Table_1_Access to diabetes diagnosis in Brazil based on recent testing and consultation: The Brazilian national health survey, 2013 and 2019.docx

BackgroundScreening for undiagnosed diabetes using glucose testing is recommended globally to allow preventive action among those detected. Our aim was to evaluate the access to glucose testing to screen for diabetes in Brazil using self-reported information on recent testing and medical consultation from national surveys of Brazilian adults.
MethodsThe Pesquisa Nacional de Saúde (PNS) was conducted in 2013 and 2019 drawing probabilistic samples of Brazilians aged 18 years and above. To evaluate glucose testing among those undiagnosed, we excluded those self-reporting a previous diagnosis of diabetes. We then defined recent access to diabetes diagnosis by considering the previous two years and choosing the last blood glucose test and the proximal medical consultation reported. We used Poisson regression with robust variance to assess correlates of access, expressing them with adjusted prevalence ratios (PR) and their 95% confidence intervals.
ResultsAccess to recent glucose testing documented that over 70% reported a recent glycemic test, 71% in 2013, and 77% in 2019. These findings are consistent with a wide recent access to medical consultation, 86% and 89% in 2013 and 2019, respectively. Reporting recent glucose testing and medical consultation may better reflect the actual access to medical diagnostic testing. When analyzing this joint outcome, diagnostic access was still wide, 67% and 74%, respectively. Greater access (p< 0.001) was seen for women (PR=1.16; 1.15-1.17), older individuals (PR=1.25; 1.22-1.28), and those with higher education (PR=1.17; 1.15-1.18), obesity (PR=1.06; 1.05-1.08), and hypertension (PR=1.12; 1.11-1.13). In contrast, lower access (p<0.001) was seen for those declaring being Black (PR=0.97; 0.95-0.99) or of mixed-race (PR=0.97; 0.96-0.98), those residing in rural areas (PR=0.89; 0.87-0.90), and not having a private health insurance plan (PR=0.85; 0.84-0.86).
ConclusionsAlthough access to diagnostic testing for diabetes is high in Brazil, partly due to its universal health system, social inequities are still present, demanding specific actions, particularly in rural areas and among those self-declaring as being Black or mixed-race.

背景 全球范围内推荐采用血糖检测对未确诊糖尿病进行筛查，以便对确诊者采取预防干预措施。本研究旨在利用巴西成年人群全国调查中关于近期检测与门诊就诊的自我报告数据，评估巴西国内糖尿病筛查的血糖检测可及性。

方法 本研究使用2013年与2019年开展的巴西全国健康调查（Pesquisa Nacional de Saúde, PNS）数据，该调查招募了18岁及以上巴西人群的概率抽样样本。为评估未确诊人群的血糖检测情况，我们排除了自我报告既往确诊糖尿病的参与者。随后，我们以过去两年为时间窗，结合报告的最近一次血糖检测与最近一次门诊就诊情况，定义糖尿病诊断的近期可及性。本研究采用稳健方差泊松回归分析可及性的相关影响因素，并以校正患病率比（PR）及其95%置信区间呈现结果。

结果 近期血糖检测可及性数据显示，超过70%的参与者报告近期接受过血糖检测，2013年与2019年的比例分别为71%与77%。这一结果与门诊就诊的高可及性相符，2013年与2019年的门诊就诊率分别为86%与89%。同时报告近期血糖检测与门诊就诊的情况，可更准确反映医学诊断检测的实际可及性。分析该联合结局时，糖尿病诊断检测的可及性仍处于较高水平，2013年与2019年的比例分别为67%与74%。亚组分析显示，女性（PR=1.16；95%CI：1.15~1.17）、老年人群（PR=1.25；95%CI：1.22~1.28）、受教育程度较高者（PR=1.17；95%CI：1.15~1.18）、肥胖人群（PR=1.06；95%CI：1.05~1.08）以及高血压患者（PR=1.12；95%CI：1.11~1.13）的检测可及性显著更高（p<0.001）。与之相反，自我报告为黑人（PR=0.97；95%CI：0.95~0.99）或混血人群（PR=0.97；95%CI：0.96~0.98）、居住在农村地区（PR=0.89；95%CI：0.87~0.90）以及无私人医疗保险者（PR=0.85；95%CI：0.84~0.86）的检测可及性显著更低（p<0.001）。

结论 尽管巴西的糖尿病诊断检测可及性较高，这部分得益于其全民医疗体系，但社会公平性差距依然存在，亟需采取针对性干预措施，尤其是在农村地区以及自我报告为黑人或混血的人群中。