Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh.
NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
PLoS One. 2023 May 2;18(5):e0284117. doi: 10.1371/journal.pone.0284117. eCollection 2023.
BACKGROUND: Chronic diseases are considered one of the major causes of illness, disability, and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) among Bangladesh patients with chronic diseases from a gender perspective. METHODS: Data from the nationally representative Household Income and Expenditure Survey 2016-2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed to identify the potential factors to higher or lower utilisation of healthcare services. Logistic regression with step-by-step adjustment for independent confounding factors was the method used. RESULTS: The five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female, M/F: 16.77%/16.40%), arthritis/rheumatism (M/F: 13.70%/ 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types, which held true for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51-3.26) than their female counterparts (OR = 1.44; 1.02-2.04). A similar association was observed among patients with diabetes and respiratory diseases. CONCLUSION: A burden of chronic diseases was observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient's gender as well as their employment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people in society might enhance reaching universal health coverage.
背景：慢性疾病被认为是全球范围内导致疾病、残疾和死亡的主要原因之一。慢性疾病导致了巨大的健康和经济负担，尤其是在中低收入国家。本研究从性别角度考察了孟加拉国慢性疾病患者的疾病分层医疗保健利用情况。
方法：本研究使用了来自具有全国代表性的 2016-2017 年家庭收入和支出调查的 12005 名确诊患有慢性疾病的患者数据。对慢性疾病进行性别分层分析，以确定导致医疗服务利用程度较高或较低的潜在因素。采用逐步调整独立混杂因素的逻辑回归方法。
结果：患者中最常见的五种慢性疾病分别是胃病/溃疡（男性/女性，M/F：16.77%/16.40%）、关节炎/风湿病（M/F：13.70%/13.86%）、呼吸疾病/哮喘/支气管炎（M/F：12.09%/12.55%）、慢性心脏病（M/F：8.30%/7.41%）和高血压（M/F：8.20%/8.87%）。86%的慢性疾病患者在过去 30 天内使用了医疗保健服务。尽管大多数患者接受了门诊医疗保健服务，但我们观察到有工作的男性（53%）和女性（8%）患者之间的医疗保健服务利用情况存在显著差异。与其他疾病类型相比，患有慢性心脏病的患者更有可能利用医疗保健服务，这种情况在两性中都存在，而男性患者的医疗保健服务利用率明显更高（OR=2.22；95%CI：1.51-3.26），高于女性（OR=1.44；1.02-2.04）。在患有糖尿病和呼吸疾病的患者中也观察到了类似的关联。
结论：在孟加拉国，慢性疾病负担沉重。患有慢性心脏病的患者比患有其他慢性疾病的患者利用了更多的医疗保健服务。医疗保健服务的利用情况因患者的性别以及他们的就业状况而异。在社会中最弱势群体中建立风险共担机制和获得免费或低成本的医疗保健服务可能会增强实现全民健康覆盖的机会。
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