Instituto de Investigaciones en Salud, Universidad de Costa Rica, San José, Costa Rica.
Centro Centroamericano de Población, Universidad de Costa Rica, San José, Costa Rica.
Health Policy Plan. 2019 Nov 1;34(Supplement_2):ii45-ii55. doi: 10.1093/heapol/czz109.
Diabetes is a major cause of morbidity and mortality and represents a source of demands on already constrained healthcare systems in Latin America and the Caribbean. We estimate inequalities in diabetes incidence, prevalence and mortality and assess the economic burden on the healthcare system in Costa Rica. The main source of data is the Costa Rican Longevity and Healthy Aging Study, a longitudinal nationally representative survey of the elderly population (n = 2827). Data analyses include descriptive statistics, multiple regression models and survival analysis models. More than a fifth of Costa Rican elderly experience diabetes. Incidence is estimated at 5 per 1000 person-years in the population 30+. Gender and geographical inequalities were found. Men have a significantly lower prevalence (16.51% vs 24.02%, P < 0.05) and incidence (4.3 vs 6.0 per 1000 person-years, P < 0.05), but higher mortality (hazard ratio = 1.31, P < 0.01). Longer time to the closest facility translates into a lower probability of having the condition diagnosed [odds ratio (OR) = 0.77, P < 0.05]. The diabetic as compared to the non-diabetic population imposes a larger economic burden on the healthcare system with a higher probability of using outpatient care (OR = 3.08, P < 0.01), medications (OR = 3.44, P < 0.01) and hospitalizations (OR = 1.24, P > 0.05). Individuals living in the Metro Area have a significantly lower probability of being hospitalized (OR = 0.72, P < 0.05), which may be evidence of better access to primary care that prevents hospitalization. Along the same line, women have higher utilization rates of outpatient care (OR = 2.02, P < 0.01) and medications (OR = 1.73, P < 0.01), which may contribute to lower odds of hospitalization (OR = 0.61, P < 0.01). Aligned with the aim of attaining Sustainable Development Goals, this study highlights the importance of generating health policies focused on prevention of diabetes that take into consideration gender and geographical inequalities. Strategies should booster preventive healthcare utilization by men and aim to make healthcare services accessible to all, regardless of geographical location.
糖尿病是发病率和死亡率的主要原因，也是拉丁美洲和加勒比地区医疗保健系统负担过重的一个原因。我们评估了哥斯达黎加糖尿病发病率、患病率和死亡率的不平等，并评估了糖尿病对医疗保健系统的经济负担。主要数据来源是哥斯达黎加长寿和健康老龄化研究，这是一项针对老年人口（n=2827 人）的全国代表性纵向调查。数据分析包括描述性统计、多元回归模型和生存分析模型。超过五分之一的哥斯达黎加老年人患有糖尿病。在 30 岁以上的人群中，发病率估计为每 1000 人年 5 例。发现存在性别和地域不平等。男性的患病率（16.51%比 24.02%，P<0.05）和发病率（4.3 比 6.0 每 1000 人年，P<0.05）显著较低，但死亡率较高（危险比=1.31，P<0.01）。距离最近的医疗机构的时间越长，诊断出该疾病的可能性就越低[优势比（OR）=0.77，P<0.05]。与非糖尿病患者相比，糖尿病患者给医疗保健系统带来了更大的经济负担，他们更有可能使用门诊护理（OR=3.08，P<0.01）、药物（OR=3.44，P<0.01）和住院治疗（OR=1.24，P>0.05）。居住在大都市区的人住院的可能性显著降低（OR=0.72，P<0.05），这可能表明他们更容易获得初级保健，从而预防住院治疗。同样，女性门诊护理（OR=2.02，P<0.01）和药物（OR=1.73，P<0.01）的使用率更高，这可能有助于降低住院的几率（OR=0.61，P<0.01）。本研究旨在实现可持续发展目标，强调了制定注重预防糖尿病的卫生政策的重要性，这些政策应考虑到性别和地域不平等。应加强男性对预防保健的利用，并努力使所有人都能获得医疗保健服务，而不论其地理位置如何。
