The burden of chronic kidney disease among people with diabetes by insurance schemes: Findings from a primary referral hospital in Thailand

Abstract

Background: Chronic Kidney Disease (CKD), a microvascular complication of diabetes, poses a significant threat of pre-mature deaths and morbidities globally, including Thailand. This study aimed to assess the burden of CKD among people with diabetes by their health insurance schemes in rural Thailand.Methods: Cross-sectional data were collected from a clinical registry of 4050 people with diabetes attending a primary referral hospital in northeastern Thailand between January 2015 and December 2015. CKD was defined based on the determination of the estimated glomerular filtration rate (<60 mL/min/1.73 m2). Blood pressure, blood glucose, and anthropometry were measured. Information about insurance schemes, namely, civil service medical benefits, social security, and universal coverage, were obtained from the participant's healthcare card. We performed multivariable logistic regression to determine the association of CKD with the corresponding insurance schemes.Results: The majority of the participants were aged at or over 60 years (56.6%), were female (64.3%), were farmers (60.1%), completed secondary level education (70.7%), and were hypertensive (57.3%). Among all, 25.3% of participants had CKD (n = 1027), ranging from 26.9% in the universal coverage scheme to 11.8% in the social security scheme. Under the civil service medical benefits scheme, people were less likely [adjusted odds ratio: 0.8, 95% confidence interval: (0.6–0.9)] to have CKD than people with universal coverage scheme. CKD was also greater among 50–59 [2.3 (1.3–3.5)], 60–69 [6.4 (4.3–9.5)], and ≥70-year-old [17.2 (12.5–28.1)] people than <50 years. People living with diabetes and hypertension also had a higher odd of having CKD [1.8 (1.5–2.1)] than the normotensive people.Conclusions: A significant number of people who had CKD attended the primary care hospital for receiving the management of diabetes. Primary healthcare facilities can provide CKD screening opportunities and diabetes care under the universal coverage scheme package and offer self-management education programmes for rural people.