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【Diabetes Care】糖尿病诊断的盲区
How access to health care affects the detection of diabetes
http://care.diabetesjournals.org/cgi/content/abstract/31/9/1748
OBJECTIVE—This study examined the association between access to health care and three classifications of diabetes status: diagnosed, undiagnosed, and no diabetes.
RESEARCH DESIGN AND METHODS—Using data from the 1999–2004 National Health and Nutrition Examination Survey, we identified 110 "missed patients" (fasting plasma glucose >125 mg/dl but without diagnoses of diabetes), 704 patients with diagnosed diabetes, and 4,782 people without diabetes among adults aged 18–64 years. The population percentage undetected among adults with diabetes and the odds ratio of being undetected among adults who reported not having diabetes were compared between groups based on their access to health care.
RESULTS—Among those with diabetes, the percentages having undetected diabetes were 42.2% (95% CI 36.7–47.7) among the uninsured, 25.9% (22.9–28.9) among the insured, 49.3% (43.0–55.6) for those uninsured >1 year, 38.7% (29.2–48.2) for those uninsured 1 year, and 24.5% (21.7–27.3) for those continuously insured over the past year. Type of insurance, number of times receiving health care in the past year, and routine patterns of health care utilization were also associated with undetected diabetes. Multivariate adjustment indicated that having undetected diabetes was associated with being uninsured (odds ratio 1.7 [95% CI 1.0–2.9]) and with being uninsured >1 year (2.6 [1.4–5.0]).
CONCLUSIONS—Limited access to health care, especially being uninsured and going without insurance for a long period, was significantly associated with being a "missed patient" with diabetes. Efforts to increase detection of diabetes may need to address issues of access to care. 本人已认领本文翻译48小时未提交请其他战友继续认领 The Missed Patient With Diabetes
How access to health care affects the detection of diabetes
糖尿病的漏诊
卫生保健的使用如何影响到糖尿病的发现
http://care.diabetesjournals.org/cgi/content/abstract/31/9/1748
OBJECTIVE—This study examined the association between access to health care and three classifications of diabetes status: diagnosed, undiagnosed, and no diabetes.
对象——这个研究检查了卫生保健的使用与三个糖尿病状态之间的联系：诊断出的，被诊断出的，未患糖尿病。
RESEARCH DESIGN AND METHODS—Using data from the 1999–2004 National Health and Nutrition Examination Survey, we identified 110 "missed patients" (fasting plasma glucose >125 mg/dl but without diagnoses of diabetes), 704 patients with diagnosed diabetes, and 4,782 people without diabetes among adults aged 18–64 years. The population percentage undetected among adults with diabetes and the odds ratio of being undetected among adults who reported not having diabetes were compared between groups based on their access to health care.
研究设计和方法——使用从1999-2004年全国健康和营养测试研究的数据，在18-64岁之间，我们发现了110个“漏诊病人”（空腹血糖>125mg/dl但没有被诊断为糖尿病），704个被诊断糖尿病的病人，和4782个没有糖尿病的人。根据卫生保健使用分组，成年糖尿病患者中没有被发现的比例和成年人中报告了没有患糖尿病却可能没有被发现的比例进行了组间比较。
RESULTS—Among those with diabetes, the percentages having undetected diabetes were 42.2% (95% CI 36.7–47.7) among the uninsured, 25.9% (22.9–28.9) among the insured, 49.3% (43.0–55.6) for those uninsured >1 year, 38.7% (29.2–48.2) for those uninsured 1 year, and 24.5% (21.7–27.3) for those continuously insured over the past year. Type of insurance, number of times receiving health care in the past year, and routine patterns of health care utilization were also associated with undetected diabetes. Multivariate adjustment indicated that having undetected diabetes was associated with being uninsured (odds ratio 1.7 [95% CI 1.0–2.9]) and with being uninsured >1 year (2.6 [1.4–5.0]).
结果——未上保险的糖尿病人中，未被发现的比例为42.2%（95% CI 36.7–47.7），上保险的人为25.9% (22.9–28.9)，其中未上保险>1年的为49.3% (43.0–55.6)，1年内为38.7% (29.2–48.2)，过去一年中未中断保险的为24.5% (21.7–27.3)。保险类型，过去一年接受健康保健次数，和习惯的健康保健使用方式也与发现糖尿病有关。多重变量校准提示患糖尿病未被发现与未上保险相关（概率1.7 [95% CI 1.0–2.9])，并与未上保险超过1年相关(2.6 [1.4–5.0])。
CONCLUSIONS—Limited access to health care, especially being uninsured and going without insurance for a long period, was significantly associated with being a "missed patient" with diabetes. Efforts to increase detection of diabetes may need to address issues of access to care.
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作者:admin@医学,生命科学 2010-11-04 05:11
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