Skip to main content

Advertisement

SpringerLink
Log in

Health care access and health-related quality of life among people with diabetes in the Southern Cone of Latin America—a cross-sectional analysis of data of the CESCAS I study

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

Little is known on the association of health care access and health-related quality of life (HRQoL) in people with diabetes in the Southern Cone of Latin America (SCLA).

Methods

We analyzed data of 1025 participants of CESCAS I. To determine HRQoL, we used the SF-12 physical (PCS-12) and mental component summary (MCS-12). We compared four groups regarding HRQoL: (a) insured people without self-reported barriers to health care, (b) uninsured people without self-reported barriers to health care, (c) insured people with self-reported barriers to health care, and (d) uninsured people with self-reported barriers to health care. We conducted linear regressions with PCS-12 and MCS-12 as outcome. We adjusted for sociodemographic and disease-related factors and having access to a primary physician.

Results

In the first group, there were 407, in the second 471, in the third 44, and in the fourth group 103 participants. Compared to the first group, PCS-12 was 1.9 points lower (95% Confidence Interval, CI: − 3.5, − 0.3) in the second, 4.5 points (95% CI: − 8.1, − 1) lower in the third, and 6.1 points lower (95% CI: − 8.7, − 3.6) in the fourth group. Compared to the first group, MCS-12 was 0.6 points lower (95% CI: − 2.7, 1.4) in the second, 4.8 points lower (95% CI: − 9.3, − 0.3) in the third, and 5.8 points lower (95% CI: − 9.1, − 2.5) in the fourth group.

Conclusion

In the SCLA, impeded access to care is common in people with diabetes. Self-reported barriers to care may be more important than insurance status in determining HRQoL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets used and analyzed during the current study are available from the NIH Biologic Specimen and Data Repository Information Coordinating Center (https://biolincc.nhlbi.nih.gov/studies/ghcoe_argentina/).

Code availability

Available from the corresponding author on reasonable request.

Abbreviations

HRQoL:

Health-related quality of life

SF-12/SF-36:

Short form-12/Short form-36

PCS-12:

Physical component summary-12

MCS-12:

Mental component summary-12

SD:

Standard deviation

CI:

Confidence interval

References

  1. International-Diabetes-Federation. Diabetes facts and figures. Accessed on 19th of September 2019 from: https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html. 2017.

  2. Rubinstein, A. L., Irazola, V. E., Calandrelli, M., Elorriaga, N., Gutierrez, L., Lanas, F., et al. (2015). Multiple cardiometabolic risk factors in the Southern Cone of Latin America: a population-based study in Argentina, Chile, and Uruguay. International Journal of Cardiology., 183, 82–88.

    Article  Google Scholar 

  3. Vos, T., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., et al. (2017). Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet., 390(10100), 1211–1259.

    Article  Google Scholar 

  4. World-Health-Organization. The development of the World Health Organization quality of life assessment instrument (the WHOQOL). Quality of life assessment: International perspectives: Springer; 1994. p. 41–57.

  5. Tang, T. S., Yusuf, F. L., Polonsky, W. H., & Fisher, L. (2017). Assessing quality of life in diabetes: II–deconstructing measures into a simple framework. Diabetes Research and Clinical Practice., 126, 286–302.

    Article  Google Scholar 

  6. Luscombe, F. A. (2000). Health-related quality of life measurement in type 2 diabetes. Value in Health, 3, S15–S28.

    Article  Google Scholar 

  7. Bastos LF, Hugo FN, Hilgert JB, Cardozo DD, Bulgarelli AF, Santos CMD. Access to dental services and oral health-related quality of life in the context of primary health care. Brazilian oral research. 2019;33.

  8. Erskine, N. A., Gandek, B., Tran, H. V., Abu, H., McManus, D. D., Kiefe, C. I., et al. (2018). Barriers to healthcare access and to improvements in health-related quality of life after an acute coronary syndrome (from TRACE-CORE). The American Journal of Cardiology, 122(7), 1121–1127.

    Article  Google Scholar 

  9. Maliski SL, Connor SE, Oduro C, Litwin MS, editors. Access to health care and quality of life for underserved men with prostate cancer. Seminars in Oncology Nursing; 2011: Elsevier.

  10. Hoffmann, R. L., Rohrer, W. M., South-Paul, J. E., Burdett, R., & Watzlaf, V. J. (2008). The effects of barriers on Health Related Quality of Life (HRQL) and compliance in adult asthmatics who are followed in an urban community health care facility. Journal of Community Health, 33(6), 374–383.

    Article  Google Scholar 

  11. Bharmal, M., & Thomas, J. (2005). Health insurance coverage and health-related quality of life: analysis of 2000 Medical Expenditure Panel Survey data. Journal of Health Care for the Poor and Underserved, 16(4), 643–654.

    Article  Google Scholar 

  12. Zimbudzi, E., Lo, C., Ranasinha, S., Fulcher, G., Gallagher, M., Jan, S., et al. (2018). Patient reported barriers are associated with low physical and mental well-being in patients with co-morbid diabetes and chronic kidney disease. Health and Quality of Life Outcomes, 16(1), 215.

    Article  Google Scholar 

  13. Lontchi-Yimagou E, Mapa-Tassou C, Dehayem MY, Essi M-J, Saji J, Takogue R, et al. The effect of free diabetes care on metabolic control and on health-related quality of life among youths with type 1 diabetes in Cameroon. BMJ Open Diabetes Research and Care. 2017;5(1).

  14. Konerding, U., Bowen, T., Elkhuizen, S. G., Faubel, R., Forte, P., Karampli, E., et al. (2017). The impact of travel distance, travel time and waiting time on health-related quality of life of diabetes patients: an investigation in six European countries. Diabetes Research and Clinical Practice, 126, 16–24.

    Article  Google Scholar 

  15. Pinchevsky, Y., Raal, F., Butkow, N., Chirwa, T., Distiller, L., & Rothberg, A. (2018). Quality of care delivered to type 2 diabetes mellitus patients in public and private sector facilities in Johannesburg, South Africa. International Journal of General Medicine, 11, 383.

    Article  Google Scholar 

  16. Brown, A. F., Ettner, S. L., Piette, J., Weinberger, M., Gregg, E., Shapiro, M. F., et al. (2004). Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiologic Reviews, 26(1), 63–77.

    Article  Google Scholar 

  17. Rubinstein AL, Irazola VE, Poggio R, Bazzano L, Calandrelli M, Zanetti FTL, et al. Detection and follow-up of cardiovascular disease and risk factors in the Southern Cone of Latin America: the CESCAS I study. BMJ Open 2011;1(1).

  18. Augustovski, F. A., Lewin, G., García-Elorrio, E., & Rubinstein, A. (2008). The Argentine-Spanish SF-36 Health Survey was successfully validated for local outcome research. Journal of Clinical Epidemiology, 61(12), 1279–84.

    Article  Google Scholar 

  19. Stewart, A. L., & Ware, J. E. (1992). Measuring functioning and well-being: the medical outcomes study approach. Durham: Duke University Press.

    Google Scholar 

  20. Ware J, Kosinski M. SF-36 physical & mental health summary scales: a manual for users of version 1. 2001. Lincoln, RI: QualityMetric Incorporated.

  21. Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., et al. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. Journal of Clinical Epidemiology, 51(11), 1171–1178.

    Article  CAS  Google Scholar 

  22. Wukich, D. K., Sambenedetto, T. L., Mota, N. M., Suder, N. C., & Rosario, B. L. (2016). Correlation of SF-36 and SF-12 component scores in patients with diabetic foot disease. The Journal of Foot and Ankle Surgery, 55(4), 693–696.

    Article  Google Scholar 

  23. Becerril-Montekio, V., Reyes, J. D. D., & Manuel, A. (2011). Sistema de salud de Chile. Salud pública de México, 53, s132–s42.

    PubMed  Google Scholar 

  24. Aran, D., & Laca, H. (2011). Sistema de salud de Uruguay. Salud Pública de México, 53, s265–s274.

    Article  Google Scholar 

  25. Belló, M., & Becerril-Montekio, V. M. (2011). Sistema de salud de Argentina. Salud Pública de México, 53, s96–s109.

    PubMed  Google Scholar 

  26. Bernales-Baksai, P. (2020). Tackling segmentation to advance universal health coverage: analysis of policy architectures of health care in Chile and Uruguay. International Journal for Equity in Health, 19(1), 1–11.

    Article  Google Scholar 

  27. Guerrero-Núñez S, Valenzuela-Suazo S, Cid-Henríquez P. Effective universal coverage of diabetes mellitus type 2 in Chile. Revista latino-americana de enfermagem. 2017;25.

  28. Rubinstein, A., Zerbino, M. C., Cejas, C., & López, A. (2018). Making universal health care effective in Argentina: a blueprint for reform. Health Systems & Reform, 4(3), 203–213.

    Article  Google Scholar 

  29. Schunk, M., Reitmeir, P., Schipf, S., Völzke, H., Meisinger, C., Ladwig, K.-H., et al. (2015). Health-related quality of life in women and men with type 2 diabetes: a comparison across treatment groups. Journal of Diabetes and its Complications, 29(2), 203–211.

    Article  CAS  Google Scholar 

  30. Schanner, C., Falck, A., Keskitalo, A., & Hautala, N. (2016). Health-related quality of life of Finnish patients with diabetes. Scandinavian Journal of Public Health, 44(8), 765–771.

    Article  Google Scholar 

  31. Jiao, F., Wong, C. K. H., Gangwani, R., Tan, K. C. B., Tang, S. C. W., & Lam, C. L. K. (2017). Health-related quality of life and health preference of Chinese patients with diabetes mellitus managed in primary care and secondary care setting: decrements associated with individual complication and number of complications. Health and Quality of life Outcomes, 15(1), 125.

    Article  Google Scholar 

  32. Wegeberg, A. M. L., Meldgaard, T., Hyldahl, S., Jakobsen, P. E., Drewes, A. M., Brock, B., et al. (2019). Quantities of comorbidities affects physical, but not mental health related quality of life in type 1 diabetes with confirmed polyneuropathy. World Journal of Diabetes, 10(2), 87.

    Article  Google Scholar 

  33. Aro, A.-K., Karjalainen, M., Tiihonen, M., Kautiainen, H., Saltevo, J., Haanpää, M., et al. (2017). Glycemic control and health-related quality of life among older home-dwelling primary care patients with diabetes. Primary Care Diabetes, 11(6), 577–582.

    Article  Google Scholar 

  34. Thiel, D. M., Al Sayah, F., Vallance, J., Johnson, S. T., & Johnson, J. A. (2017). Physical activity and health-related quality of life in adults with type 2 diabetes: results from a prospective cohort study. Journal of Physical Activity and Health, 14(5), 368–374.

    Article  Google Scholar 

  35. Slagter, S. N., van Vliet-Ostaptchouk, J. V., van Beek, A. P., Keers, J. C., Lutgers, H. L., van der Klauw, M. M., et al. (2015). Health-related quality of life in relation to obesity grade, type 2 diabetes, metabolic syndrome and inflammation. PLoS One, 10(10), e0140599.

    Article  Google Scholar 

  36. Kang, H. (2013). The prevention and handling of the missing data. Korean Journal of Anesthesiology, 64(5), 402.

    Article  Google Scholar 

  37. Gu X, Matloff N. A different approach to the problem of missing data. arXiv: 150904992. 2015.

  38. Daoud JI, editor Multicollinearity and regression analysis. Journal of Physics: Conference Series; 2017: IOP Publishing.

  39. Zhang, X., Bullard, K. M., Gregg, E. W., Beckles, G. L., Williams, D. E., Barker, L. E., et al. (2012). Access to health care and control of ABCs of diabetes. Diabetes Care, 35(7), 1566–1571.

    Article  Google Scholar 

  40. Sprangers, M. A., de Regt, E. B., Andries, F., van Agt, H. M., Bijl, R. V., de Boer, J. B., et al. (2000). Which chronic conditions are associated with better or poorer quality of life? Journal of Clinical Epidemiology, 53(9), 895–907.

    Article  CAS  Google Scholar 

  41. Irazola, V., Rubinstein, A., Bazzano, L., Calandrelli, M., Chung-Shiuan, C., Elorriaga, N., et al. (2017). Prevalence, awareness, treatment and control of diabetes and impaired fasting glucose in the Southern Cone of Latin America. PLoS One, 12(9), e0183953.

    Article  Google Scholar 

  42. Naughton, M. J., Joyce, P., Morgan, T. M., Seid, M., Lawrence, J. M., Klingensmith, G. J., et al. (2014). Longitudinal associations between sex, diabetes self-care, and health-related quality of life among youth with type 1 or type 2 diabetes mellitus. The Journal of Pediatrics, 164(6), 1376–83.

    Article  Google Scholar 

  43. Speight, J., Reaney, M., & Barnard, K. (2009). Not all roads lead to Rome—a review of quality of life measurement in adults with diabetes. Diabetic Medicine, 26(4), 315–327.

    Article  CAS  Google Scholar 

  44. Huang, I. C., Hwang, C. C., Wu, M. Y., Lin, W., Leite, W., & Wu, A. W. (2008). Diabetes-specific or generic measures for health-related quality of life? Evidence from psychometric validation of the D-39 and SF-36. Value in Health, 11(3), 450–461.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank all participants of the cohort study and all members of the study team who participated in the recruitment, data collection, data management, and analysis. We thank Karoline Wagner for English language editing.

Funding

CESCAS I was funded by the National Heart, Lung, and Blood Institute (NHLBI) Grant Number HHSN268200900029C. NK was supported by the German Federal Law on Support in Education for studies abroad.

Author information

Authors and Affiliations

  1. Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany

    Nadja Kartschmit

  2. Instituto de Efectividad Clinica y Sanitaria, Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina

    Andrea Beratarrechea, Laura Gutiérrez, Ana Soledad Cavallo, Adolfo Luis Rubinstein & Vilma Irazola

Authors
  1. Nadja Kartschmit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Beratarrechea
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Gutiérrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Soledad Cavallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adolfo Luis Rubinstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vilma Irazola
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VI and AR planned and coordinated the CESCAS I study. VI and NK developed the research question. NK conducted the statistical analysis and wrote the manuscript. AB advised on the statistical analysis and the discussion part. AB and ASC reviewed the manuscript. LG advised on the statistical analysis, is responsible for data management of the CESCAS I study, and calculated the PCS-12 and MCS-12 of the SF-12. All authors read and approved the final manuscript. The manuscript is part of the Master’s thesis of NK, and analysis was done during an internship of the Master’s program.

Corresponding author

Correspondence to Nadja Kartschmit.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by IRBs in all participating institutes in Argentina, Chile, Uruguay and the US, including the Institutional Review Board from Hospital Italiano in Argentina, the Araucanía Sur IRB from the Universidad de la Frontera in Chile, the Universidad de la República IRB from Uruguay, and the Tulane University Human Research Protection Office.

Informed consent

All study participants provided written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kartschmit, N., Beratarrechea, A., Gutiérrez, L. et al. Health care access and health-related quality of life among people with diabetes in the Southern Cone of Latin America—a cross-sectional analysis of data of the CESCAS I study. Qual Life Res 30, 1005–1015 (2021). https://doi.org/10.1007/s11136-020-02704-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-020-02704-1

Keywords

Search

Navigation