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

Autoři: Lily D. Yan aff001;  Piya Hanvoravongchai aff002;  Wichai Aekplakorn aff003;  Suwat Chariyalertsak aff004;  Pattapong Kessomboon aff006;  Sawitri Assanangkornchai aff007;  Surasak Taneepanichskul aff008;  Nareemarn Neelapaichit aff009;  Andrew C. Stokes aff011
Působiště autorů: Internal Medicine, Boston Medical Center, Boston, MA, United States of America aff001;  Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand aff002;  Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand aff003;  Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand aff004;  Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand aff005;  Medicine, Khon Kaen University, Khon Kaen, Thailand aff006;  Epidemiology Unit, Prince of Songkla University, Songkhla, Thailand aff007;  College of Public Health Science, Chulalongkorn University, Thailand aff008;  Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand aff009;  Thailand Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand aff010;  Global Health, Boston University School of Public Health, Boston, MA, United States of America aff011
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226286



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.


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.


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.


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.

Klíčová slova:

Blood plasma – Body Mass Index – diabetes mellitus – Oral glucose suppression test – Public and occupational health – Socioeconomic aspects of health – Thai people – Thailand


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