Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City 06720, Mexico.
Dirección de Prestaciones Económicas y Sociales, Instituto Mexicano del Seguro Social, Mexico City 06600, Mexico.
Int J Environ Res Public Health. 2022 Jul 25;19(15):9010. doi: 10.3390/ijerph19159010.
Health needs assessment is a relevant tracer of planning process of healthcare programs. The objective is to assess the health needs of chronic kidney disease (CKD) secondary to type 2 diabetes mellitus (T2 DM) in a population without social security in Mexico. The study design was a statistical simulation model based on data at the national level of Mexico. A stochastic Markov model was used to simulate the progression from diabetes to CKD. The time horizon was 16 years. The results indicate that in 2022, kidney damage progression and affectation in the diabetic patient cohort will be 34.15% based on the time since T2 DM diagnosis. At the end of the 16-year period, assuming that the model of care remains unchanged, early renal involvement will affect slightly more than twice as many patients (118%) and cases with macroalbuminuria will triple (228%). The need for renal replacement therapy will more than double (169%). Meanwhile, deaths associated with cardiovascular risk will more than triple (284%). We concluded that the clinical manifestations of patients with CKD secondary to T2 DM without social security constitute a double challenge. The first refers to the fact that the greatest health need is early care of CKD, and the second is the urgent need to address cardiovascular risk in order to reduce deaths in the population at risk.
健康需求评估是医疗保健计划规划过程的一个重要指标。本研究旨在评估墨西哥无社会保障人群中 2 型糖尿病（T2DM）继发慢性肾脏病（CKD）的健康需求。研究设计基于墨西哥国家层面的数据，采用统计模拟模型。使用随机马尔可夫模型来模拟糖尿病向 CKD 的进展。时间范围为 16 年。结果表明，2022 年，基于 T2DM 诊断后的时间，糖尿病患者队列的肾脏损伤进展和影响将达到 34.15%。在 16 年的时间结束时，假设护理模式保持不变，早期肾脏受累将影响略多于两倍的患者（118%），且伴有大量白蛋白尿的病例将增加两倍（228%）。需要肾脏替代治疗的患者将增加一倍以上（169%）。同时，与心血管风险相关的死亡人数将增加两倍以上（284%）。我们得出结论，无社会保障的 T2DM 继发 CKD 患者的临床表现构成了双重挑战。第一个挑战是最大的健康需求是早期 CKD 的护理，第二个挑战是迫切需要解决心血管风险，以降低高危人群的死亡人数。
