背景:作为墨西哥残疾的主要原因和过早死亡的第四大原因,2型糖尿病(T2D)是一个严重的公共卫生问题。近年来糖尿病的发病率急剧上升,墨西哥国家健康和营养调查(ENSANUT)的数据表明,许多人仍未被诊断。持续的社会经济卫生保健障碍加剧了这种情况,由于脆弱人群的T2D发病率和死亡率恶化,比如那些没有社会保障的人。我们通过有效覆盖率(EC,综合衡量医疗保健需求,使用,和质量)在全国,state,卫生管辖权,和市政级别。
方法:这项回顾性分析使用了2017年在非传染性疾病国家信息系统(SIC)中记录的盲法数据和2018年ENSANUT报告的T2D患病率来评估实现的EC。我们包括年龄≥20岁无社会保障的个人,他们没有宣布使用私人医疗保健服务。每个EC组件(需要,使用,和质量)是根据圣利亚适应框架进行估计的。Kruskal-Wallis检验用于评估EC五分位数和人口统计学之间的关联。
结果:2017年,2650万人,年龄≥20岁,没有社会保障,并且不使用私人医疗保健服务,在12,086个PHC的照顾下。全国T2D患病率为10.3%,相当于260万患有T2D的人需要初级卫生保健。墨西哥各州之间和内部的EC组件之间形成了巨大的对比。我们发现,上述个人中只有37.1%在PHC接受了卫生服务,其中,25.8%改善了他们的代谢状况。全国EC为9.3%,范围(按卫生管辖区划分)为0.2%-38.6%,代表欧共体的巨大地理差异。我们发现需求之间存在明显的脱节,利用率,和全国的质量率。
结论:迫切需要扩大和改善EC,以解决墨西哥T2D患者数量不断增长的问题,特别是在人口脆弱的国家。
As the leading cause of disability and the fourth leading cause of premature death in Mexico, type 2 diabetes (T2D) represents a serious public health concern. The incidence of diabetes has increased dramatically in recent years, and data from the Mexican National Health and Nutrition Survey (ENSANUT) indicate that many people remain undiagnosed. Persistent socioeconomic health care barriers exacerbate this situation, as T2D morbidity and mortality are worsened in vulnerable populations, such as those without social security. We evaluated the performance of public primary health centers (PHCs) in T2D medical attention through the measure of effective coverage (EC, a combined measure of health care need, use, and quality) at national, state, health jurisdiction, and municipality levels.
This retrospective analysis used blinded data recorded during 2017 in the Non-communicable Diseases National Information System (SIC) and T2D prevalence reported in 2018 ENSANUT to evaluate the EC achieved. We included individuals ≥ 20 years old without social security who did not declare the use of private health care services. Each EC component (need, use, and quality) was estimated based on the Shengelia adapted framework. The Kruskal-Wallis test was applied to evaluate the associations among EC quintiles and demographics.
In 2017, 26.5 million individuals, aged ≥ 20 years, without social security, and without the use of private health care services, were under the care of 12,086 PHCs. The national prevalence of T2D was 10.3%, equivalent to 2.6 million people living with T2D in need of primary health care. Large contrasts were seen among EC components between and within Mexican states. We found that only 37.1% of the above individuals received health services at PHCs and of them, 25.8% improved their metabolic condition. The national EC was 9.3%, and the range (by health jurisdiction) was 0.2%-38.6%, representing a large geographic disparity in EC. We found an evident disconnect among need, utilization, and quality rates across the country.
Expansion and improvement of EC are urgently needed to address the growing number of people living with T2D in Mexico, particularly in states with vulnerable populations.