Factores asociados a recibir tratamiento para hipertensión arterial y diabetes mellitus tipo 2 en personas privadas de su libertad en Perú: Análisis secundario del Censo Nacional Penitenciario 2016

Abstract

Introducción: Hipertensión arterial (HTA) y Diabetes Mellitus (DM2) son enfermedades no transmisibles con elevada prevalencia. Las personas privadas de libertad (PPL) representan una población vulnerable en cuanto a acceso a servicios de salud. Se desconoce qué factores se asocian a recibir tratamiento en esta población. El objetivo del estudio es por tanto evaluar el porcentaje de PPL que reciben tratamiento para su enfermedad, y cuáles son los factores asociados a esto.

Métodos: Estudio transversal analítico basado en el análisis secundario del Censo Nacional Penitenciario 2016 en Perú. Se incluyó pacientes que auto reportaron tener HTA y/o DM diagnosticadas por personal de salud. El desenlace fue recibir tratamiento farmacológico para dichas enfermedades al momento del Censo. Se calcularon Razones de Prevalencia (RP) usando Regresión de Poisson con varianzas robustas por conglomerados en forma cruda y ajustada.

Resultados: Se incluyeron 4930 personas. El porcentaje de PPL que reciben tratamiento para HTA fue de 61.65%, y para DM2 fue 68.8%. Los factores asociados a recibir tratamiento para HTA fueron mayor edad (RP 1.68; 1.54-1.63), tener sentencia (RP 1.15; 1.07-1.24), y usar los servicios de salud (RP 1.56; 1.45-1.69). Los mismos factores, así como haber reingresado (RP 1.12; 1.04-1.22), se asociaron a mayor probabilidad de recibir tratamiento para DM2. De igual forma, los factores asociados a recibir menos tratamiento para HTA fueron: sexo masculino (RP 0.86; 0.81-0.91), sufrir de discriminación (RP 0.85; 0.80-0.91) y no tener seguro de salud (RP 0.86; 0.81-0.91), y para DM2 fueron: sexo masculino (RP 0.86; 0.81-0.92), consumir drogas (RP 0.86; 0.77-0.95), sufrir de discriminación (RP 0.85; 0.79-0.92) y hacinamiento (RP 0.92; 0.85-0.99).

Conclusiones: Existe un importante porcentaje de PPL que no reciben tratamiento para enfermedades crónicas a pesar de estar institucionalizados. Tener una mayor edad, estar sentenciado, y usar los servicios de salud se asociaron tanto a recibir tratamiento para HTA como para DM. Además, discapacidad motora e ingresos previos se asociaron solo a recibir tratamiento para DM2. Por otro lado, sexo masculino y reportar discriminación se asociaron a menos tratamiento para ambas enfermedades. No tener seguro afectó negativamente tratamiento para HTA; mientras que consumo de drogas psicoactivas, y hacinamiento disminuyeron la probabilidad de recibir tratamiento para DM2.

Background: Hypertension (HBP) and Diabetes mellitus (DM) are highly prevalent non-transmissible diseases. People deprived of their liberty (PDL) represent a vulnerable population in terms of access to health services. It is unknown the factors associated with receiving treatment in this population. The objective of this study is therefore, evaluate the percentage and associated factors of PDL that receive treatment for Hypertension and/or Diabetes mellitus.

Methods: Analytical cross-sectional study based on a secondary analysis of the 2016 national penitentiary census in Peru. Patients included in this study self-reported having HBP and/or DM diagnosed by a health professional. The outcome was: receiving pharmacological treatment for HBP and/or DM at the time de census was done. Odds ratio were calculated using the Poisson regression with robust variances in conglomerates with raw and tight forms.

Results: 4930 people were included in this study. 61.65% of PDL with HBP received treatment. 68.8% of PDL with DM received treatment. In HBP, the associated factors were age (OR 1.68; 1.54-1.63), having a judicial sentence (OR 1.15; 1.07-1.24), use of the health services (OR 1.56; 1.45-1.69). The same factors were associated with receiving treatment in DM, as well as having been readmitted (PR 1.12; 1.04-1.22), were associated with a higher probability of receiving treatment for DM2. Similarly, the factors associated with receiving less treatment for HT were: male sex (PR 0.86; 0.81-0.91), suffer discrimination (PR 0.85; 0.80-0.91) and not having health insurance (PR 0. 86; 0.81-0.91), and for DM2 were: male sex (PR 0.86; 0.81-0.92), drug abuse (PR 0.86; 0.77-0.95), suffer discrimination (PR 0.85; 0.79-0.92) and overcrowding (PR 0.92; 0.85-0.99).

Conclusions: There is a significant percentage of PDL who do not receive treatment for chronic diseases despite being institutionalized. Being older, having a judicial sentence, and using health services were associated with receiving treatment for both HBP and DM. In addition, motor disability and previous admissions were associated only with receiving treatment for DM2. On the other hand, male sex and reporting discrimination were associated with less treatment for both diseases. Not having health insurance negatively affected treatment for HBP; while psychoactive drug use and overcrowding decreased the probability of receiving treatment for DM2.