Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA.
Bull World Health Organ. 2011 Mar 1;89(3):172-83. doi: 10.2471/BLT.10.080820. Epub 2010 Nov 22.
To examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socioeconomic factors.
We used nationally representative health examination surveys from Colombia, England, the Islamic Republic of Iran, Mexico, Scotland, Thailand and the United States of America to obtain data on diagnosis, treatment and control of hyperglycaemia, arterial hypertension and hypercholesterolaemia among individuals with diabetes. Using logistic regression, we explored the socioeconomic determinants of diagnosis and effective case management.
A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries. The figures range from 24% of the women in Scotland and the USA to 62% of the men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure and serum cholesterol was very low, ranging from 1% of male patients in Mexico to about 12% in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States.
There are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia. While no large socioeconomic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.
考察不同环境下卫生系统应对糖尿病挑战的效果，并探讨与社会经济因素相关的糖尿病护理不平等现象。
我们使用来自哥伦比亚、英国、伊朗伊斯兰共和国、墨西哥、苏格兰、泰国和美国的全国代表性健康检查调查数据，获取有关糖尿病患者高血糖、动脉高血压和高胆固醇血症的诊断、治疗和控制情况的数据。我们使用逻辑回归方法，探讨了社会经济因素对诊断和有效病例管理的决定作用。
在发达国家和发展中国家，大量糖尿病患者未被诊断和治疗，这一比例从苏格兰和美国女性的 24%到泰国男性的 62%不等。达到血糖、动脉血压和血清胆固醇治疗目标的糖尿病患者比例非常低，从墨西哥男性患者的 1%到美国约 12%不等。除了泰国以外，收入和教育与诊断和治疗率之间没有发现显著关系，但在有可用数据的三个国家中，保险状况是诊断和有效管理的一个强有力的预测因素，尤其是在美国。
通过改善血糖控制水平以及提高对动脉高血压和高胆固醇血症的诊断和治疗，可以有更多机会减轻糖尿病的负担。虽然在糖尿病患者的管理方面没有发现明显的社会经济不平等现象，但获得医疗保健的经济机会是诊断和管理的一个强有力的预测因素。
