Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Norwegian Refugee Council (NRC), Beirut, Lebanon.
JAMA Netw Open. 2022 Oct 3;5(10):e2231633. doi: 10.1001/jamanetworkopen.2022.31633.
Older Syrian refugees have a high burden of noncommunicable diseases (NCDs) and economic vulnerability.
To develop and internally validate a predictive model to estimate inability to manage NCDs in older Syrian refugees, and to describe barriers to NCD medication adherence.
DESIGN, SETTING, AND PARTICIPANTS: This nested prognostic cross-sectional study was conducted through telephone surveys between September 2020 and January 2021. All households in Lebanon with Syrian refugees aged 50 years or older and who received humanitarian assistance from a nongovernmental organization were invited to participate. Refugees who self-reported having chronic respiratory disease (CRD), diabetes, history of cardiovascular disease (CVD), or hypertension were included in the analysis. Data were analyzed from November 2021 to March 2022.
The main outcome was self-reported inability to manage any NCD (including CRD, CVD, diabetes, or hypertension). Predictors of inability to manage any NCD were assessed using logistic regression models. The model was internally validated using bootstrapping techniques, which gave an estimate of optimism. The optimism-adjusted discrimination is presented using the C statistic, and calibration of the model is presented using calibration slope (C slope).
Of 3322 older Syrian refugees, 1893 individuals (median [IQR] age, 59 [54-65] years; 1089 [57.5%] women) reported having at least 1 NCD, among whom 351 (10.6% overall; 18.6% of those with ≥1 NCD) had CRD, 781 (23.7% overall; 41.4% of those with ≥1 NCD) had diabetes, 794 (24.1% overall; 42.2% of those with ≥1 NCD) had history of CVD, and 1388 (42.3% overall; 73.6% of those with ≥1 NCD) had hypertension. Among individuals with NCDs, 387 participants (20.4%) were unable to manage at least 1 of their NCDs. Predictors for inability to manage NCDs were age, nonreceipt of cash assistance, household water insecurity, household food insecurity, and having multiple chronic diseases, with an adjusted C statistic of 0.650 (95% CI, 0.620-0.676) and C slope of 0.871 (95% CI, 0.729-1.023). The prevalence of nonadherence to medication was 9.2%, and the main reasons for nonadherence were unaffordability of medication (40.8%; 95% CI, 33.4%-48.5%) and the belief that they no longer required the medication after feeling better (22.4%; 95% CI, 16.4%-29.3%).
In this cross-sectional study, the predictors of inability to manage NCDs among older Syrian refugees in Lebanon were mainly related to financial barriers. Context-appropriate assistance is required to overcome financial barriers and enable equitable access to medication and health care.
老年叙利亚难民患有大量非传染性疾病（NCDs）且经济脆弱。
开发并内部验证一种预测模型，以估计老年叙利亚难民无法管理 NCD 的情况，并描述 NCD 药物依从性的障碍。
设计、设置和参与者：这是一项嵌套的预后性横断面研究，于 2020 年 9 月至 2021 年 1 月期间通过电话调查进行。黎巴嫩所有有 50 岁及以上叙利亚难民并接受非政府组织人道主义援助的家庭都被邀请参加。报告患有慢性呼吸道疾病（CRD）、糖尿病、心血管疾病（CVD）或高血压病史的难民被纳入分析。数据分析于 2021 年 11 月至 2022 年 3 月进行。
主要结果是自我报告无法管理任何 NCD（包括 CRD、CVD、糖尿病或高血压）。使用逻辑回归模型评估无法管理任何 NCD 的预测因素。使用自举技术对模型进行了内部验证，该技术给出了乐观程度的估计。使用 C 统计量表示优化调整后的区分度，并使用校准斜率（C 斜率）表示模型的校准。
在 3322 名老年叙利亚难民中，有 1893 名（中位数[IQR]年龄，59[54-65]岁；1089[57.5%]为女性）报告至少患有 1 种 NCD，其中 351 名（总体 10.6%；≥1 种 NCD 者的 18.6%）患有 CRD，781 名（总体 23.7%；≥1 种 NCD 者的 41.4%）患有糖尿病，794 名（总体 24.1%；≥1 种 NCD 者的 42.2%）患有 CVD，1388 名（总体 42.3%；≥1 种 NCD 者的 73.6%）患有高血压。在患有 NCD 的人群中，有 387 名参与者（20.4%）无法管理至少 1 种 NCD。无法管理 NCD 的预测因素包括年龄、未获得现金援助、家庭用水不安全、家庭食物不安全和患有多种慢性疾病，调整后的 C 统计量为 0.650（95%CI，0.620-0.676），C 斜率为 0.871（95%CI，0.729-1.023）。药物不依从率为 9.2%，不依从的主要原因是药物负担不起（40.8%；95%CI，33.4%-48.5%）和在感觉好转后认为不再需要药物（22.4%；95%CI，16.4%-29.3%）。
在这项横断面研究中，黎巴嫩老年叙利亚难民无法管理 NCD 的预测因素主要与经济障碍有关。需要提供适当的援助，以克服经济障碍，实现公平获得药物和医疗保健的机会。
