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墨西哥≥50 岁有糖尿病的参保和未参保成年人获得医疗保健服务的情况:墨西哥健康与老龄化研究(MHAS-2018)。

Access to healthcare services between insured and uninsured adults aged ≥50 years with diabetes in Mexico: the Mexican Health and Aging Study (MHAS-2018).

机构信息

Faculty of Higher Studies (FES), Iztacala, National Autonomous University of Mexico (UNAM), Mexico.

Faculty of Higher Studies (FES), Iztacala, National Autonomous University of Mexico (UNAM), Mexico.

出版信息

Public Health. 2021 May;194:176-181. doi: 10.1016/j.puhe.2021.03.006. Epub 2021 May 4.

Abstract

OBJECTIVES

Analyze the association between health insurance coverage and the use of health care services, dentist visits, and self-medication in a national sample of Mexican adults aged ≥50 years with diabetes.

METHODS

Participants with diabetes taken from a subsample of the Mexican Health and Aging Study (MHAS-2018) (n = 3667) were examined, with data pertaining to the frequency of their doctor and dentist visits, residence, years of education, self-medication, and health insurance coverage (insured/uninsured) also collected. A logistic regression model was used to identify the association between independent variables and health insurance coverage, whereas Poisson regression models were also estimated to ascertain whether health insurance coverage was associated with the number of doctor and dentist visits.

RESULTS

The prevalence of self-reported diabetes was 24.6%, whereas approximately 93.3% of subjects had visited a doctor, 40.6% had visited a dentist, and 20.3% self-medicated. Individuals with insurance coverage were 75% (Odds ratio [OR] = 1.75 [95% confidence interval {CI}1.32-2.31]; P < 0.001) more likely to have visited a doctor and 57% more likely to have visited a dentist (OR = 1.57 [95% CI 1.35-1.83]; P < 0.001) than uninsured adult subjects, while adults living in rural areas were 77% less likely to be insured than adults living in urban areas. Doctor and dentist visits [rate ratio {RR} = 1.32 (95% CI 1.28-1.35); P < 0.001] and [RR = 1.47 (95% CI 1.37-1.58); P < 0.001, respectively] were found to be positively associated with the insured members of the study population.

CONCLUSION

A positive association was found between doctor and dentist visits in the population insured with diabetes. A major public health challenge is the population of diabetics who report being uninsured, wherein this population requires coverage to access the necessary clinical follow-up and control to prevent complications.

摘要

目的

分析医疗保险覆盖与医疗服务利用、看牙医和自我用药在墨西哥≥50 岁患有糖尿病的成年人全国样本中的关联。

方法

对来自墨西哥健康和老龄化研究(MHAS-2018)子样本的糖尿病患者(n=3667)进行了检查,收集了他们看医生和牙医的频率、居住地、受教育年限、自我用药和医疗保险覆盖情况(参保/未参保)的数据。使用逻辑回归模型来确定自变量与医疗保险覆盖之间的关联,同时还使用泊松回归模型来确定医疗保险覆盖是否与看医生和牙医的次数有关。

结果

自我报告糖尿病的患病率为 24.6%,约有 93.3%的患者看过医生,40.6%看过牙医,20.3%自我用药。有保险的人看医生的可能性高 75%(优势比[OR] = 1.75 [95%置信区间 {CI}1.32-2.31];P < 0.001),看牙医的可能性高 57%(OR = 1.57 [95% CI 1.35-1.83];P < 0.001),而农村地区的成年人比城市地区的成年人参保的可能性低 77%。医生和牙医就诊[比率比{RR} = 1.32(95% CI 1.28-1.35);P < 0.001]和[RR = 1.47(95% CI 1.37-1.58);P < 0.001]与参保研究人群呈正相关。

结论

在参保的糖尿病患者中,发现看医生和看牙医与医疗保险之间存在正相关。一个主要的公共卫生挑战是报告没有保险的糖尿病患者,这部分人群需要参保以获得必要的临床随访和控制,以预防并发症。

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