RESUMO
Factors influencing the morbidity and mortality associated with viremic hepatitis C virus (HCV) infection change over time and place, making it difficult to compare reported estimates. Models were developed for 17 countries (Bahrain, Bulgaria, Cameroon, Colombia, Croatia, Dominican Republic, Ethiopia, Ghana, Hong Kong, Jordan, Kazakhstan, Malaysia, Morocco, Nigeria, Qatar and Taiwan) to quantify and characterize the viremic population as well as forecast the changes in the infected population and the corresponding disease burden from 2015 to 2030. Model inputs were agreed upon through expert consensus, and a standardized methodology was followed to allow for comparison across countries. The viremic prevalence is expected to remain constant or decline in all but four countries (Ethiopia, Ghana, Jordan and Oman); however, HCV-related morbidity and mortality will increase in all countries except Qatar and Taiwan. In Qatar, the high-treatment rate will contribute to a reduction in total cases and HCV-related morbidity by 2030. In the remaining countries, however, the current treatment paradigm will be insufficient to achieve large reductions in HCV-related morbidity and mortality.
Assuntos
Saúde Global , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/mortalidade , Modelos Estatísticos , Viremia/epidemiologia , Viremia/mortalidade , Antivirais/uso terapêutico , Política de Saúde , Hepatite C Crônica/tratamento farmacológico , Humanos , Incidência , Prevalência , Viremia/tratamento farmacológicoRESUMO
The total number, morbidity and mortality attributed to viraemic hepatitis C virus (HCV) infections change over time making it difficult to compare reported estimates from different years. Models were developed for 15 countries to quantify and characterize the viraemic population and forecast the changes in the infected population and the corresponding disease burden from 2014 to 2030. With the exception of Iceland, Iran, Latvia and Pakistan, the total number of viraemic HCV infections is expected to decline from 2014 to 2030, but the associated morbidity and mortality are expected to increase in all countries except for Japan and South Korea. In the latter two countries, mortality due to an ageing population will drive down prevalence, morbidity and mortality. On the other hand, both countries have already experienced a rapid increase in HCV-related mortality and morbidity. HCV-related morbidity and mortality are projected to increase between 2014 and 2030 in all other countries as result of an ageing HCV-infected population. Thus, although the total number of HCV countries is expected to decline in most countries studied, the associated disease burden is expected to increase. The current treatment paradigm is inadequate if large reductions in HCV-related morbidity and mortality are to be achieved.
Assuntos
Hepacivirus/isolamento & purificação , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/virologia , Modelos Estatísticos , Viremia/epidemiologia , Viremia/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Feminino , Saúde Global , Hepatite C Crônica/mortalidade , Hepatite C Crônica/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Sobrevida , Viremia/mortalidade , Viremia/terapia , Adulto JovemRESUMO
Morbidity and mortality attributable to chronic hepatitis C virus (HCV) infection are increasing in many countries as the infected population ages. Models were developed for 15 countries to quantify and characterize the viremic population, as well as estimate the number of new infections and HCV related deaths from 2013 to 2030. Expert consensus was used to determine current treatment levels and outcomes in each country. In most countries, viremic prevalence has already peaked. In every country studied, prevalence begins to decline before 2030, when current treatment levels were held constant. In contrast, cases of advanced liver disease and liver related deaths will continue to increase through 2030 in most countries. The current treatment paradigm is inadequate if large reductions in HCV related morbidity and mortality are to be achieved.
Assuntos
Antivirais/uso terapêutico , Efeitos Psicossociais da Doença , Hepatite C Crônica/epidemiologia , Modelos Biológicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Progressão da Doença , Feminino , Saúde Global , Hepatite C Crônica/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
Millions of Americans are plagued by serious problems of inadequate health care benefits, limiting their access to services and creating hardship. For those under 65 years of age, the problem is the lack of insurance for many working poor and others. For the elderly, the problem is one of underinsurance in terms of both cost and coverage, particularly for long-term care. Policies of cost containment and cost shifting to consumers have exacerbated these problems, and current health policy proposals offer little respite. Arguments are made for a program of public national health care. Health policy interventions are considered at four levels: incrementalism, modification, alteration, and transformation. A proposal is presented for universal health benefits that are organized and operated to eliminate for-profit medical care and to promote social and preventive care.