Health care of non-communicable diseases and associated imprisonment factors in Mexico City's male prisons

Transcription

1 Health care of non-communicable diseases and associated imprisonment factors in Mexico City's male prisons Omar Silverman-Retana Edson Servan-Mori Ruy Lopez-Ridaura Sergio Bautista-Arredondo

2 Background 1. Health care of prisoners should be based on the equivalence principle, with the appropriate standards of care protocols. 2. NCDs prevalence inside the prisons had being recognized as a Public Health issue. High prevalence of NCDs in Mexico (2006: HT=30.8%, DM2= 7.3%. 2012: HT=31.5%, DM2=9.6%). 3. Aim: To document prison factors associated with the odds to receive health care follow up during imprisonment for NCDs (DM2 and HT). To compare the results on quality of care features of type 2 diabetic inmates during imprisonment with results from ENSANUT 2012.

3 Methods: study design

4 Analytical strategy 1. Descriptive analysis 2. Multiple adjusted logistic regression model: association between receiving at least one follow up visit during imprisonment, selfreported medical diagnoses and prison related factors. 3. Compare selected quality of care features from type 2 diabetic prisoners to general population.

5 Main results

6 1. Sample profile stratified by diagnosis HT DM2 Both diagnosis N % Age (yrs.) Age at admission to the prison (yrs.) Health care and treatment indicators (%) Receive at least one follow up visit per year during imprisonment Take medication regularly for controlling their disease Received health care before incarceration First degree family background Diabetes Hypertension ɸ Health indicators (%) Obesity ɸ Uncontrolled blood pressure p-value p-value ɸ p-value 0.10

7 2. Sample profile stratified by follow-up status Without follow-up At least one follow-up visit per year N % Age (yrs.) Age at admission to the prison (yrs.) Diagnosis: Hypertension Diabetes Both Health care and treatment indicators (%) Take medication regularly for controlling the disease Received health care before incarceration Co-morbidities Previously diagnosis of elevated blood cholesterol ɸ Previously diagnosis of elevated blood triglycerides ɸ Health indicators (%) Uncontrolled blood pressure p-value p-value ɸ p-value 0.10

8 3. Associated factors to follow-up visit Reference group: not health care (no follow-up visits during imprisonment) Variable OR IC 95% HT [Ref.] 1.00 Self-reported diagnosis DM , 3.67 Both diagnosis , 7.51 Received health care before incarceration , 2.39 I [Ref.] 1.00 II [0.51,1.32] , 3.91 Time of incarceration quintiles III [1.32, 2.56] , 3.11 IV [2.59, 5.17] , 3.37 V [5.18, 24.9] , 2.55 Age at admission to the prison , 1.05 Prison Facility North [Ref.] 1.00 South , 1.17 Observations 496

9 4. Quality of health care features of type 2 diabetes

10 Conclusions 1. This study contributes to document how the health care of prisoners with NCDs is driven in two large Mexico City prisons. a. Inequalities on health care: ~50% of the inmates without follow-up visits reported health care before incarceration. b. Access to health care improves access to medical treatment 2. Some limitations: a. Lax definition of cases may overestimate the OR found. b. No information on disease complications and blood tests c. Cross sectional study design 3. Screening for this diseases during intake to the prison is crucial for keeping continuum of care; thus improving engagement to the prison health facility for inmates follow up during imprisonment.