Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, US.
Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, DE.
Glob Heart. 2022 Jan 31;17(1):7. doi: 10.5334/gh.1056. eCollection 2022.
The prevalence of multimorbidity in low- and middle-income countries (LMICs) is thought to be rising rapidly. Research on the state of healthcare for multimorbidity in LMICs is needed to provide an impetus for integration of care across conditions, a baseline to monitor progress, and information for targeting of interventions to those most in need. Focusing on multimorbid cardiometabolic disease in India, this study thus aimed to determine 1) the proportion of adults with co-morbid diabetes and hypertension who successfully completed each step of the chronic disease care continuum from diagnosis to control for both conditions, and 2) how having additional cardiovascular disease (CVD) risk factors is associated with health system performance along the care continuum for diabetes, hypertension, and co-morbid diabetes and hypertension.
Using a nationally representative household survey carried out in 2015 and 2016 among women aged 15-49 years and men aged 15-54 years, we created a 'cascade of care' for diabetes, hypertension, and co-morbid diabetes and hypertension by determining the proportion of those with the condition who had been diagnosed, were on treatment, and achieved control. We used Poisson regression with a robust error structure to estimate how having additional cardiovascular disease (CVD) risk factors (diabetes, hypertension, current smoking, and obesity) was associated with reaching each cascade step for diabetes, hypertension, and co-morbid diabetes and hypertension.
Seven hundred thirty-four thousand seven hundred ninety-four adults were included in the analysis. Among individuals with co-morbid diabetes and hypertension, 28·8% (95% CI, 26·7%-31·0%), 16·1% (95% CI, 14·4%-17·9%), and 3·7% (95% CI, 2·8%-4·9%) - with these proportions varying between states by a factor of 4·8, 7·9, and 56·8 - were aware, treated, and achieved control of both conditions, respectively. Men, adults with lower household wealth, and those living in rural areas were less likely to reach each cascade step. Having additional CVD risk factors generally did not increase the probability of reaching each cascade step for diabetes, hypertension, and co-morbid diabetes and hypertension, except that having concurrent diabetes increased the probability of successfully transitioning through the hypertension care cascade.
While varying widely between states and population groups, health system performance for co-morbid diabetes and hypertension is generally low in India, and there appears to be little integration of care across CVD risk factors.
European Research Council.
中低收入国家（LMICs）的多种疾病患病率被认为正在迅速上升。需要研究 LMICs 中多种疾病的医疗保健状况，为跨病种护理整合提供动力，为监测进展提供基准，并为针对最需要的人群的干预措施提供信息。本研究聚焦于印度的合并心血管代谢疾病，旨在确定 1）患有合并糖尿病和高血压的成年人成功完成两种疾病的慢性病护理连续体的每个步骤的比例，以及 2）患有其他心血管疾病（CVD）危险因素如何与糖尿病、高血压和合并糖尿病和高血压的护理连续体的卫生系统绩效相关。
我们使用 2015 年至 2016 年在 15-49 岁女性和 15-54 岁男性中进行的一项全国代表性家庭调查，通过确定患有该疾病的人的诊断、治疗和控制比例，为糖尿病、高血压和合并糖尿病和高血压创建了“护理连续体”。我们使用具有稳健误差结构的泊松回归来估计患有其他心血管疾病（CVD）危险因素（糖尿病、高血压、当前吸烟和肥胖）与达到糖尿病、高血压和合并糖尿病和高血压的每个连续体步骤的相关性。
分析中纳入了 734794 名成年人。在合并患有糖尿病和高血压的人群中，分别有 28.8%（95%CI，26.7%-31.0%）、16.1%（95%CI，14.4%-17.9%）和 3.7%（95%CI，2.8%-4.9%） -这些比例在各州之间相差 4.8、7.9 和 56.8 倍 -了解、治疗和控制两种疾病的比例分别为 28.8%、16.1%和 3.7%。男性、家庭财富较低的成年人和居住在农村地区的成年人更不可能达到每个连续体步骤。除了同时患有糖尿病会增加成功过渡到高血压护理连续体的概率外，患有其他 CVD 危险因素通常不会增加达到糖尿病、高血压和合并糖尿病和高血压的每个连续体步骤的概率。
尽管在各州和人群组之间差异很大，但印度合并糖尿病和高血压的卫生系统绩效普遍较低，而且似乎几乎没有跨 CVD 危险因素进行护理整合。
欧洲研究理事会。
