Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costs
Abstract Background The prevalence of diabetes is escalating globally, underscoring the need for comprehensive evidence to inform health systems in effectively addressing this epidemic. The purpose of this study was to examine the patterns of countries’ capacity to manage diabetes using latent class...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12913-024-12052-2 |
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| author | Samuel Akyirem Emmanuel Ekpor Charles Boakye Kwanin |
| author_facet | Samuel Akyirem Emmanuel Ekpor Charles Boakye Kwanin |
| author_sort | Samuel Akyirem |
| collection | DOAJ |
| description | Abstract Background The prevalence of diabetes is escalating globally, underscoring the need for comprehensive evidence to inform health systems in effectively addressing this epidemic. The purpose of this study was to examine the patterns of countries’ capacity to manage diabetes using latent class analysis (LCA) and to determine whether the patterns are associated with diabetes-related deaths and healthcare costs. Methods Eight indicators of country-level capacity were drawn from the World Health Organization Global Health Observatory dataset: the widespread availability of hemoglobin A1C (HbA1c) testing, existence of diabetes registry, national diabetes management guidelines, national strategy for diabetes care, blood glucose testing, diabetic retinopathy screening, sulfonylureas, and metformin in the public health sector. We performed LCA of these indicators, testing 1–5 class solutions, and selecting the best model based on Bayesian Information Criteria (BIC), entropy, corrected Akaike Information Criteria (cAIC), as well as theoretical interpretability. Multivariable linear regression was used to assess the association between capacity to manage diabetes (based on the latent class a country belongs) and diabetes-related deaths and healthcare costs. Results We included 194 countries in this secondary analysis. Countries were classified into “high capacity” (88.7%) and “limited capacity” (11.3%) countries based on the two-class solution of the LCA (entropy = 0.91, cAIC = 1895.93, BIC = 1862.93). Limited capacity countries were mostly in Africa. Limited capacity countries had significantly higher percentage of their deaths attributable to diabetes (adjusted beta = 1.34; 95% CI: 0.15, 2.53; p = 0.027) compared to high capacity countries even after adjusting for income status and diabetes prevalence. Conclusions Our findings support the report by the Lancet commission on diabetes, which suggests that differences in diabetes outcomes among countries may be explained by variations in the capacity of and investments made in their health systems. Future studies should evaluate initiatives such as the WHO Global Diabetes Compact that are currently underway to improve the capacity of resource-limited countries. |
| format | Article |
| id | doaj-art-73d557aa4afb4193a3070e464552834d |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-73d557aa4afb4193a3070e464552834d2025-01-19T12:15:19ZengBMCBMC Health Services Research1472-69632025-01-0125111010.1186/s12913-024-12052-2Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costsSamuel Akyirem0Emmanuel Ekpor1Charles Boakye Kwanin2School of Nursing, Yale UniversitySchool of Nursing and Midwifery, University of GhanaSchool of Nursing, University of WashingtonAbstract Background The prevalence of diabetes is escalating globally, underscoring the need for comprehensive evidence to inform health systems in effectively addressing this epidemic. The purpose of this study was to examine the patterns of countries’ capacity to manage diabetes using latent class analysis (LCA) and to determine whether the patterns are associated with diabetes-related deaths and healthcare costs. Methods Eight indicators of country-level capacity were drawn from the World Health Organization Global Health Observatory dataset: the widespread availability of hemoglobin A1C (HbA1c) testing, existence of diabetes registry, national diabetes management guidelines, national strategy for diabetes care, blood glucose testing, diabetic retinopathy screening, sulfonylureas, and metformin in the public health sector. We performed LCA of these indicators, testing 1–5 class solutions, and selecting the best model based on Bayesian Information Criteria (BIC), entropy, corrected Akaike Information Criteria (cAIC), as well as theoretical interpretability. Multivariable linear regression was used to assess the association between capacity to manage diabetes (based on the latent class a country belongs) and diabetes-related deaths and healthcare costs. Results We included 194 countries in this secondary analysis. Countries were classified into “high capacity” (88.7%) and “limited capacity” (11.3%) countries based on the two-class solution of the LCA (entropy = 0.91, cAIC = 1895.93, BIC = 1862.93). Limited capacity countries were mostly in Africa. Limited capacity countries had significantly higher percentage of their deaths attributable to diabetes (adjusted beta = 1.34; 95% CI: 0.15, 2.53; p = 0.027) compared to high capacity countries even after adjusting for income status and diabetes prevalence. Conclusions Our findings support the report by the Lancet commission on diabetes, which suggests that differences in diabetes outcomes among countries may be explained by variations in the capacity of and investments made in their health systems. Future studies should evaluate initiatives such as the WHO Global Diabetes Compact that are currently underway to improve the capacity of resource-limited countries.https://doi.org/10.1186/s12913-024-12052-2DiabetesDiabetes-related deathDiabetes-related expenditureLatent class analysisNational capacity |
| spellingShingle | Samuel Akyirem Emmanuel Ekpor Charles Boakye Kwanin Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costs BMC Health Services Research Diabetes Diabetes-related death Diabetes-related expenditure Latent class analysis National capacity |
| title | Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costs |
| title_full | Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costs |
| title_fullStr | Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costs |
| title_full_unstemmed | Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costs |
| title_short | Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costs |
| title_sort | latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes related deaths and healthcare costs |
| topic | Diabetes Diabetes-related death Diabetes-related expenditure Latent class analysis National capacity |
| url | https://doi.org/10.1186/s12913-024-12052-2 |
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