Brenes-Camacho Gilbert, Rosero-Bixby Luis
Center for Demography and Ecology, University of Wisconsin-Madison, USA.
BMC Int Health Hum Rights. 2008 May 14;8:5. doi: 10.1186/1472-698X-8-5.
Costa Rica, like other developing countries, is experiencing an increasing burden of chronic conditions such as diabetes mellitus (DM), especially among its elderly population. This article has two goals: (1) to assess the level of metabolic control among the diabetic population age >or= 60 years old in Costa Rica, and (2) to test whether diabetic elderly patients of community health centers differ from patients in other health care settings in terms of the level of metabolic control.
Data come from the project CRELES, a nationally representative study of people aged 60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with self-reported diagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at different health care settings are computed using logistic regressions.
Lack of metabolic control among elderly diabetic population in Costa Rica is described as follows: 37% have glycated hemoglobin >or= 7%; 78% have systolic blood pressure >or= 130 mmHg; 66% have diastolic blood pressure >or= 80 mmHg; 48% have triglycerides >or= 150 mg/dl; 78% have LDL >or= 100 mg/dl; 70% have HDL <or= 40 mg/dl. Elevated levels of triglycerides and LDL were higher in patients of community health centers than in patients of other clinical settings. There were no statistical differences in the other metabolic control indicators across health care settings.
Levels of metabolic control among elderly population with DM in Costa Rica are not that different from those observed in industrialized countries. Elevated levels of triglycerides and LDL at community health centers may indicate problems of dyslipidemia treatment among diabetic patients; these problems are not observed in other health care settings. The Costa Rican health care system should address this problem, given that community health centers constitute a means of democratizing access to primary health care to underserved and poor areas.
与其他发展中国家一样，哥斯达黎加的慢性病负担日益加重，如糖尿病（DM），在老年人群中尤为明显。本文有两个目标：（1）评估哥斯达黎加60岁及以上糖尿病患者的代谢控制水平；（2）检验社区卫生中心的糖尿病老年患者与其他医疗机构的患者在代谢控制水平方面是否存在差异。
数据来自CRELES项目，这是一项对哥斯达黎加60岁及以上人群具有全国代表性的研究。本文分析了CRELES中542名自我报告患有糖尿病的参与者的子样本。使用逻辑回归计算不同医疗机构中代谢控制水平不佳的比值比。
哥斯达黎加老年糖尿病患者的代谢控制情况如下：37%的糖化血红蛋白≥7%；78%的收缩压≥130 mmHg；66%的舒张压≥80 mmHg；48%的甘油三酯≥150 mg/dl；78%的低密度脂蛋白≥100 mg/dl；70%的高密度脂蛋白≤40 mg/dl。社区卫生中心患者的甘油三酯和低密度脂蛋白水平高于其他临床机构的患者。其他代谢控制指标在不同医疗机构之间没有统计学差异。
哥斯达黎加老年糖尿病患者的代谢控制水平与工业化国家观察到的情况没有太大差异。社区卫生中心甘油三酯和低密度脂蛋白水平升高可能表明糖尿病患者存在血脂异常治疗问题；在其他医疗机构未观察到这些问题。鉴于社区卫生中心是为服务不足和贫困地区提供初级卫生保健的一种民主化手段，哥斯达黎加医疗保健系统应解决这一问题。
