Social Determinants of Health and Tobacco Use in Thirteen Low and Middle Income Countries: Evidence from Global Adult Tobacco Survey

BACKGROUND: Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries. METHODOLOGY/PRINCIPAL FINDINGS: We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008-2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Viet Nam. These surveys provided information on 209,027 respondent's aged 15 years and above and the country datasets were analyzed individually for estimating current tobacco use across various socio-demographic factors (gender, age, place of residence, education, wealth index, and knowledge on harmful effects of smoking). Multiple logistic regression analysis was used to predict the impact of these determinants on current tobacco use status. Current tobacco use was defined as current smoking or use of smokeless tobacco, either daily or occasionally. Former smokers were excluded from the analysis. Adjusted odds ratios for current tobacco use after controlling other cofactors, was significantly higher for males across all countries and for urban areas in eight of the 13 countries. For educational level, the trend was significant in Bangladesh, Egypt, India, Philippines and Thailand demonstrating decreasing prevalence of tobacco use with increasing levels of education. For wealth index, the trend of decreasing prevalence of tobacco use with increasing wealth was significant for Bangladesh, India, Philippines, Thailand, Turkey, Ukraine, Uruguay and Viet Nam. The trend of decreasing prevalence with increasing levels of knowledge on harmful effects of smoking was significant in China, India, Philippines, Poland, Russian Federation, Thailand, Ukraine and Viet Nam. CONCLUSIONS/SIGNIFICANCE: These findings demonstrate a significant but varied role of social determinants on current tobacco use within and across countries

Million record hits: Genre niches, strategic alliances and product success in the recorded music industry.

Million record hits: Genre niches, strategic alliances and product success in the recorded music industry

Medical Costs Associated with Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older with Type 2 Diabetes

   Objective: To estimate medical costs associated with 17 major diabetes-related complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 2 diabetes. Methods: Data were from the 2006–2017 100% Medicare claims database among beneficiaries enrolled in fee-for-service plans. Records with type 2 diabetes and complications were identified using International Classification of Diseases codes, Ninth Revision and Tenth Revision, and diagnosis-related group codes. The index year was the year when a person was first identified with diabetes with an inpatient claim, or an outpatient claim plus another inpatient/outpatient claim in the 2 years following the first claim in Medicare. Included individuals were followed from index years until death, discontinuation of plan coverage, or December 31, 2017. Fixed-effect regression was used to estimate the cost in years when the complication event occurred and in subsequent years. The total cost for each complication was calculated for 2017 by multiplying the complication prevalence by the cost estimate. All costs were standardized to 2017 U.S. dollars. Results: Our study included 10,982,900 persons with type 2 diabetes. Follow-up ranged from 3 to 10 years. The three costliest complications were kidney failure treated by transplantation (occurring year $79,045; subsequent years$17,303), kidney failure treated by dialysis ($54,394;$38,670), and lower-extremity amputation ($38,982;$8,084). Congestive heart failure accounted for the largest share (18%) of total complication cost.  Conclusions: Costs associated with diabetes complications were substantial. Our cost estimates provide essential information needed for conducting economic evaluation of treatment/programs to prevent/delay diabetes complications in Medicare beneficiaries.  </p

Medical Costs Associated with Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older with Type 1 Diabetes

   Aims: To estimate medical costs associated with 17 diabetes complications and treatment procedures among Medicare beneficiaries ≥65 years old with type 1 diabetes. Methods: Using the 2006–2017 100% Medicare claims database for beneficiaries enrolled in fee-for-service plans and Part D, we estimated the annual cost of 17 diabetes complications and treatment procedures. Type 1 diabetes and its complications and procedures were identified using ICD 9/10 codes, procedure codes, and diagnosis-related group codes. Individuals with type 1 diabetes were followed from the year when their diabetes was initially identified in Medicare (2006–2015) until death, discontinuing plan coverage, or December 31, 2017. Fixed-effect regression was used to estimate costs in the complication occurrence years and subsequent years. The cost-proportion of a complication was equal to the total cost of the complication, calculated by multiplying prevalence by the per person cost, divided by the total cost for all complications. All costs were standardized to 2017 US dollars. Results: Our study included 114,879 persons with type 1 diabetes with lengths of follow-up from 3 to 10 years. The costliest complications per person were kidney failure treated by transplantation (occurrence year $77,809; subsequent years$13,556), kidney failure treated by dialysis ($56,469;$41,429), and neuropathy treated by lower-extremity amputation ($40,698;$7,380). Sixteen percent of the total medical cost for diabetes complications was for treating congestive heart failure.  Conclusions: Costs of diabetes complications were large and varied by complications. Our results can assist in cost-effectiveness analysis of treatments and interventions for preventing or delaying diabetes complications in Medicare beneficiaries aged 65 years or older with type 1 diabetes.</p

Prevalence of current tobacco use among adults aged 15 years and above by socio-demographic characteristics in 13 low-and-middle income countries, Global Adult Tobacco Survey, 2008–2010.

<p>Prevalence of current tobacco use among adults aged 15 years and above by socio-demographic characteristics in 13 low-and-middle income countries, Global Adult Tobacco Survey, 2008–2010.</p

Predictors of current tobacco use among adults age 15 years and above in 13 low-and-middle income countries using logistic regression analysis, Global Adult Tobacco Survey, 2008–2010.

<p>Note: OR-Odds Ratio; CI-Confidence Interval; RC-Reference Category;</p>***<p>p<0.001,</p>**<p>p<0.01,</p>*<p>p<0.05;</p>‡<p>p-values shown for test of linear trend.</p

Type of current tobacco use among adults aged 15 years and above in 13 low-and-middle income countries, Global Adult Tobacco Survey, 2008–2010.

<p>Type of current tobacco use among adults aged 15 years and above in 13 low-and-middle income countries, Global Adult Tobacco Survey, 2008–2010.</p

Distribution of adults aged 15 years and above by socio-demographic characteristics in 13 low-and-middle income countries, Global Adult Tobacco Survey, 2008–2010.

<p><b>Note:</b> n - sample size.</p