Development of a Prediction Model for the Management of Noncommunicable Diseases Among Older Syrian Refugees Amidst the COVID-19 Pandemic in Lebanon

  1. Stephen J. McCall
  2. Tanya El Khoury
  3. Noura Salibi
  4. Berthe Abi Zeid
  5. Maria El Haddad
  6. Marwan F. Alawieh
  7. Sawsan Abdulrahim
  8. Monique Chaaya
  9. Hala Ghattas
  10. Abla M. Sibai

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Abstract

Older Syrian refugees have a high burden of noncommunicable diseases (NCDs) and economic vulnerability.

Objectives

To develop and internally validate a predictive model to estimate inability to manage NCDs in older Syrian refugees, and to describe barriers to NCD medication adherence.

Design, Setting, and Participants

This nested prognostic cross-sectional study was conducted through telephone surveys between September 2020 and January 2021. All households in Lebanon with Syrian refugees aged 50 years or older and who received humanitarian assistance from a nongovernmental organization were invited to participate. Refugees who self-reported having chronic respiratory disease (CRD), diabetes, history of cardiovascular disease (CVD), or hypertension were included in the analysis. Data were analyzed from November 2021 to March 2022.

Main Outcomes and Measures

The main outcome was self-reported inability to manage any NCD (including CRD, CVD, diabetes, or hypertension). Predictors of inability to manage any NCD were assessed using logistic regression models. The model was internally validated using bootstrapping techniques, which gave an estimate of optimism. The optimism-adjusted discrimination is presented using the C statistic, and calibration of the model is presented using calibration slope ( C slope).

Results

Of 3322 older Syrian refugees, 1893 individuals (median [IQR] age, 59 [54-65] years; 1089 [57.5%] women) reported having at least 1 NCD, among whom 351 (10.6% overall; 18.6% of those with ≥1 NCD) had CRD, 781 (23.7% overall; 41.4% of those with ≥1 NCD) had diabetes, 794 (24.1% overall; 42.2% of those with ≥1 NCD) had history of CVD, and 1388 (42.3% overall; 73.6% of those with ≥1 NCD) had hypertension. Among individuals with NCDs, 387 participants (20.4%) were unable to manage at least 1 of their NCDs. Predictors for inability to manage NCDs were age, nonreceipt of cash assistance, household water insecurity, household food insecurity, and having multiple chronic diseases, with an adjusted C statistic of 0.650 (95% CI, 0.620-0.676) and C slope of 0.871 (95% CI, 0.729-1.023). The prevalence of nonadherence to medication was 9.2%, and the main reasons for nonadherence were unaffordability of medication (40.8%; 95% CI, 33.4%-48.5%) and the belief that they no longer required the medication after feeling better (22.4%; 95% CI, 16.4%-29.3%).

Conclusions and Relevance

In this cross-sectional study, the predictors of inability to manage NCDs among older Syrian refugees in Lebanon were mainly related to financial barriers. Context-appropriate assistance is required to overcome financial barriers and enable equitable access to medication and health care.

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  1. Version published to 10.1001/jamanetworkopen.2022.31633
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    SciScore for 10.1101/2022.04.12.22273786: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: The present study has enhanced our understanding of the predictors of inability to manage NCDs among older Syrian refugees in Lebanon and fills a major gap in the international literature. Furthermore, this study is one of the largest on older Syrian refugees in the published literature with a high response rate of >85% among those who were eligible.11 The study was limited as the predictive model had a moderate discriminative ability, which may be explained by missing predictors, such as perception of medication regime as being complicated, not knowing the purpose of the medication, accessibility issues, side effects due to medication, lack of healthcare support, lack of trust in doctors, stressful living conditions and time since diagnosis15,30,44,45. Furthermore, the calibration of the model showed overfitting and may not perform well in future samples, hence, future studies should aim to be larger if they wish to develop a predictive model. Another limitation was that data were self-reported to data collectors so misclassification in the data is possible; however, we tried to limit this through data quality and consistency checks. Conclusions: This study highlights that inability to manage NCDs was mainly related to financial barriers. The predictors from this study will allow healthcare professionals and humanitarian organizations to identify older refugees who are at a greater risk of being unable to manage their NCDs. These vulnerable groups ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2022.04.12.22273786 on medRxiv