Search

Objective: Diabetes is an important risk factor for severe coronavirus disease 2019 (COVID-19), but little is known about the marginal effect of additional risk factors for severe COVID-19 among individuals with diabetes. We tested the hypothesis that sociodemographic, access to health care, and presentation to care characteristics among individuals with diabetes in Mexico confer an additional risk of hospitalization with COVID-19., Research Design and Methods: We conducted a cross-sectional study using public data from the General Directorate of Epidemiology of the Mexican Ministry of Health. We included individuals with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 between 1 March and 31 July 2020. The primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required intensive care unit admission., Results: Among 373,963 adults with COVID-19, 16.1% (95% CI 16.0-16.3) self-reported diabetes. The predicted probability of hospitalization was 38.4% (37.6-39.2) for patients with diabetes only and 42.9% (42.2-43.7) for patients with diabetes and one or more comorbidities (obesity, hypertension, cardiovascular disease, and chronic kidney disease). High municipality-level of social deprivation and low state-level health care resources were associated with a 9.5% (6.3-12.7) and 17.5% (14.5-20.4) increased probability of hospitalization among patients with diabetes, respectively. In age-, sex-, and comorbidity-adjusted models, living in a context of high social vulnerability and low health care resources was associated with the highest predicted probability of hospitalization., Conclusions: Social vulnerability contributes considerably to the probability of hospitalization among individuals with COVID-19 and diabetes with associated comorbidities. These findings can inform mitigation strategies for populations at the highest risk of severe COVID-19., (© 2020 by the American Diabetes Association.)

Aims: We aimed to evaluate the readiness and predictors of diabetes service capability at the level of primary care in Bangladesh as an illustrative instance of readiness for diabetes care in low- and middle-income countries (LMICs)., Methods: We used data from the 2014 Bangladesh Health Facility Survey (BHFS), a cross-sectional, nationally representative survey (n = 1596 health facilities). We constructed a diabetes-specific readiness index to assess diabetes service readiness in facilities with outpatient capability and used multivariable regression analysis to evaluate contextual predictors of diabetes service readiness., Results: Three-hundred and forty-five facilities with outpatient and diabetes service capability were included. Mean readiness for diabetes service capability on a scale of 0-100 was 24.9 (95%CI: 20.8-28.9) and was lowest in rural settings, districts with high social deprivation, and public facilities, where diabetes diagnostic equipment and medications were largely unavailable. Facility type was the strongest, independent predictor of diabetes service readiness., Conclusions: Diabetes service readiness in outpatient facilities in Bangladesh was low, particularly in public facilities, rural settings, and districts with high social deprivation. .These findings could inform policies aimed at improving diabetes care in areas of high unmet need and may serve as a model to assess diabetes service readiness in other LMICs., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The article reports that despite advances in type 2 diabetes management, disparities persist among Latinos living in the United States. Topics include examines the Latinos, the fastest-growing ethnic minority population in the United States, are twice as likely to have diabetes-related complications and 1.3 times more likely to die of diabetes than non-Latino Whites.

Objective To describe the temporal and geographical patterns of the continuum of maternal health care in Mexico, as well as the sociodemographic characteristics that affect the likelihood of receiving this care. Methods We conducted a pooled cross-sectional analysis using the 1997, 2009, 2014 and 2018 waves of the National Survey of Demographic Dynamics, collating sociodemographic and obstetric characteristics of 93 745 women aged 12--54 years at last delivery. We defined eight variables along the antenatal--postnatal continuum, both independently and conditionally. We used a pooled fixed-effects multivariable logistic model to determine the likelihood of receiving the continuum of care for various properties. We also mapped the quintiles of adjusted state-level absolute change in continuum of care coverage during 1994--2018. Findings We observed large absolute increases in the proportion of women receiving timely antenatal and postnatal care (from 48.9% to 88.2% and from 39.1% to 68.7%, respectively). In our conditional analysis, we found that the proportion of women receiving adequate antenatal care doubled over this period. We showed that having social security and a higher level of education is positively associated with receiving the continuum of care. We observed the largest relative increases in continuum of care coverage in Chiapas (181.5%) and Durango (160.6%), assigned human development index categories of low and medium, respectively. Conclusion Despite significant progress in coverage of the continuum of maternal health care, disparities remain. While ensuring progress towards achievement of the health-related sustainable development goal, government intervention must also target underserved populations. [ABSTRACT FROM AUTHOR]