Anales de la RANM

15 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 MIGRATION AND HEALTH INEQUITY Aagaard-Hansen J, et al. An RANM. 2025;142(01): 11 - 20 5.2. Diabetes mellitus Diabetes mellitus (DM) is a chronic, endocrine disease caused by inadequate production of insulin in the pancreas and/or ineffective use of the hormone, which leads to increased blood glucose. It is estimated that 537 million adults lived with DM in 2021 out of whom 75% lived in Low-and Middle-Income Countries. The annual mortality due to DM was 6.7 million deaths that same year (35). The two main variants of DM are types 1 and 2. The former has a sudden onset typically in childhood or youth with need of insulin injections from the start. The latter, which constitutes 95% of all cases, has a more gradual course and frequently remains undiagnosed. Type 2 DM mostly occurs later in life and is often manageable with oral medication. Both types of DM require healthy dietar y practices and adequate physical activity and benefit from maintenance of normal weight. The main challenges are vascular or neural complications potentially leading to blindness, foot ulcers and potentially loss of limbs, kidney dysfunction and major cardio-vascular events such as strokes or heart attacks. Especially when not controlled appropriately, DM may increase susceptibility to various infectious diseases (36). Irrespectively of the type, a person with DM depends on a stable supply of drugs such as insulin or metformin, and quite often additional treatment for hypertension and elevated blood fats. Apart from the drugs themselves, optimal diabetes care also includes access to blood glucose monitoring and to qualified staff who can advise on dosage and screen for renal, ophthalmological, and neural complications. Though this is the ideal, it admittedly rarely happens even among non-migrating populations, and quality of DM control of blood sugar and hypertension is inversely associated with the national levels of economic development. This trend is less pronounced but still existent in countries with universal and therefore af fordable health care. Similar disparages are found for DM-related complications and mortality in various countries (37). National health care systems usually find it difficult to cater for pastoral groups with no fixed residential location even within a given country leading to reduced health outcomes. Population segments forced to take sudden refuge either due to natural disasters or human/political reasons, may find themselves in neighboring countries without nearby health care facilities, leave alone entitlement to the services provided within the local socio-economic context and this may subsequently lead to disparities in health outcomes or consequences. The same goes for the flows of migrants often crossing several countries and sometimes oceans in order to reach more affluent parts of the world such as United States of America (USA) or the European Union (37). 5.3. Tuberculosis Tuberculosis (TB) is a communicable disease caused by the bacillus Mycobacterium tubercu- losis. An estimated 10.6 million people fell ill with TB worldwide in 2021, equivalent to 134 cases per 100,000 population (38). It is present in all countries and age groups. A total of 90% of the TB cases are adults, with more men than women being affected. TB mostly affects the lungs based on transmission by droplets from person to person, but there is also a bovine form spread by contaminated milk (39). The death rate is about 50% in manifest TB without treatment. However, about 85% of the patients can be cured with the currently recommended standard treatment (4-6 months course of a combination of anti-TB drugs). Some strains of the TB bacillus have developed resistance to the commonly prescribed drugs (DR), which is a public health threat of great concern. In addition to contagion, DR-TB occurs when drugs for proper treatment are not available or they have poor quality, health care providers prescribe the wrong dosage, or the patients do not complete a full course of treatment. An important problem for adherence to DR-TB treatment is the serious side effects as well as the higher cost (40). DR-TB is categorized into five categories of increasing severity according to the number of drugs (39). Migrants from countries with high TB incidence are the dominant group of people with active TB disease in many recipient countries (41). Foreign-born migrants contribute to the burden of TB with an increasing number of newly diagnosed cases in many high-income countries (39). Re-activation of latent TB infection among migrants in Europe has driven national policies for identifying and treating latent TB infection among them to reduce TB incidence (42). More than 50% of previously treated cases with severe DR-TB in 2021 have been found in the Russian Federation, Central Asia, and Eastern Europe (30), and migrants from Eastern Europe have a higher degree of multi-DR than other regions like sub-Saharan Africa (43-44). Long and expensive treatment regimens for TB together with economic barriers can affect access to health care for diagnosis and comple- tion of treatment (outcomes), with catastrophic total costs for migrants and their families (consequences) (45). The World Health Organization (WHO) suggests that improving TB care among migrants should be considered as a key public health priority towards elimination of TB, and the multi- pronged ‘End TB strategy’ includes universal access to hygiene and infection control measures and cross-border care as priorities (39,46).