Browsing by Author "Emmanuela Gakidou"

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    Management of diabetes and associated cardiovascular risk factors in seven countries: A comparison of data from national health examination surveys
    (2011-03-01) Emmanuela Gakidou; Leslie Mallinger; Jesse Abbott-Klafter; Ramiro Guerrero; Salvador Villalpando; Ruy Lopez Ridaura; Wichai Aekplakorn; Mohsen Naghavi; Stephen Lim; Rafael Lozano; Christopher J.L. Murray; Institute for Health Metrics and Evaluation; UCSF School of Medicine; PROESA; Instituto Nacional de Salud Publica; Mahidol University
    Objective To examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socioeconomic factors. Methods We used nationally representative health examination surveys from Colombia, England, the Islamic Republic of Iran, Mexico, Scotland, Thailand and the United States of America to obtain data on diagnosis, treatment and control of hyperglycaemia, arterial hypertension and hypercholesterolaemia among individuals with diabetes. Using logistic regression, we explored the socioeconomic determinants of diagnosis and effective case management. Findings A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries. The figures range from 24% of the women in Scotland and the USA to 62% of the men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure and serum cholesterol was very low, ranging from 1% of male patients in Mexico to about 12% in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States. Conclusion There are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia. While no large socioeconomic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.
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    Reductions in child mortality levels and inequalities in Thailand: analysis of two censuses
    (2007-03-10) Patama Vapattanawong; Margaret C. Hogan; Piya Hanvoravongchai; Emmanuela Gakidou; Theo Vos; Alan D. Lopez; Stephen S. Lim; Mahidol University; University of Queensland; Setting Priorities using Information on Cost-Effectiveness (SPICE) Project Ministry of Public Health; International Health Policy Program; Chulalongkorn University; Harvard Initiative for Global Health
    Background: Thailand's progress in reducing the under-five mortality rate (U5MR) puts the country on track to achieve the fourth Millennium Development Goal (MDG). Whether this success has been accompanied by a widening or narrowing of the child mortality gap between the poorest and richest populations is unknown. We aimed to measure changes in child-mortality inequalities by household-level socioeconomic strata of the Thai population between 1990 and 2000. Methods: We measured changes in the distribution of the U5MR by economic strata using data from the 1990 and 2000 censuses. Economic status was measured using household assets and characteristics. The U5MR was estimated using the Trussell version of the Brass indirect method. Findings: Average household economic status improved and inequalities declined between the two censuses. There were substantially larger reductions in U5MR in the poorer segments of the population. Excess child mortality risk between the poorest and richest quintile decreased by 55% (95% CI 39% to 68%). The concentration index, measured using percentiles of economic status, in 1990 was -0·20 (-0·23 to -0·18), whereas in 2000 it had dropped to -0·12 (-0·15 to -0·08), a 43% (22% to 63%) reduction. Interpretation: These findings draw attention to the feasibility of incorporating equity measurement into census data. Thailand has achieved both an impressive average decrease in U5MR and substantial reductions in U5MR inequality over a 10 year period. Contributing factors include overall economic growth and poverty reduction, improved insurance coverage, and a scaling-up and more equitable distribution of primary health-care infrastructure and intervention coverage. Understanding the factors that have led to Thailand's success could help inform countries struggling to meet the fourth MDG and reduce inequality. © 2007 Elsevier Ltd. All rights reserved.