Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis

Saleh Aljadeeah,Eckhard Nagel,Veronika J Wirtz

doi:10.1186/s12913-021-07124-6

Saleh Aljadeeah, Eckhard Nagel + Show 1 more

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https://doi.org/10.1186/s12913-021-07124-6

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Abstract

BackgroundLow- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines.MethodsOutpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate.ResultsBeneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government.ConclusionsAdditional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria.

Highlights

Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity
There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to Cardiovascular Disease (CVD) and diabetes medicines in some regions in Syria
This study presents the first estimates of CVDs and diabetes medicines dispensing rates and patterns at population level in Syria using health insurance data from a large sample (81,314 beneficiaries) over 12 months

Summary

Introduction

Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Non-communicable diseases (NCDs) account for 71% of all deaths globally. Seven NCDs were in the top 10 causes of death in 2019 where cardiovascular diseases (CVDs) and diabetes are listed among the four leading causes of death globally [1, 2]. Low- and middle-income countries (LMICs) bear the highest burden of NCDs mortality and morbidity [3]. CVDs and diabetes are underdiagnosed and undertreated in LMICs and result in considerable morbidity and mortality [4]. It is estimated that this disease burden will continue to rise and cause financial burdens on health systems and households, in LMICs [3]

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