Lack of access to medication could be a reason for a higher risk of mortality in low income countries, an international study has found.
The study, which looked at population across 21 countries, found that the risk of death due to diabetes is higher in low income countries than in high income countries. It compared people with diabetes and those without diabetes, in low, middle and high income countries and found that the overall mortality rate is three times higher among those with diabetes as compared to those without diabetes.
The rate doubles when the risk of mortality among persons with diabetes in a low income country is compared to persons without diabetes in high income countries. “Primarily rates of cardiovascular events like heart attack are about three times higher in those with diabetes across all countries,” explains Anjana Ranjit Mohan, lead author and vice-president of Madras Diabetes Research Foundation. “The overall mortality is higher in low income countries. In the lower income countries, the background mortality is higher among those with diabetes and non-diabetes. The mortality rate among those with diabetes is manifold higher here when compared to those in higher income countries,” she says.
The study, Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study (Anjana et al), was published in the journal Diabetes Care .
The researchers looked at the access to healthcare and medication across the countries. Dr. Anjana says, “We looked at the categories of anti-diabetes drugs, anti-hypertensives, statins and aspirins. In high income countries, about 60% of people are taking their medication correctly but only 20% in low income countries take their medication. This could be one of the reasons that the event rate is higher and the death rate is higher.”
The researchers also felt individuals in low income countries were not prescribed drugs at optimal dose or at optimal time, which they termed “therapeutic inertia”.
Access to finance
This non-availability of medicines could be related to access to finance, as in low income countries most patients pay out of pocket for medicines. It could also be due to patient or providers’ belief regarding the safety and efficacy of the medicines prescribed.
The researchers said individuals with self-reported diabetes had “higher hazards of mortality” when compared to those with newly diagnosed diabetes. They made a case for more widespread screening of the population so that risk factors are identified early and treated appropriately.
