Institute of Public Health, 250, 2 C Cross, 2 C Main, Girinagar, First Phase, Bangalore 560085, Karnataka, India.
BMC Health Serv Res. 2013 Aug 13;13:306. doi: 10.1186/1472-6963-13-306.
The burden of chronic conditions is high in low- and middle-income countries and poses a significant challenge to already weak healthcare delivery systems in these countries. Studies investigating chronic conditions among the urban poor remain few and focused on specific chronic conditions rather than providing overall profile of chronic conditions in a given community, which is critical for planning and managing services within local health systems. We aimed to assess the prevalence and health- seeking behaviour for self-reported chronic conditions in a poor neighbourhood of a metropolitan city in India.
We conducted a house-to-house survey covering 9299 households (44514 individuals) using a structured questionnaire. We relied on self-report by respondents to assess presence of any chronic conditions, including diabetes and hypertension. Multivariable logistic regression was used to analyse the prevalence and health-seeking behaviour for self-reported chronic conditions in general as well as for diabetes and hypertension in particular. The predictor variables included age, sex, income, religion, household poverty status, presence of comorbid chronic conditions, and tiers in the local health care system.
Overall, the prevalence of self-reported chronic conditions was 13.8% (95% CI = 13.4, 14.2) among adults, with hypertension (10%) and diabetes (6.4%) being the most commonly reported conditions. Older people and women were more likely to report chronic conditions. We found reversal of socioeconomic gradient with people living below the poverty line at significantly greater odds of reporting chronic conditions than people living above the poverty line (OR = 3, 95% CI = 1.5, 5.8). Private healthcare providers managed over 80% of patients. A majority of patients were managed at the clinic/health centre level (42.9%), followed by the referral hospital (38.9%) and the super-specialty hospital (18.2%) level. An increase in income was positively associated with the use of private facilities. However, elderly people, people below the poverty line, and those seeking care from hospitals were more likely to use government services.
Our findings provide further evidence of the urgent need to improve care for chronic conditions for urban poor, with a preferential focus on improving service delivery in government health facilities.
在中低收入国家，慢性病负担沉重，对这些国家本来就薄弱的医疗体系构成了重大挑战。研究表明，城市贫困人口患慢性病的情况仍然很少，而且主要集中在特定的慢性病上，而没有提供特定社区内慢性病的整体概况，这对于规划和管理当地卫生系统内的服务至关重要。我们旨在评估印度一个大都市贫困社区中自我报告的慢性病的患病率和寻求医疗服务的行为。
我们使用结构化问卷对 9299 户家庭（44514 人）进行了逐户调查。我们依靠受访者的自我报告来评估是否存在任何慢性疾病，包括糖尿病和高血压。多变量逻辑回归用于分析一般自我报告的慢性疾病以及特定的糖尿病和高血压的患病率和寻求医疗服务的行为。预测变量包括年龄、性别、收入、宗教、家庭贫困状况、合并存在的慢性疾病以及当地卫生保健系统的层级。
总体而言，成年人自我报告的慢性病患病率为 13.8%（95%CI=13.4,14.2），其中高血压（10%）和糖尿病（6.4%）是最常见的报告疾病。老年人和女性更有可能报告患有慢性疾病。我们发现，与生活在贫困线以上的人相比，生活在贫困线以下的人报告患有慢性疾病的可能性要高得多（OR=3，95%CI=1.5,5.8），这表明社会经济梯度发生了逆转。私人医疗保健提供者管理着超过 80%的患者。大多数患者在诊所/保健中心（42.9%）接受治疗，其次是转诊医院（38.9%）和特级专科医院（18.2%）。收入增加与使用私人设施呈正相关。然而，老年人、生活在贫困线以下的人和从医院寻求治疗的人更有可能使用政府服务。
我们的研究结果进一步证明，迫切需要改善城市贫困人口的慢性病护理，优先注重改善政府卫生设施的服务提供。
