Pacific Islands Health Officers Association, Honolulu, HI (AMD, HLC).
Cancer Council of the Pacific Islands, Honolulu, HI (MR).
Hawaii J Health Soc Welf. 2023 Mar;82(3):66-71.
Hypertension and diabetes are major causes of disability and mortality in the US-Affiliated Pacific Islands (USAPI). Control of these conditions has the potential to avert much of the burden of non-communicable diseases in the region. To realize this potential, people living with hypertension and diabetes must be identified and receive treatment of sufficient intensity to control their blood pressure and blood glucose. Data from recent cross-sectional surveys conducted in 5 jurisdictions-Pohnpei, Palau, Kosrae, Marshall Islands and American Samoa-were used to estimate the adult prevalence of hypertension and diabetes as well as diagnosis awareness, treatment, and control status of the adults with these conditions. In addition to traditional prevalence indicators, the authors provide a novel presentation of non-communicable disease (NCD) data, using the concept of "protection gaps", defined as the number of people living in a community who have an NCD for which effective control is not attained. The protection gap is determined by applying survey-derived population prevalence estimates to the community's population size using census data. The protection gap is further divided into 3 groups: (1) case-finding gap-those who are unaware of their conditions; (2) tracking and outreach gap-those who are aware of their condition but not receiving treatment; and (3) treatment efficacy gap-those who are receiving treatment but whose disease is not under control. The findings show a large protection gap, with a majority of adults living with hypertension (80.8%) and diabetes (91.6%) not having their condition under control. The case-finding gap accounts for more than half of these, followed by treatment efficacy, and tracking and outreach gaps. These findings can guide public health strategies and monitoring for control of hypertension and diabetes in the USAPI region.
高血压和糖尿病是美国太平洋属地（USAPI）残疾和死亡的主要原因。控制这些疾病有可能避免该地区非传染性疾病的大部分负担。为了实现这一潜力，必须确定患有高血压和糖尿病的人，并为他们提供足够强度的治疗，以控制他们的血压和血糖。利用最近在五个司法管辖区（波纳佩、帕劳、科斯雷、马绍尔群岛和美属萨摩亚）进行的横断面调查的数据，估计了成年人高血压和糖尿病的患病率，以及这些疾病患者的诊断意识、治疗和控制状况。除了传统的流行率指标外，作者还使用“保护差距”的概念，以新颖的方式呈现非传染性疾病（NCD）数据，该概念定义为一个社区中患有无法有效控制的 NCD 的人数。保护差距是通过将调查得出的人口流行率估计值应用于使用人口普查数据的社区人口规模来确定的。保护差距进一步分为三组：（1）病例发现差距——那些不知道自己病情的人；（2）跟踪和外联差距——那些知道自己病情但未接受治疗的人；（3）治疗效果差距——那些接受治疗但病情未得到控制的人。研究结果表明，存在很大的保护差距，大多数患有高血压（80.8%）和糖尿病（91.6%）的成年人病情未得到控制。病例发现差距占了其中的大部分，其次是治疗效果和跟踪外联差距。这些发现可以为美国太平洋属地地区控制高血压和糖尿病的公共卫生策略和监测提供指导。
