Publication:
Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand

dc.contributor.authorLily D. Yanen_US
dc.contributor.authorPiya Hanvoravongchaien_US
dc.contributor.authorWichai Aekplakornen_US
dc.contributor.authorSuwat Chariyalertsaken_US
dc.contributor.authorPattapong Kessomboonen_US
dc.contributor.authorSawitri Assanangkornchaien_US
dc.contributor.authorSurasak Taneepanichskulen_US
dc.contributor.authorNareemarn Neelapaichiten_US
dc.contributor.authorAndrew C. Stokesen_US
dc.contributor.otherChulalongkorn Universityen_US
dc.contributor.otherBoston University School of Public Healthen_US
dc.contributor.otherKhon Kaen Universityen_US
dc.contributor.otherFaculty of Medicine, Ramathibodi Hospital, Mahidol Universityen_US
dc.contributor.otherPrince of Songkla Universityen_US
dc.contributor.otherBoston Medical Centeren_US
dc.contributor.otherChiang Mai Universityen_US
dc.date.accessioned2020-01-27T03:28:48Z
dc.date.available2020-01-27T03:28:48Z
dc.date.issued2020-01-01en_US
dc.description.abstractBACKGROUND: Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. METHODS: We conducted a cross-sectional analysis of the 2014 Thai National Health Examination Survey. Diabetes was defined as fasting plasma glucose ≥126mg/dL or on treatment. National and regional care cascades were constructed across screening, diagnosis, treatment, and control. Unmet need was defined as the total loss across cascade levels. Logistic regression was used to examine the demographic and healthcare factors associated with cascade attrition. FINDINGS: We included 15,663 individuals. Among Thai adults aged 20+ with diabetes, 67.0% (95% CI 60.9% to 73.1%) were screened, 34.0% (95% CI 30.6% to 37.2%) were diagnosed, 33.3% (95% CI 29.9% to 36.7%) were treated, and 26.0% (95% CI 22.9% to 29.1%) were controlled. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast. Multivariable models indicated older age (OR 1.76), males (OR 0.65), and a higher density of medical staff (OR 2.40) and health centers (OR 1.58) were significantly associated with being diagnosed among people with diabetes. Older age (OR 1.80) and higher geographical density of medical staff (OR 1.82) and health centers (OR 1.56) were significantly associated with being controlled. CONCLUSIONS: Substantial attrition in the diabetes care continuum was observed at diabetes screening and diagnosis, related to both individual and health system factors. Even with universal health insurance, Thailand still needs effective behavioral and structural interventions, especially in primary health care settings, to address unmet need in diabetes care for its population.en_US
dc.identifier.citationPloS one. Vol.15, No.1 (2020), e0226286en_US
dc.identifier.doi10.1371/journal.pone.0226286en_US
dc.identifier.issn19326203en_US
dc.identifier.other2-s2.0-85077941875en_US
dc.identifier.urihttps://repository.li.mahidol.ac.th/handle/123456789/49527
dc.rightsMahidol Universityen_US
dc.rights.holderSCOPUSen_US
dc.source.urihttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85077941875&origin=inwarden_US
dc.subjectAgricultural and Biological Sciencesen_US
dc.subjectBiochemistry, Genetics and Molecular Biologyen_US
dc.subjectMultidisciplinaryen_US
dc.titleUniversal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailanden_US
dc.typeArticleen_US
dspace.entity.typePublication
mu.datasource.scopushttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85077941875&origin=inwarden_US
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