- Division of Information Services for Economic and Social Benefits, Mexican Institute of Social Security, Tokio 80, Col. Juárez, Cuauhtémoc, 06600, Mexico City, Mexico
| | - Verónica Miriam López-Roldán
- Division of Rehabilitation, Mexican Institute of Social Security, Durango 289, Col. Roma Norte, Cuauhtémoc, 06700, Mexico City, Mexico
| | - Edgar Jesús Zitle-García
- Occupational Health Coordination, Mexican Institute of Social Security, Av. Cuauhtémoc 330, Col. Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - María Del Carmen Solís-Cruz
- Occupational Health Coordination, Mexican Institute of Social Security, Av. Cuauhtémoc 330, Col. Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Ismael Velázquez-Ramírez
- Occupational Health Coordination, Mexican Institute of Social Security, Av. Cuauhtémoc 330, Col. Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Miriam Aguilar-Jiménez
- Occupational Health Coordination, Mexican Institute of Social Security, Av. Cuauhtémoc 330, Col. Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Leonel Villa-Caballero
- University of California, San Diego Extension, 8950 Villa La Jolla Drive, Suite C-215, La Jolla, California, 92093-0170, USA
| | - Nelly Cisneros-González
- Epidemiological Surveillance Coordination, Mexican Institute of Social Security, Mier y Pesado 120, Col. del Valle, Benito Juárez, 03100, Mexico City, Mexico.
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Seuring T, Archangelidi O, Suhrcke M. The Economic Costs of Type 2 Diabetes: A Global Systematic Review. PHARMACOECONOMICS 2015; 33:811-31. [PMID: 25787932 PMCID: PMC4519633 DOI: 10.1007/s40273-015-0268-9] [Citation(s) in RCA: 482] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. OBJECTIVE We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. METHODS We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries. RESULTS We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs-in stark contrast to HICs-a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis revealed that direct diabetes costs are closely and positively associated with a country's gross domestic product (GDP) per capita, and that the USA stood out as having particularly high costs, even after controlling for GDP per capita. Studies on the labour market impact of diabetes were almost exclusively confined to HICs and found strong adverse effects, particularly for male employment chances. Many of these studies also took into account the possible endogeneity of diabetes, which was not the case for COI studies. CONCLUSIONS The reviewed studies indicate a large economic burden of diabetes, most directly affecting patients in LMICs. The magnitude of the cost estimates differs considerably between and within countries, calling for the contextualization of the study results. Scope remains large for adding to the evidence base on labour market effects of diabetes in LMICs. Further, there is a need for future COI studies to incorporate more advanced statistical methods in their analysis to account for possible biases in the estimated costs.
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Affiliation(s)
- Till Seuring
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK,
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Arredondo A. Type 2 diabetes and health care costs in Latin America: exploring the need for greater preventive medicine. BMC Med 2014; 12:136. [PMID: 25266304 PMCID: PMC4243717 DOI: 10.1186/s12916-014-0136-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/23/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite advances in medicine, health systems in Latin America are not coping with the challenges of chronic diseases. Incidence of disease and the economic burdens as a consequence have both increased in recent years. We have chosen Type 2 diabetes as an example to highlight the challenges posed by chronic diseases, in terms of the epidemiological transition and the economic burden of the demand for services to treat such problems. DISCUSSION Current health systems are not prepared to respond in a comprehensive manner to all phases of the natural history of the disease. There are new models of universal coverage, but resources and models of care are focused on programs aimed at healing/rehabilitation, and very sparsely at detection/prevention. SUMMARY In this scenario, chronic problems have alarmingly increased direct costs (medical care) and indirect costs (temporary disability, permanent disability and premature mortality). If more resources are not assigned to preventive medicine, these trends, in addition to not meeting the needs of the population, will financially collapse health systems and the patients' pockets. This Opinion piece outlines some possible changes that can be implemented to better prepare the health services in Latin American countries.
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Ferreira-Hermosillo A, Valdez-Martínez E, Bedolla M. Ethical issues relating to renal transplantation from prediabetic living donor. BMC Med Ethics 2014; 15:45. [PMID: 24935278 PMCID: PMC4065609 DOI: 10.1186/1472-6939-15-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 06/09/2014] [Indexed: 12/04/2022] Open
Abstract
Background In Mexico, diabetes mellitus is the main cause of end − stage kidney disease, and some patients may be transplant candidates. Organ supply is limited because of cultural issues. And, there is a lack of standardized clinical guidelines regarding organ donation. These issues highlight the tension surrounding the fact that living donors are being selected despite being prediabetic. This article presents, examines and discusses using the principles of non-maleficience, autonomy, justice and the constitutionally guaranteed right to health, the ethical considerations that arise from considering a prediabetic person as a potential kidney donor. Discussion Diabetes is an absolute contraindication for donating a kidney. However, the transplant protocols most frequently used in Mexico do not consider prediabetes as exclusion criteria. In prediabetic persons there are well known metabolic alterations that may compromise the long − term outcomes of the transplant if such donors are accepted. Even so, many of them are finally included because there are not enough donor candidates. Both, families and hospitals face the need to rapidly accept prediabetic donors before the clinical conditions of the recipient and the evolution of the disease exclude him/her as a transplant candidate; however, when using a kidney potentially damaged by prediabetes, neither the donor’s nor the recipient’s long term health is usually considered. Considering the ethical implication as well as the clinical and epidemiological evidence, we conclude that prediabetic persons are not suitable candidates for kidney donation. This recommendation should be taken into consideration by Mexican health institutions who should rewrite their transplant protocols. Summary We argue that the decision to use a kidney from a living donor known to be pre-diabetic or from those persons with family history of T2DM, obesity, hypertension, or renal failure, should be considered unethical in Mexico if the donor bases the decision to donate on socially acceptable norms rather than informed consent as understood in modern medicine.
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Affiliation(s)
- Aldo Ferreira-Hermosillo
- Unidad de Investigación en Endocrinología Experimental, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Cuauhtémoc 330, colonia Doctores, 06729 Mexico City, Mexico.
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Escalante M, Gagliardino JJ, Guzmán JR, Tschiedel B. Call-to-action: timely and appropriate treatment for people with type 2 diabetes in Latin America. Diabetes Res Clin Pract 2014; 104:343-52. [PMID: 24835577 DOI: 10.1016/j.diabres.2014.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/27/2013] [Accepted: 01/01/2014] [Indexed: 01/27/2023]
Abstract
Latin America faces a unique set of challenges in the treatment of type 2 diabetes mellitus (T2DM). This report identifies these challenges and provides a framework for implementation of the strategies, policies and education programs which are needed to optimize the management of this condition. In order to improve future diabetes care, it will be necessary to address existing problems such as limitation of resources, inadequate management of hyperglycemia, and inappropriate education of healthcare team members and people with diabetes. Achieving these goals will require collaborative efforts by many individuals, groups and organizations. These include policymakers, international organizations, healthcare providers, those responsible for setting medical school curricula, patients and society as a whole. It is anticipated that improved/continuing education of healthcare professionals, diabetes self-management education and development of a team approach for T2DM care will lead to optimization of patient-centered care. Implementation of multicentric demonstration studies and rational use of antidiabetic treatments will be necessary to demonstrate the long-term favorable impact of these strategies upon quality of care, prevention of chronic complications, mortality, healthcare costs and patient quality of life.
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Affiliation(s)
- Miguel Escalante
- Hospital de Especialidades, Centro Medico Nacional de Occidente, Mexican Institute of Social Security, Guadalajara, Mexico.
| | - Juan José Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata), PAHO/WHO Collaborating Centre for Diabetes, Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Juan Rosas Guzmán
- Centro de Especialidades Medicas de Celaya, Latin University of Mexico in Celaya, Guanajuato, Mexico
| | - Balduino Tschiedel
- Institute for Children with Diabetes in Porto Alegre and the Brazilian Diabetes Society, Porto Alegre, Brazil
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16
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Yisahak SF, Beagley J, Hambleton IR, Narayan KMV. Diabetes in North America and the Caribbean: an update. Diabetes Res Clin Pract 2014; 103:223-30. [PMID: 24321468 DOI: 10.1016/j.diabres.2013.11.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 11/20/2022]
Abstract
The North America and Caribbean (NAC) Region faces a high burden of diabetes. In 2013, the number of children (aged 0-14 years) with type 1 diabetes was 108,600, with 16.7 new cases diagnosed per 100,000 children. Furthermore, there were 36,755,500 individuals with diabetes (mostly type 2 diabetes) in adults (20-79 years), and an additional 44,277,700 individuals had impaired glucose tolerance. The age-adjusted prevalence of diabetes in adults was 9.6%; the second highest among the seven Regions of the International Diabetes Federation. This estimate is expected to grow to 9.9% by 2035. There was some heterogeneity in the estimates within the Region with the age-adjusted prevalence for the USA estimated at 9.2%, 7.9% for Canada, 12.6% for Mexico, and 9.6% for the Caribbean islands. Mortality due to diabetes in the NAC Region is not limited to older age groups, with 37.6% of deaths occurring in people under the age of 60. The economic impact was also enormous, with healthcare expenditure due to diabetes estimated at 263.2 billion USD for 2013 - the highest of all IDF Regions. Diabetes threatens the public health and economies of countries in the NAC Region, and efforts in prevention and management must be intensified in order to surmount this growing problem.
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Affiliation(s)
- Samrawit F Yisahak
- Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | | | - Ian R Hambleton
- Department of Biostatistics, Chronic Disease Research Centre, The University of the West Indies, Barbados
| | - K M Venkat Narayan
- Ruth and O.C. Hubert Professor of Global Health and Epidemiology, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Yang F, Liu L, Xu W, Liu H, Yin Q, Li H, Guo R, Zhang R, Liu X. Comparison of carotid and cerebrovascular stenosis between diabetic and nondiabetic patients using digital subtraction angiography. J Stroke Cerebrovasc Dis 2014; 23:1327-31. [PMID: 24389378 DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/05/2013] [Accepted: 11/07/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of our study was to evaluate the differences of prevalence and manifestation of extracranial and intracranial artery stenosis between patients with and without type 2 diabetes using digital subtraction angiography. METHODS A retrospective study was conducted by analyzing clinical and lifestyle data collected from 1137 patients enrolled in the Nanjing Stroke Registry Program between June 2004 and March 2011. Vascular risk factors were analyzed, and carotid and cerebrovascular artery stenoses were measured in 383 patients with type 2 diabetes mellitus and 754 nondiabetic patients by digital subtraction angiography. RESULTS In all, 1069 stenoses were found among 383 diabetic patients and 1990 among 754 nondiabetic patients. No statistical differences were observed for the distribution of stenosis in intracranial-extracranial vessels between diabetic and nondiabetic patients (P=.210). There was no difference in the distribution of stenosis in the anterior and posterior circulation vessels between these 2 groups (P=.628). Among diabetic patients with stenosis, a single stenosis was found in 116 (30.29%) and multiple stenoses were found in 267 (69.71%). In their nondiabetic counterparts, a single stenosis was found in 249 (33.02%) and multiple stenoses were found in 505 (66.98%). Compared with nondiabetic patients, the diabetic patients have a tendency of a higher incidence of multiple stenosis. Nonobstructive stenosis occurs more often in diabetic than in nondiabetic patients (P=.002). CONCLUSIONS This retrospective study suggests that diabetes be associated with higher incidence of nonobstructive stenosis and that there be no significant difference observed in the extent and distribution of the extra- and intracranial artery stenoses between diabetic and nondiabetic patients.
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Affiliation(s)
- Fang Yang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China
| | - Ling Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China
| | - Weijun Xu
- Department of Health Care, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China
| | - Haibo Liu
- Department of Dermatology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China
| | - Qin Yin
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China
| | - Hua Li
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China
| | - Ruibing Guo
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China
| | - Renliang Zhang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China.
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Abstract
Objective: While the education gradient in prevention of chronic conditions is well documented, contributing factors remain underexplored. The contribution of income, knowledge and management of illness, market prices, cognitive ability, ability to act, perception about the future, and psychosocial constraints to the education gradient in prevention is examined. Methods: To solve problems of unobservable factors that influence prevention and illness severity, we estimate the role of each component of the education gradient on prevention using data on diabetes and hypertension from five Latin American countries. Results: Overall, these components explain 50% to 70% of the education gradient in prevention, with income being the most important. Discussion: Cognitive ability and ability to act capture an important part of the education gradient in prevention whereas knowledge about illness explains little. Medicine individualized to patients’ cognitive ability and ability to act could improve adherence to prevention protocols among patients with chronic conditions.
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Affiliation(s)
| | - Lisa K. Fleisher
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ascencio-Montiel IDJ, Parra EJ, Valladares-Salgado A, Gómez-Zamudio JH, Kumate-Rodriguez J, Escobedo-de-la-Peña J, Cruz M. SOD2 gene Val16Ala polymorphism is associated with macroalbuminuria in Mexican type 2 diabetes patients: a comparative study and meta-analysis. BMC MEDICAL GENETICS 2013; 14:110. [PMID: 24119114 PMCID: PMC3853578 DOI: 10.1186/1471-2350-14-110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/01/2013] [Indexed: 02/08/2023]
Abstract
Background Several studies in type 2 diabetes patients have shown significant associations between the SOD2 gene Val16Ala polymorphism and albuminuria, but this association has not been explored in the Mexican population. Methods We evaluated the association between the SOD2 gene Val16Ala polymorphism (rs4880) and macroalbuminuria in a sample of 994 unrelated Mexican type 2 diabetes patients. The study included 119 subjects with urinary albumin >300 mg/dL and 875 subjects with urinary albumin ≤ 30 mg/dL. Genotyping of the SOD2 gene Val16Ala SNP was carried out with Real-Time Polymerase Chain Reaction (RT-PCR). Results The frequency of the TT genotype was 6.7% higher in participants with macroalbuminuria than in the normoalbuminuria group (16.8% vs. 10.1%). Using a logistic regression analysis, we observed that individuals with the CC genotype had significantly lower risks of macroalbuminuria than those with the TT genotype (OR=0.42, p=0.034). We carried out a meta-analysis combining our data with data from four previous studies and estimated an odds ratio (95% CI) for the C allele (with respect to the reference T allele) of 0.65 (0.52-0.80, p<0.001). Conclusions A significant association was found between the SOD2 Val16Ala polymorphism and macroalbuminuria in a sample of Mexican type 2 diabetes patients.
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Affiliation(s)
- Iván de Jesús Ascencio-Montiel
- Biochemistry Research Unit, Hospital de Especialidades, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico DF, Mexico.
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Arredondo A, Reyes G. Health disparities from economic burden of diabetes in middle-income countries: evidence from México. PLoS One 2013; 8:e68443. [PMID: 23874629 PMCID: PMC3709919 DOI: 10.1371/journal.pone.0068443] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/29/2013] [Indexed: 12/27/2022] Open
Abstract
The rapid growth of diabetes in middle-income countries is generating disparities in global health. In this context we conducted a study to quantify the health disparities from the economic burden of diabetes in México. Evaluative research based on a longitudinal design, using cost methodology by instrumentation. For the estimation of epidemiological changes during the 2010–2012 period, several probabilistic models were developed using the Box-Jenkins technique. The financial requirements were obtained from expected case management costs by disease and the application of an econometric adjustment factor to control the effects of inflation. Comparing the economic impact in 2010 versus 2012 (p<0.05), there was a 33% increase in financial requirements. The total amount for diabetes in 2011 (US dollars) was $7.7 billion. It includes $3.4 billion in direct costs and $4.3 in indirect costs. The total direct costs were $.4 billion to the Ministry of Health (SSA), serving the uninsured population; $1.2 to the institutions serving the insured population (Mexican Institute for Social Security–IMSS-, and Institute for Social Security and Services for State Workers-ISSSTE-); $1.8 to users; and $.1 to Private Health Insurance (PHI). If the risk factors and the different health care models remain as they currently are in the analyzed institutions, health disparities in terms of financial implications will have the greatest impact on users’ pockets. In middle-income countries, health disparities generated by the economic burden of diabetes is one of the main reasons for catastrophic health expenditure. Health disparities generated by the economic burden of diabetes suggests the need to design and review the current organization of health systems and the relevance of moving from biomedical models and curative health care to preventive and socio-medical models to meet expected challenges from diseases like diabetes in middle-income countries.
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Affiliation(s)
- Armando Arredondo
- Research Center on Health System, National Institute of Public Health, Cuernavaca, Morelos, México.
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Home P, Haddad J, Latif ZA, Soewondo P, Benabbas Y, Litwak L, Guler S, Chen JW, Zilov A. Comparison of National/Regional Diabetes Guidelines for the Management of Blood Glucose Control in non-Western Countries. Diabetes Ther 2013; 4:91-102. [PMID: 23645286 PMCID: PMC3687090 DOI: 10.1007/s13300-013-0022-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Development of higher standards for diabetes care is a core element of coping with the global diabetes epidemic. Diabetes guidelines are part of the approach to raising standards. The epidemic is greatest in countries with recent rises in income from a low base. The objective of the current study was to investigate the availability and nature of locally produced diabetes guidelines in such countries. METHODS Searches were conducted using Medline, Google, and health ministry and diabetes association websites. RESULTS Guidelines were identified in 33 of 75 countries outside North America, western Europe, and Australasia. In 25 of these 33 countries, management strategies for type 1 diabetes were included. National guidelines relied heavily on pre-existing national and international guidelines, with reference to American Diabetes Association standards of medical care and/or other consensus statements by 55%, International Diabetes Federation by 36%, European Association for the Study of Diabetes by 12%, and American Association of Clinical Endocrinologists by 9%. The identified guidelines were generally evidence-based, though there was some use of secondary evidence reviews, including other guidelines, rather than original literature reviews and evidence synthesis. In type 1 diabetes guidelines, the option of different insulin regimens (mostly meal-time + basal or premix regimens) was recommended depending on patient need. Type 2 diabetes guidelines either recommended a glycosylated hemoglobin target of <7.0% (<53 mmol/mol) (70% of guidelines) or <6.5% (<47 mmol/mol) (30% of guidelines) as the ideal glycemic target. Most guidelines recommended a target fasting plasma glucose that fell within the range of 3.8-7.2 mmol/L. Most guidelines also set a 2-h post-prandial glucose target value within the range of 4.0-8.3 mmol/L. CONCLUSION While only a first step in achieving a high quality of disease management, national guidelines of quality and with fair consistency of recommendations are becoming prevalent globally. A further challenge is implementation of guidelines, by integration into local care processes.
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Affiliation(s)
- Philip Home
- Institute of Cellular Medicine, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK,
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Zhao FL, Xie F, Hu H, Li SC. Transferability of indirect cost of chronic disease: a systematic review and meta-analysis. PHARMACOECONOMICS 2013; 31:501-508. [PMID: 23620212 DOI: 10.1007/s40273-013-0053-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Indirect cost is an important component in economic evaluations. The variation in the magnitude of indirect costs across studies and countries is substantial and affects the transferability of results across jurisdictions. OBJECTIVE This study explored the factors involved in the variation of reported indirect cost and investigated the feasibility of transferring indirect costs across settings. METHODS A systematic literature review was conducted to identify studies estimating indirect costs for four selected chronic diseases, namely, asthma (AS), diabetes (DI), rheumatoid arthritis (RA) and schizophrenia (SC). A multiple linear regression analysis was run to identify the factors that potentially explain the variation in reported indirect costs. Parametric (fixed- and random-effect models) and non-parametric (bootstrapping method) meta-analyses were applied to local gross domestic product (GDP)/capita-adjusted indirect costs for each disease. Results from the three different analytical methods were compared to ascertain the robustness of estimation. RESULTS The systematic literature review identified 77 articles that reported indirect costs of AS (n = 18), DI (n = 20), RA (n = 25) and SC (n = 14) for literature synthesis. Substantial inter- and intra-disease variations among the indirect cost studies were observed with respect to geographic distribution, methodology and magnitude of cost estimation. Regression analysis showed that disease categories and local GDP/capita significantly (p < 0.001) contributed to the variance of indirect cost. The range of intra-disease variation in indirect costs was substantially reduced after adjusting by and expressing values as local GDP/capita. The GDP-adjusted indirect cost in terms of percentage of local GDP/capita of AS was the lowest and that of SC was the highest. Bootstrapping estimation was relatively conservative, with slightly wider confidence intervals (CIs) than the parametric method, with a mean (95 % CI) of 2.12 % (1.4089-2.9332) for AS, 10.65 % (7.215-14.7438) for DI, 21.98 % (17.4360-27.0631) for RA, and 79.19 % (52.4243-117.833) for SC. CONCLUSION It would be convenient and feasible to construct a universal reference range of indirect cost for a specific disease based on existing data and present this as a percentage of local GDP to assist local decision making in jurisdictions where indirect cost data are not available.
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Affiliation(s)
- Fei-Li Zhao
- School of Biomedical Sciences and Pharmacy, University of Newcastle, R108, MS building, University of Newcastle, Callaghan, NSW 2308, Australia
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Barquera S, Campos-Nonato I, Aguilar-Salinas C, Lopez-Ridaura R, Arredondo A, Rivera-Dommarco J. Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy. Global Health 2013; 9:3. [PMID: 23374611 PMCID: PMC3599194 DOI: 10.1186/1744-8603-9-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/25/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy. METHOD We review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field. RESULTS There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country. CONCLUSIONS The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future.
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Affiliation(s)
- Simon Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Ismael Campos-Nonato
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Carlos Aguilar-Salinas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F, Mexico
| | - Ruy Lopez-Ridaura
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Armando Arredondo
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Juan Rivera-Dommarco
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
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Arredondo A. Diabetes: a global challenge with high economic burden for public health systems and society. Am J Public Health 2012; 103:e1-2. [PMID: 23237161 DOI: 10.2105/ajph.2012.301106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pérez-Cuevas R, Doubova SV, Suarez-Ortega M, Law M, Pande AH, Escobedo J, Espinosa-Larrañaga F, Ross-Degnan D, Wagner AK. Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico. BMC Med Inform Decis Mak 2012; 12:50. [PMID: 22672471 PMCID: PMC3437217 DOI: 10.1186/1472-6947-12-50] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 06/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM. METHODS We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009. RESULTS We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c <7% (or plasma glucose≤130 mg/dl). CONCLUSIONS EHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC.
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Affiliation(s)
- Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Washignton, USA
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, México, DF, Mexico
| | - Magdalena Suarez-Ortega
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, México, DF, Mexico
| | - Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Aakanksha H Pande
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jorge Escobedo
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1 Carlos MacGregor Sánchez Navarro, IMSS, México, DF, México
| | | | - Dennis Ross-Degnan
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Anita K Wagner
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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de León-Castañeda CD, Altagracia-Martínez M, Kravzov-Jinich J, Cárdenas-Elizalde MDR, Moreno-Bonett C, Martínez-Núñez JM. Cost-effectiveness study of oral hypoglycemic agents in the treatment of outpatients with type 2 diabetes attending a public primary care clinic in Mexico City. CLINICOECONOMICS AND OUTCOMES RESEARCH 2012; 4:57-65. [PMID: 22427724 PMCID: PMC3304331 DOI: 10.2147/ceor.s27826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Worldwide, diabetes mellitus presents a high burden for individuals and society. In Latin America, many people with diabetes have limited access to health care, which means that indirect costs may exceed direct health care cost. Diabetes is Mexico's leading cause of death. PURPOSE To evaluate the cost-effectiveness ratios of the most used oral hypoglycemic agents (OHA) in the treatment of outpatients with type 2 diabetes attending a public primary care clinic in Mexico City. DESIGN A cross-sectional and analytic study was conducted in Mexico City. METHODOLOGY Twenty-seven adult outpatients with type 2 diabetes who were treated either with metformin or glibenclamide were included. Acarbose was used as an alternative strategy. The study was carried out from the perspective of Mexican society. Direct medical and nonmedical costs as well as indirect costs were evaluated using a structured questionnaire. Efficacies of all drug treatments were evaluated retrospectively. A systematic search was conducted to select published randomized clinical trials based on predetermined inclusion criteria, and treatment success was defined as glycosylated hemoglobin factor ≤ 7%. Efficacy data of each drug and/or combination were analyzed using meta-analysis. The Monte Carlo Markov model was used. Quality-adjusted life-years (QALY) were used as the unit of effectiveness; incremental and sensitive analyses were performed and a 5% discount rate was calculated. A hypothetical cohort of 10,000 patients was modeled. RESULTS The odds ratios of the success of each drug treatment were obtained from the meta-analyses, and were the following: 5.82 (glibenclamide), 3.86 (metformin), 3.5 (acarbose), and 6.76 (metformin-glibenclamide). The cost-effectiveness ratios found were US$272.63/QALY (glibenclamide), US$296.48/QALY (metformin), and US$409.86/QALY (acarbose). Sensitivity analysis did not show changes for the most cost-effective therapy when the effectiveness probabilities or treatment costs were modified. CONCLUSION Glibenclamide is the most cost-effective treatment for the present study outpatient population diagnosed with type 2 diabetes in the early stages.
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Affiliation(s)
- Christian Díaz de León-Castañeda
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Marina Altagracia-Martínez
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Jaime Kravzov-Jinich
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Ma del Rosario Cárdenas-Elizalde
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Consuelo Moreno-Bonett
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
| | - Juan Manuel Martínez-Núñez
- Department of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, Mexico
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Elgart JF, Gonzalez L, Caporale JE, Valencia JE, Gagliardino JJ. Economic evaluation of type 2 diabetes treatment with saxagliptin in Colombia. Medwave 2012. [DOI: 10.5867/medwave.2012.02.5306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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ALANIS ALMAY, LEON BLANCAS, SANCHEZ EDGARN, RUIZ-VELAZQUEZ EDUARDO. BLOOD GLUCOSE LEVEL NEURAL MODEL FOR TYPE 1 DIABETES MELLITUS PATIENTS. Int J Neural Syst 2012; 21:491-504. [DOI: 10.1142/s0129065711003000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper deals with the blood glucose level modeling for Type 1 Diabetes Mellitus (T1DM) patients. The model is developed using a recurrent neural network trained with an extended Kalman filter based algorithm in order to develop an affine model, which captures the nonlinear behavior of the blood glucose metabolism. The goal is to derive a dynamical mathematical model for the T1DM as the response of a patient to meal and subcutaneous insulin infusion. Experimental data given by continuous glucose monitoring system is utilized for identification and for testing the applicability of the proposed scheme to T1DM subjects.
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Affiliation(s)
- ALMA Y. ALANIS
- CUCEI, Universidad de Guadalajara, Apartado Postal 51–71, Col. las Aguilas, C.P. 45080, Zapopan, Jalisco, Mexico
| | - BLANCA S. LEON
- CINVESTAV, Unidad Guadalajara, Apartado Postal 31–438, Plaza La Luna, Guadalajara, Jalisco, C.P. 45091, Mexico
| | - EDGAR N. SANCHEZ
- CINVESTAV, Unidad Guadalajara, Apartado Postal 31–438, Plaza La Luna, Guadalajara, Jalisco, C.P. 45091, Mexico
| | - EDUARDO RUIZ-VELAZQUEZ
- Division de Electronica y Computacion, CUCEI, Universidad de Guadalajara, Av. Revolucion 1500, Guadalajara, Jal., Mexico
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Abdulameer SA, Sulaiman SAS, Hassali MAA, Subramaniam K, Sahib MN. Osteoporosis and type 2 diabetes mellitus: what do we know, and what we can do? Patient Prefer Adherence 2012; 6:435-48. [PMID: 22791981 PMCID: PMC3393120 DOI: 10.2147/ppa.s32745] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Diabetes mellitus (DM) is a pandemic and chronic metabolic disorder with substantial morbidity and mortality. In addition, osteoporosis (OP) is a silent disease with a harmful impact on morbidity and mortality. Therefore, this systematic review focuses on the relationship between OP and type 2 diabetes mellitus (T2DM). Systematic reviews of full-length articles published in English from January 1950 to October 2010 were identified in PubMed and other available electronic databases on the Universiti Sains Malaysia Library Database. The following keywords were used for the search: T2DM, OP, bone mass, skeletal. Studies of more than 50 patients with T2DM were included. Forty-seven studies were identified. The majority of articles (26) showed increased bone mineral density (BMD), while 13 articles revealed decreased BMD; moreover, eight articles revealed normal or no difference in bone mass. There were conflicting results concerning the influence of T2DM on BMD in association with gender, glycemic control, and body mass index. However, patients with T2DM display an increased fracture risk despite a higher BMD, which is mainly attributable to the increased risk of falling. As a conclusion, screening, identification, and prevention of potential risk factors for OP in T2DM patients are crucial and important in terms of preserving a good quality of life in diabetic patients and decreasing the risk of fracture. Patients with T2DM may additionally benefit from early visual assessment, regular exercise to improve muscle strength and balance, and specific measures for preventing falls. Patient education about an adequate calcium and vitamin D intake and regular exercise is important for improving muscle strength and balance. Furthermore, adequate glycemic control and the prevention of diabetic complications are the starting point of therapy in diabetic patients.
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Affiliation(s)
- Shaymaa Abdalwahed Abdulameer
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Correspondence: Shaymaa Abdalwahed Abdulameer, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia, Tel +60 4 603 5422, Fax +60 4 657 0017, Email
| | | | | | | | - Mohanad Naji Sahib
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Arredondo A, De Icaza E. [The cost of diabetes in Latin America: evidence from Mexico]. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:S85-8. [PMID: 21839907 DOI: 10.1016/j.jval.2011.05.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
UNLABELLED The main objective was to identify economic burden from epidemiological changes and expected demand for health care services for diabetes in México. The cost evaluation method to estimate direct and indirect costs was based on instrumentation and consensus techniques. To estimate the epidemiological changes for 2009-2011, three probabilistic models were constructed according to the Box-Jenkins technique. Comparing the economic impact in 2009 versus 2011 (p< 0.05), there is a 33% increase in financial requirements. The total amount for diabetes in 2010 (US dollars) will be $778,427,475. It includes $343,226,541 in direct costs and $435,200,934 in indirect costs. The total direct costs expected are: $40,787,547 for the Ministry of Health (SSA), serving to uninsured population; $113,664,454 for insured population (Mexican Institute for Social Security-IMSS-, and Institute for Social Security and Services for State Workers-ISSSTE-); $178,477,754 to users; and $10,296,786 to Private Health Insurance (PHI). CONCLUSIONS If the risk factors and the different health care models remain as they are currently in the institutions analyzed, the financial consequences would be of major impact for the pockets of the users, following in order of importance, social security institutions and finally Ministry of Health. Allocate more resources to promotion and prevention of diabetes will decrease the cost increase by decreasing the demand for treatment of complications.
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Affiliation(s)
- Armando Arredondo
- Instituto Nacional de Salud Pública, Av Universidad # 655, Cuernavaca Mor, México.
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Trujillo AJ, Vecino Ortiz AI, Ruiz Gómez F, Steinhardt LC. Health insurance doesn't seem to discourage prevention among diabetes patients in Colombia. Health Aff (Millwood) 2011; 29:2180-8. [PMID: 21134918 DOI: 10.1377/hlthaff.2010.0463] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the South American nation of Colombia, as elsewhere, patients with type 2 diabetes often avoid care that could prevent their condition from worsening. Availability of health insurance may play a role in explaining this behavior. Some patients with diabetes skip preventive measures because they have insurance and calculate that they can access curative services later in life. Insurers may limit preventive services coverage because they can't be assured of sharing in the eventual savings that emerge when a chronic condition such as diabetes is managed properly. Our analysis of a nationally representative sample of Colombians who have type 2 diabetes and who pay premiums into the country's "contributory" insurance program, found no evidence that insurance influences those individuals to avoid preventive services. The evidence is less clear for those participating in a different, fully subsidized insurance program, who-despite the availability of preventive care-are no more likely to seek preventive visits than are uninsured patients. We propose controlled experiments to identify and measure the true causal effects of insurance on prevention and, more broadly, steps to increase patients' understanding of the benefits of prevention.
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Affiliation(s)
- Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, USA.
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Martínez Núñez JM, Altagracia Martínez M, Ríos C, Kravzov Jinich J, Hinojosa Cruz JC, Vital Reyes VS. Cost-effectiveness study of clomiphene citrate versus anastrozole for inducing ovulation in infertile adult patients in a public hospital, La Raza in Mexico City. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2011. [DOI: 10.1111/j.1759-8893.2010.00027.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Valladares-Salgado A, Angeles-Martínez J, Rosas M, García-Mena J, Utrera-Barillas D, Gómez-Díaz R, Escobedo-de la Peña J, Parra EJ, Cruz M. Association of polymorphisms within the transforming growth factor-β1 gene with diabetic nephropathy and serum cholesterol and triglyceride concentrations. Nephrology (Carlton) 2011; 15:644-8. [PMID: 20883286 DOI: 10.1111/j.1440-1797.2010.01302.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM The TGF-β gene participates in the development of chronic kidney disease. We investigated whether the 869 T > C, 915 G > C and -800 G > A polymorphisms of TGF-β1 are associated with diabetic nephropathy (DN). METHODS Polymorphisms were genotyped in 439 type 2 diabetes mellitus patients, 233 with diabetic nephropathy (DN+) and 206 without (DN-). The sample was characterized for relevant clinical and biochemical parameters. RESULTS The 869 T > C (P = 0.016; odds ratio (OR) = 1.818, 95% confidence interval (CI) = 1.128-2.930) and the 915 G > C polymorphisms (P = 0.008, OR = 4.073, 95% CI = 1.355-12.249) were associated with diabetic nephropathy. The 869 T > C variant was associated with total cholesterol levels: CC + CT genotypes had a mean cholesterol concentration of 5.62 ± 1.40 mmol/L vs a mean concentration of 5.15 ± 1.40 mmol/L for the TT genotype (P = 0.011). Triglycerides were also higher in CC + CT genotypes (2.49 ± 1.56 mmol/L) in comparison with TT homozygotes (2.1 ± 1.22 mmol/L, P = 0.042). Multivariate logistic regression showed that the polymorphisms 869 T > C and 915 G > C were independent predictors for DN (P = 0.049 and 0.046, respectively). CONCLUSION The 869 T > C and 915 G > C polymorphisms within the TGF-β1 gene were associated with DN+. Lower cholesterol and triglycerides levels were observed in TT homozygotes for the 869 T > C polymorphism. The TGF-β1 869 T allele seems to confer protection against DN+.
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Affiliation(s)
- Adán Valladares-Salgado
- Siglo XXI National Medical Centre, Dr Carlos McGregor Sánchez Regional General Hospital, IMSS, México D.F., Mexico.
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Affiliation(s)
- Iliana V. Kohler
- a Population Studies Center , University of Pennsylvania , 239 McNeil Building, 3718 Locust Walk, Philadelphia , PA , 19104–6298 E-mail:
| | - Beth J. Soldo
- b Population Studies Center , University of Pennsylvania
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Andrade FCD. Measuring the impact of diabetes on life expectancy and disability-free life expectancy among older adults in Mexico. J Gerontol B Psychol Sci Soc Sci 2010; 65B:381-9. [PMID: 20028950 PMCID: PMC2853602 DOI: 10.1093/geronb/gbp119] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 08/25/2009] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED OBJECTIVES. The aim of the present study is to investigate differences in total life expectancy (TLE), disability-free life expectancy (DFLE), disabled life expectancy (DLE), and personal care assistance between individuals with and without diabetes in Mexico. METHODS The sample was drawn from the nationally representative Mexican Health and Aging Study. Disability was assessed through a basic Activities of Daily Living (ADL) measure, the Instrumental Activities of Daily Living (IADL) scale, and the Nagi physical performance measure. The Interpolation of Markov Chains method was used to estimate the impact of diabetes on TLE and DFLE. RESULTS Results indicate that diabetes reduces TLE at ages 50 and 80 by about 10 and 4 years, respectively. Diabetes is also associated with fewer years in good health. DFLE (based on ADL measures) at age 50 is 20.8 years (95% confidence interval [CI]: 19.2-22.3) for those with diabetes, compared with 29.9 years (95% CI: 28.8-30.9) for those without diabetes. Regardless of diabetes status, Mexican women live longer but face a higher disability burden than men. CONCLUSION Among older adults in Mexico, diabetes is associated with shorter TLE and DFLE. The negative effect of diabetes on the number of years lived, particularly in good health, creates significant economic, social, and individual costs for elderly Mexicans.
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Affiliation(s)
- Flávia C D Andrade
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, 123 Huff Hall, 1206 South Fourth Street, Champaign, IL 61820, USA.
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Affiliation(s)
- Philip D Home
- ICM-Diabetes, The Medical School, Newcastle University, Newcastle upon Tyne, UK.
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Baik S, Chacra AR, Yuxiu L, White J, Güler S, Latif ZA. Conducting cost-effectiveness analyses of type 2 diabetes in low- and middle-income countries: can locally generated observational study data overcome methodological limitations? Diabetes Res Clin Pract 2010; 88 Suppl 1:S17-22. [PMID: 20466164 DOI: 10.1016/s0168-8227(10)70004-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In low- and middle-income countries, the high personal and economic burden of type 2 diabetes is further compounded by inadequate resources for diabetes care when compared with high-income countries. Health technology assessments (HTAs) aim to inform policy decision makers in their efforts to achieve more effective allocation of resources by providing evidence-based input on new technologies. Within the hierarchy of evidence, randomized controlled trials (RCTs) remain the 'gold standard' used to inform HTAs, but are limited by poor external validity (ie, generalizability to real-world populations). Unlike RCTs, observational studies are able to enrol broader patient populations, but their design renders such studies vulnerable to confounding factors and selection bias. However, it is increasingly recognized that observational studies can complement RCTs by supporting and extending efficacy findings from RCTs to real-world clinical practice, particularly across geographical populations. They can also provide locally relevant baseline and disease natural history data to populate health economic models. Thus, observational data are likely to be of considerable informative value to policy makers in developing countries reaching decisions on diabetes care within an environment of scarce resources.
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Affiliation(s)
- Seihyun Baik
- Division of Endocrinology, Korea University Guro Hospital, Seoul, South Korea
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Hughes C, Spence D, Holmes VA, McCorry NK. Preconception care for women with diabetes: the midwife's role. ACTA ACUST UNITED AC 2010. [DOI: 10.12968/bjom.2010.18.3.46915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Escobedo J, Buitrón LV, Velasco MF, Ramírez JC, Hernández R, Macchia A, Pellegrini F, Schargrodsky H, Boissonnet C, Champagne BM. High prevalence of diabetes and impaired fasting glucose in urban Latin America: the CARMELA Study. Diabet Med 2009; 26:864-71. [PMID: 19719706 DOI: 10.1111/j.1464-5491.2009.02795.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Cardiovascular risk is increased with glucose metabolism abnormalities. Prevalence data can support public health initiatives required to address this risk. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was designed to estimate the prevalence of Type 2 diabetes, impaired fasting glucose and related risk factors in seven urban Latin American populations. METHODS CARMELA was a cross-sectional, population-based study of 11 550 adults 25-64 years of age. With a multi-stage sample design of a probabilistic nature, approximately 1600 subjects were randomly selected in each city. RESULTS Overall, the prevalence of diabetes was 7.0% (95% confidence intervals 6.5-7.6%). The prevalence of individuals with diabetes or impaired fasting glucose increased with increasing age. In the oldest age category, 55-64 years of age, prevalence of diabetes ranged from 9 to 22% and prevalence of impaired fasting glucose ranged from 3 to 6%. Only 16.3% of people with prior diagnosis of diabetes and who were receiving pharmacologic treatment, were in good glycaemic control (fasting glucose < 6.1 mmol/l). The prevalence of diabetes in individuals with abdominal obesity was approximately twofold higher. Participants with hypertension, elevated serum triglycerides and increased common carotid artery intima-media thickness were also more likely to have diabetes. CONCLUSIONS The prevalence of diabetes and impaired fasting glucose is high in seven major Latin American cities; intervention is needed to avoid substantial medical and socio-economic consequences. CARMELA supports the associations of abdominal obesity, hypertension, elevated serum triglycerides and carotid intima-media thickness with diabetes.
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Affiliation(s)
- J Escobedo
- Medical Research Unit on Clinical Epidemiology, Mexican Social Security Institute, Mexico City, Mexico.
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Corona-Rojo JA, Altagracia-Martínez M, Kravzov-Jinich J, Vázquez-Cervantes L, Pérez-Montoya E, Rubio-Poo C. Potential prescription patterns and errors in elderly adult patients attending public primary health care centers in Mexico City. Clin Interv Aging 2009; 4:343-50. [PMID: 19750234 PMCID: PMC2739633 DOI: 10.2147/cia.s5198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Six out of every 10 elderly persons live in developing countries. Objective To analyze and assess the drug prescription patterns and errors in elderly outpatients attending public health care centers in Mexico City, Mexico. Materials and methods A descriptive and retrospective study was conducted in 2007. Fourteen hundred prescriptions were analyzed. Prescriptions of ambulatory adults aged >70 years who were residents of Mexico City for at least two years were included. Prescription errors were divided into two groups: (1) administrative and legal, and (2) pharmacotherapeutic. In group 2, we analyzed drug dose strength, administration route, frequency of drug administration, treatment length, potential drug–drug interactions, and contraindications. Variables were classified as correct or incorrect based on clinical literature. Variables for each drug were dichotomized as correct (0) or incorrect (1). A Prescription Index (PI) was calculated by considering each drug on the prescription. SPSS statistical software was used to process the collected data (95% confidence interval; p <0.05). Results The drug prescription pattern in elderly outpatients shows that 12 drugs account for 70.72% (2880) of prescribed drugs. The most prescribed drugs presented potential pharmacotherapeutic errors (as defined in the present study). Acetylsalicylic acid–captopril was the most common potential interaction (not clinically assessed). Potential prescription error was high (53% of total prescriptions). Most of the prescription errors were due to omissions of dosage, administration route, and length of treatment and may potentially cause harm to the elderly outpatients. Conclusions A high number of potential prescription errors were found, mainly due to omissions. The drug prescription pattern of the study population is mainly constituted by 12 drugs. The results indicate that prescription quality depends on the number of prescribed drugs per prescription (p < 0.000).
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Affiliation(s)
- José Antonio Corona-Rojo
- Division of Biological Sciences and Health, Metropolitan Autonomous University, Campus Xochimilco, Xochimilco, México
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Gómez-Rico JA, Altagracia-Martínez M, Kravzov-Jinich J, Cárdenas-Elizalde R, Rubio-Poo C. The costs of breast cancer in a Mexican public health institution. Risk Manag Healthc Policy 2008; 1:15-21. [PMID: 22312199 PMCID: PMC3270895 DOI: 10.2147/rmhp.s4500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Breast cancer (BC) is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94) were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM) surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS) were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS.
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Affiliation(s)
- Jacobo Alejandro Gómez-Rico
- Universidad Autónoma Metropolitano-Xochimilco (UAM-X), Departments: Biological Systems and Healthcare, Biological and Health Sciences Division (DCBS)
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Alonso-Castro AJ, Salazar-Olivo LA. The anti-diabetic properties of Guazuma ulmifolia Lam are mediated by the stimulation of glucose uptake in normal and diabetic adipocytes without inducing adipogenesis. JOURNAL OF ETHNOPHARMACOLOGY 2008; 118:252-256. [PMID: 18487028 DOI: 10.1016/j.jep.2008.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 04/02/2008] [Accepted: 04/05/2008] [Indexed: 05/26/2023]
Abstract
ETHNOPHARMACOLOGICAL IMPORTANCE Guazuma ulmifolia Lam (Sterculiaceae) is a plant extensively used in México for the empirical treatment of type 2 diabetes. AIM OF THE STUDY To investigate the anti-diabetic mechanisms of Guazuma ulmifolia. MATERIALS AND METHODS Non-toxic concentrations of Guazuma ulmifolia aqueous extracts (GAE) were assayed on adipogenesis and 2-NBDglucose uptake in the murine 3T3-F442A preadipose cell line. RESULTS GAE added to adipogenic medium (AM) did not affect adipogenesis at any of the tested concentrations (1-70 microg/ml), whereas in AM lacking insulin GAE 70 microg/ml induced triglyceride accumulation by 23%. On the other hand, GAE 70 microg/ml stimulated 2-NBDG uptake by 40% in insulin-sensitive 3T3-F442A adipocytes and by 24% in insulin-resistant adipocytes, with respect to the incorporation showed by insulin-sensitive adipocytes stimulated with the hormone. CONCLUSION Guazuma ulmifolia exerts its anti-diabetic effects by stimulating glucose uptake in both insulin-sensitive and insulin-resistant adipocytes without inducing adipogenesis.
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Affiliation(s)
- Angel Josabad Alonso-Castro
- Instituto Potosino de Investigación Científica y Tecnológica, División de Biología Molecular, Camino a la Presa San José 2055, Lomas 4a secc., 78216 San Luis Potosí, SLP, Mexico
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Arredondo A, Barceló A. The economic burden of out-of-pocket medical expenditures for patients seeking diabetes care in Mexico. Diabetologia 2007; 50:2408-9. [PMID: 17879080 DOI: 10.1007/s00125-007-0828-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 08/10/2007] [Indexed: 11/30/2022]
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Rahman S, Rahman T, Ismail AAS, Rashid ARA. Diabetes-associated macrovasculopathy: pathophysiology and pathogenesis. Diabetes Obes Metab 2007; 9:767-80. [PMID: 17924861 DOI: 10.1111/j.1463-1326.2006.00655.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The complications associated with diabetic vasculopathy are commonly grouped into two categories: microvascular and macrovascular complications. In diabetes, macrovascular disease is the commonest cause of mortality and morbidity and is responsible for high incidence of vascular diseases such as stroke, myocardial infarction and peripheral vascular diseases. Macrovascular diseases are traditionally thought of as due to underlying obstructive atherosclerotic diseases affecting major arteries. Pathological changes of major blood vessels leading to functional and structural abnormalities in diabetic vessels include endothelial dysfunction, reduced vascular compliance and atherosclerosis. Besides, advanced glycation end product formation interacts with specific receptors that lead to overexpression of a range of cytokines. Haemodynamic pathways are activated in diabetes and are possibly amplified by concomitant systemic hypertension. Apart from these, hyperglycaemia, non-enzymatic glycosylation, lipid modulation, alteration of vasculature and growth factors activation contribute to development of diabetic vasculopathy. This review focuses on pathophysiology and pathogenesis of diabetes-associated macrovasculopathy.
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Affiliation(s)
- Sayeeda Rahman
- Department of Pharmacology, School of Medical Sciences, Kubang Kerian, University Sains Malaysia, Kelantan, Malaysia.
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Quiroz G, Femat R. On hyperglicemic glucose basal levels in Type 1 Diabetes Mellitus from dynamic analysis. Math Biosci 2007; 210:554-75. [PMID: 17709117 DOI: 10.1016/j.mbs.2007.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 06/26/2007] [Accepted: 06/26/2007] [Indexed: 11/21/2022]
Abstract
Compartmental-Physiological Models (CPM's) have been used to derive feedback controllers for the glucose regulation in Diabetes Mellitus (DM). Despite these important advances, there are two criticisms about the use of the CPM's in DM: (i) Can this class of model reproduce severe basal glucose levels (e.g., larger than 300 mg/dl)? and (ii) Does a CPM reproduce a distinct glucose level as its parameters change or is it unique even if its parameters change? This contribution aims these criticisms from the study of the parametric sensitivity of a CPM. The results exploit the analysis of the dynamic properties of the chosen CPM and permit to show that such model can reproduce distinct severe basal levels by modifying the values of the metabolic parameters, which agree with expectations on a realistic model. Mainly, the chosen CPM has been selected due to the following two reasons. (i) It includes the main organs related to the glucose metabolism in Type 1 Diabetes Mellitus (T1DM); as, for example, the liver, brain and kidney. (ii) It models metabolic phenomena as, for instance, the counter-regulatory effects by glucagon and the hepatic glucose uptake/production. Additionally, the chosen model has been recently used to design feedback controllers for the glucose regulation with very promissory results.
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Affiliation(s)
- G Quiroz
- Laboratorio para Biodinámica y Sistemas Alineales, División de Matemáticas Aplicadas IPICyT, Apdo Postal 3-90 Tangamanga, 78231 San Luis Potosí, SLP, Mexico.
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Garcia-Garcia G, Aviles-Gomez R, Luquin-Arellano VH, Padilla-Ochoa R, Lepe-Murillo L, Ibarra-Hernandez M, Briseño-Renteria G. Cardiovascular risk factors in the Mexican population. Ren Fail 2007; 28:677-87. [PMID: 17162426 DOI: 10.1080/08860220600936096] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Chronic degenerative disorders have become a major health problem in Mexico. Cardiovascular diseases represent the first cause of death in our country. Diabetes mellitus (DM) has emerged as the main health problem in Mexico. Its prevalence doubled from < 3% in the 1960s to 6% in the 1980s. Between 1993 and 2000, diabetes mellitus increased from 6.7% to 8.2%, a 22% growth over a seven-year period. In 1995, the cost of the treatment of DM represented 15.48% of the health budget and 0.79% of the GDP. The prevalence of hypertension (HTN) increased from 10% in 1933 to 20% in 1990 and from 23.8% to 30.7% between 1993 and 2000. The expenditures from HTN in 1999 corresponded to 13.9% of the health budget, and 0.71% of GDP. Dyslipidemias are very common. Close to 40% of the population has levels of HDL cholesterol < 35 mg/dL, 24.3% has fasting triglycerides > 200 mg/dL, and 10% has hypercholesterolemia. The prevalence of obesity increased from 21.4% in 1993, to 23.7% in the year 2000. Eight percent of the population has a glomerular filtration rate < 60 mL/min, and 9.1% has proteinuria. Twenty-four percent uses tobacco regularly, and 13% had the habit in the past. Smoking is more frequent among diabetics (34%).In conclusion, cardiovascular risks factors are highly common among the Mexican population and increasing at alarming rates. Preventive programs targeted to decrease their prevalence are urgently needed in Mexico and should become a national priority.
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Neufeld LM, Jones-Smith JC, García R, Fernald LCH. Anthropometric predictors for the risk of chronic disease in non-diabetic, non-hypertensive young Mexican women. Public Health Nutr 2007; 11:159-67. [PMID: 17601359 DOI: 10.1017/s136898000700002x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To assess the ability of anthropometric measurements to identify young women at risk of developing diabetes, hypertension and heart disease in the future and to compare cut-off points for common anthropometric measures established with receiver-operating characteristic (ROC) curves with those reported in the literature. DESIGN Cross-sectional study. SUBJECTS Eight hundred and two young Mexican women living in semi-urban poverty. MEASUREMENTS/METHODS: The ability of anthropometric measures of fatness and fat distribution (body mass index (BMI), summed skinfold thickness (SST), waist circumference (WC), waist-to-hip ratio (WHR), conicity index (CI), abdominal volume index (AVI)) to predict risk of future disease (pre-diabetes: fasting blood glucose 100-126 mg dl-1; pre-hypertension: systolic blood pressure 120-139 mmHg and/or diastolic blood pressure 80-89 mmHg; hypertriglyceridaemia: triglycerides > or =150 mg dl-1; or a combination of risk factors) was assessed using ROC curve analysis. RESULTS Twenty-three of the 802 women who were interviewed had incomplete data and 50 (6.4%) were eliminated from the analysis due to hypertension and/or diabetes. Mean age of the remaining 729 women was 29.6 +/- 5.4 years and mean BMI was 27.7 +/- 4.5 kg m-2. There were no significant differences in the area under the ROC curve for BMI, WC, AVI or SST for any of the four outcomes. However, these indices performed significantly better than WHR and CI (P < 0.05). The BMI cut-off points that maximised sensitivity and specificity for the four outcomes were in the range of 27.7-28.4 kg m-2, and for WC were 89.3-91.2 cm. To detect 90% of the cases of any metabolic alteration, the necessary BMI cut-off was 26.1 kg m-2. Younger women (<25 years) were at greater risk than older women for a given BMI increment (P < 0.05). CONCLUSIONS We found that BMI and WC cut-off points commonly used for the identification of risk of existing disease were also appropriate in this population for the identification of risk in the future among women without diabetes or hypertension. The early identification of at-risk individuals, prior to the onset of disease, is fundamental particularly in the context of a country with scarce resources that is rapidly undergoing nutrition transition.
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Affiliation(s)
- Lynnette M Neufeld
- National Institute of Public Health - Mexico, División de Epidemiología de la Nutrición, Av. Universidad 655, Sta. Ma. Ahuacatitlan, Cuernavaca, Morelos, 62508, México.
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Riewpaiboon A, Pornlertwadee P, Pongsawat K. Diabetes cost model of a hospital in Thailand. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2007; 10:223-30. [PMID: 17645676 DOI: 10.1111/j.1524-4733.2007.00172.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This study aims to formulate a cost model from a provider perspective regarding the direct medical costs for diabetic patients who received care in a 30-bed public hospital in Thailand during the fiscal year of 2001. METHODS This study is a retrospective prevalence-based cost of illness study. Data were collected by reviewing the medical record of each patient for the whole year. The statistical analysis employed was the stepwise multiple regression method. RESULTS The study covered 186 diabetic patients. It was found that the average cost of caring for a diabetic patient per year was 6331 Thai baht (THB) at 2001 prices (approximately 40 THB = US 1 dollar). A major portion of this cost was spent for pharmacy services, which accounted for 45% of the whole cost, followed by outpatient services (24%), inpatient services (16%), and laboratory investigation (11%). Regarding the model for forecasting the cost, the type of diabetes and its accompanying complications, i.e., hyperlipidemia, cardiovascular accident, hypertension, hyperglycemia, hypoglycemia, gangrene, and diabetic foot, were considered as significant predictor variables (adjusted R(2) = 0.48). The quantitative effects in monetary term of these significant predictors were also demonstrated. CONCLUSIONS The results could be beneficial in forecasting the economic burden of diabetes mellitus in Thailand. Furthermore, the results could be used as a financial tool for cost control and disease management at the community hospital level.
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Coronado-González JA, Del Razo LM, García-Vargas G, Sanmiguel-Salazar F, Escobedo-de la Peña J. Inorganic arsenic exposure and type 2 diabetes mellitus in Mexico. ENVIRONMENTAL RESEARCH 2007; 104:383-9. [PMID: 17475235 DOI: 10.1016/j.envres.2007.03.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2006] [Revised: 03/12/2007] [Accepted: 03/22/2007] [Indexed: 05/15/2023]
Abstract
Inorganic arsenic exposure in drinking water has been recently related to diabetes mellitus. To evaluate this relationship the authors conducted in 2003, a case-control study in an arseniasis-endemic region from Coahuila, a northern state of Mexico with a high incidence of diabetes. The present analysis includes 200 cases and 200 controls. Cases were obtained from a previous cross-sectional study conducted in that region. Diagnosis of diabetes was established following the American Diabetes Association criteria, with two fasting glucose values > or = 126 mg/100 ml (> or = 7.0 mmol/l) or a history of diabetes treated with insulin or oral hypoglycemic agents. The next subject studied, subsequent to the identification of a case in the cross-sectional study was taken as control. Inorganic arsenic exposure was measured through total arsenic concentrations in urine, measured by hydride-generation atomic absorption spectrophotometry. Subjects with intermediate total arsenic concentration in urine (63.5-104 microg/g creatinine) had two-fold higher risk of having diabetes (odds ratio=2.16; 95% confidence interval: 1.23, 3.79), but the risk was almost three times greater in subjects with higher concentrations of total arsenic in urine (odds ratio=2.84; 95% confidence interval: 1.64, 4.92). This data provides additional evidence that inorganic arsenic exposure may be diabetogenic.
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Affiliation(s)
- José Antonio Coronado-González
- Clinical Epidemiologic Research Unit, General Regional Hospital 1 Gabriel Mancera, Mexican Institute of the Social Security, México, D.F., México
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