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1.
J Environ Manage ; 267: 110635, 2020 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-32349956

RESUMEN

The differences in consumption levels across different strata of income and income inequality give raise to differences in the effects of income inequality on the level of the consumption-based greenhouse gas (GHG) emission. However, the impact of inequality on consumption-based emissions has been scarcely analysed. Therefore, the aim of this study is to test the relationship between income inequality and consumption-based GHG emission per capita by applying the country-level data for 1990-2014. Due to the prevailing economic structures, those relationships may be non-linear and imposition of pre-defined functional relationships in the estimation may induce additional bias. In order to circumvent this issue, the partially linear regression is applied in this paper. The non-parametric part of the regression is applied to examine the linkages between the income inequality and GHG emission per capita, whereas the other controlling variables are included in the linear part of the model. The results indicate a non-liner relationship between income inequality and GHG emission per capita along with a U-shape relationship between GDP per capita and the GHG emission per capita. This suggests tailored environmental policies are required for regions with diverse economic structures. This paper reveals how to achieve the reduction of income inequality and climate change simultaneously.


Asunto(s)
Gases de Efecto Invernadero , Política Ambiental , Efecto Invernadero , Renta , Modelos Lineales , Factores Socioeconómicos
2.
Psychiatr Prax ; 47(4): 214-217, 2020 May.
Artículo en Alemán | MEDLINE | ID: mdl-32340050

RESUMEN

AIM: To date, to our knowledge there are no studies regarding attitudes and experiences of outpatient medical personnel during a pandemic. This study's aim was to evaluate the impact of the COVID-19 pandemic in March 2020 on German psychiatrists and neurologists. METHODS: An e-mail and fax-based short survey of 2,072 practice-based psychiatrists and neurologists was performed including Likert-type questions on personal burden and concerns, anticipated risk of infection, practice management as well as anxiety and sleep problems. RESULTS: 396 physicians returned the questionnaire (19 %). More than 60 % of the participants felt restricted strongly or very strongly, more than 30 % were strongly and very strongly concerned. They anticipated a high own risk of infection. However, 91 % did not report any contact with patients positively screened for COVID-19, which they were aware of. One third felt financially threatened and loss of business volume was anticipated. 18 % reported, that the pandemic triggers substantial anxiety. Sleep problems, which occur at least almost every night, were rarely reported (9 %). CONCLUSION: Practice-based psychiatrists and neurologists are negatively affected by the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/psicología , Neurólogos/psicología , Neumonía Viral/psicología , Gestión de la Práctica Profesional , Psiquiatría , Betacoronavirus , Alemania , Humanos , Renta , Control de Infecciones , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Pandemias , Encuestas y Cuestionarios
3.
J Environ Manage ; 264: 109948, 2020 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-32250882

RESUMEN

There is growing interest in understanding the benefits of parks and green space in financial terms, particularly from policymakers and decision-makers. Applying a financial value is an increasingly popular practice designed to communicate urban green space benefits to budget holders. This is pertinent for local governments who routinely struggle to secure funding for parks, given their non-statutory status around the world. To address this, it is perhaps inevitable that the application of a wide range of funding models to parks is being explored. However, there is little empirical evidence that users and residents share this sentiment. This paper aims to address this gap in knowledge by exploring how feasible and acceptable such income generation practices are for stakeholders directly involved in using and managing parks. We asked local residents, parks managers, community groups and academics in one northern English city how feasible and acceptable they considered different income generation practices if applied to their local parks. The findings show that overall, income generated by cafés and organised events were considered acceptable by residents but to a lesser extent by community groups and professionals. Voluntary donations, car parking and increased taxation were considered unacceptable by all stakeholders, while using the planning system to secure funding was considered acceptable. The findings suggest a variety of acceptable, context-specific income-generating practices which may help stakeholders to address pragmatically the current challenges of managing urban parks.


Asunto(s)
Renta , Parques Recreativos , Ciudades , Gobierno Local , Impuestos
4.
J Environ Manage ; 264: 110482, 2020 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-32250907

RESUMEN

Environmental pollution and income inequality have become two salient issues in China. To achieve a green economic transformation, China urgently needs to develop renewable energy technologies to reduce carbon dioxide (CO2) emissions. However, the relationship among income inequality, renewable energy technological innovation (RETI) and CO2 emissions has not received sufficient attention in the current literature. Based on Chinese provincial panel data from 2000 to 2015, this paper adopts a panel fixed effect regression model and a panel threshold model to perform an analysis on the nonlinear relationship among these factors. The results show that (1) RETI is conducive to reducing per capita CO2 emissions (PCE). However, with an increase in income inequality, the abatement effect of RETI on per capita CO2 emissions will be hindered, and RETI will even positively contribute to PCE. (2) The panel threshold model shows that the impact of RETI on PCE has a significant single-threshold effect with regard to income inequality. When income inequality is lower than the threshold value, the impact of RETI on PCE is not significant. However, above the threshold value, that is, within the interval of higher income inequality, an increase in RETI will positively contribute to PCE. Finally, from the perspectives of income inequality and RETI, relevant policy implications are put forward for achieving the transformation of a low-carbon economy.


Asunto(s)
Dióxido de Carbono , Desarrollo Económico , China , Renta , Invenciones , Energía Renovable , Factores Socioeconómicos
5.
J Glob Health ; 10(1): 010502, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257157

RESUMEN

Background: The 2016 World Health Organization (WHO) guidelines for antenatal care (ANC) shift the recommended minimum number of ANC contacts from four to eight, specifying the first contact to occur within the first trimester of pregnancy. We quantify the likelihood of meeting this recommendation in 54 Countdown to 2030 priority countries and identify the characteristics of women being left behind. Methods: Using 54 Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) since 2012, we reported the proportion of women with timely ANC initiation and those who received 8-10 contacts by coverage levels of ANC4+ and by Sustainable Development Goal (SDG) regions. We identified demographic, socio-economic and health systems characteristics of timely ANC initiation and achievement of ANC8+. We ran four multiple regression models to quantify the associations between timing of first ANC and the number and content of ANC received. Results: Overall, 49.9% of women with ANC1+ and 44.3% of all women had timely ANC initiation; 11.3% achieved ANC8+ and 11.2% received no ANC. Women with timely ANC initiation had 5.2 (95% confidence interval (CI) = 5.0-5.5) and 4.7 (95% CI = 4.4-5.0) times higher odds of receiving four and eight ANC contacts, respectively (P < 0.001), and were more likely to receive a higher content of ANC than women with delayed ANC initiation. Regionally, women in Central and Southern Asia had the best performance of timely ANC initiation; Latin America and Caribbean had the highest proportion of women achieving ANC8+. Women who did not initiate ANC in the first trimester or did not achieve 8 contacts were generally poor, single women, with low education, living in rural areas, larger households, having short birth intervals, higher parity, and not giving birth in a health facility nor with a skilled attendant. Conclusions: Timely ANC initiation is likely to be a major driving force towards meeting the 2016 WHO guidelines for a positive pregnancy experience.


Asunto(s)
Instituciones de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adulto , Asia , Región del Caribe , Países en Desarrollo , Femenino , Humanos , Renta , Embarazo , Factores Socioeconómicos , Encuestas y Cuestionarios , Desarrollo Sostenible
6.
J Glob Health ; 10(1): 010807, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257170

RESUMEN

Background: The concept of healthy aging has become a global health strategy in response to the population aging. In China, old-aged migrants are facing serious health care challenges due to the obstacles in the utilization of health services, social integration and ignored public policies. We aimed to examine the old-aged migrants' utilization of the essential public health services and its underlying factors on account of change of residence, and social support. Methods: Data came from the senior sample (aged over 65 years, n = 11 161) of the 2015 National Migrant Dynamic Monitoring Survey in China that employed Probability Proportionate to Size method as a sampling strategy. χ2 tests and binary multilevel model were conducted to analyze the difference and the underlying factors of the utilization of essential health services among old-aged migrants. Results: Approximately 66.2% of old-aged migrants did not receive free physician examination services from health institutions in the past year, and 34.6% of old-aged migrants with chronic disease have been followed up by doctors. There were significant differences in the utilization of essential public health services among old-aged migrants across different individuals and families. It showed that exercise time, migrating range, migrating reason, physical health condition, chronic disease, local friends, health insurance, household expenditure, and income were significantly associated with the elderly migrants' utilization of essential public health services. Conclusions: The utilization of essential public health services among old-aged migrants was insufficient in comparison with the general population. The government should launch targeted policies such as production and work-related injuries for the floating population. The supply side should promote the equalization of essential public health services for migrants. Social organizations and community should undertake the responsibility in social support for old-aged migrants.


Asunto(s)
Servicios de Salud Comunitaria/estadística & datos numéricos , Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud , Seguro de Salud/estadística & datos numéricos , Migrantes , Adulto , Anciano , Grupo de Ascendencia Continental Asiática , China/epidemiología , Empleo , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Características de la Residencia , Población Rural , Apoyo Social , Población Urbana
7.
Braz Oral Res ; 34: e036, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32321054

RESUMEN

The aim of this study was to evaluate the factors associated with toothache in the adult population of Minas Gerais, Brazil. Individual data from a population sample (age 35 to 44 years) were collected from a secondary database of the SB Minas survey. Sampling was carried out by clusters and with multiple drawing stages. The eligibility criteria were to reside in areas chosen for the research, be within the age group, and accept to participate in the research. The individual variables assessed by a questionnaire and dental exams were sex, income, race/skin color, root caries, periodontal condition, need for dental treatment, and last dental appointment. The contextual variables, assessed by municipal indexes, were Human Development Index (HDI), illiteracy, unemployment, half minimum wage, quarter minimum wage, oral health team coverage, access to individual health care, and supervised tooth brushing average. The dependent variable was toothache in the past six months. A descriptive analysis was made using the Statistical Package for the Social Sciences and Hierarchical Linear and Nonlinear Modeling Software was used to perform the multilevel analyses for individual and contextual levels. An association was found between toothache and low income (OR = 2.00; 95%CI = 1.32-3.13), dental caries (OR = 1.86; 95%CI = 1.22-2.86), periodontal condition, and living on a quarter of the minimum wage or less (OR = 1.03; 95%CI = 1.00-1.08). Clinical and social factors were associated with toothache, reinforcing the need to improve public polices in oral health focused on the adult population.


Asunto(s)
Odontalgia/epidemiología , Odontalgia/etiología , Adulto , Brasil/epidemiología , Estudios Transversales , Índice CPO , Caries Dental/epidemiología , Femenino , Humanos , Renta/estadística & datos numéricos , Masculino , Análisis Multinivel , Salud Bucal/estadística & datos numéricos , Factores de Riesgo , Distribución por Sexo
8.
J Environ Manage ; 261: 109921, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32148251

RESUMEN

Most estimations of residential water demand are based on single-equation models that rely on assumptions that are most often not compatible with the fundamental principles of consumer theory. In this paper, we relax these assumptions by using a more flexible system of demand estimation, the Quadratic Almost Ideal Demand System (QUAIDS) (Banks et al., 1997) and reveal the existence in our sample of substitution and complementary patterns as well as non-linearities in Engel curves for water consumption. Water demand would not be, therefore, linear in income and separable from other goods consumed within the household. In this context the QUAIDS functional specification is expected to be more consistent with observed consumer behavior. Our results seem to confirm this expectation; when compared to the linear, log-linear and double-log models commonly used in water demand estimation, QUAIDS seems to produce a better overall fit and a better fit to the asymmetric shape of the real distribution of water consumption. This has important implications in terms of public policy, as it allows to explore how water policies interact with other goods consumed within the household (e.g. water-energy nexus or efficient household appliances). Furthermore, differential responses to pricing policies and taxes across the income distribution can be considered, thus contributing to avoid undesired redistributive effects and water poverty.


Asunto(s)
Comercio , Agua , Composición Familiar , Renta , Impuestos
9.
J Am Dent Assoc ; 151(3): 190-196, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32130948

RESUMEN

BACKGROUND: Income inequality has been associated with worse oral health outcomes and reduced dental care use. It is unknown whether income inequality may motivate people to seek orthodontic treatment. METHODS: This was a logistic mixed-effects model of deidentified claims from a private insurer in the United States with enrolled members having at least 1 orthodontic visit in the calendar year as the dependent variable. Total number of dental visits, age, and sex were individual-level covariates. Median household income, Gini coefficient, female population proportion, number of practicing dentists and orthodontists, population size, and population density were zip code-level covariates. RESULTS: A total of 1,860,709 people had at least 1 orthodontic claim. Adjusting for population demographics, the Gini index was significantly positively associated with orthodontic use for children but not for adults (odds ratio, 1.69 for children; P < .0001). Being female was the strongest predictor of orthodontic use for adults and was a significant predictor of use for children (odds ratio, 1.50 and 1.45, respectively; P < .0001). CONCLUSIONS: The Gini index is associated with orthodontic use in children in a privately insured population. Individual characteristics are more predictive of orthodontic use among privately insured adults. PRACTICAL IMPLICATIONS: Demographic and economic traits of communities can affect oral health care use; effects on orthodontic use may be more dramatic than on other forms of oral health care.


Asunto(s)
Renta , Salud Bucal , Adulto , Niño , Atención Odontológica , Femenino , Humanos , Oportunidad Relativa , Factores Socioeconómicos , Estados Unidos
10.
J Am Dent Assoc ; 151(5): 349-357.e1, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32220345

RESUMEN

BACKGROUND: Similar to the United States, inequality in oral health care use is longstanding in Canada. It remains unclear whether this inequality is improving or worsening. In this study, the authors report on income-related inequality in dental visits in Canada and across its provinces over time and interprovincial inequality in dental visits among Canadian provinces. METHODS: The authors used 7 nationally representative health surveys of the Canadian population and collected data from 2001 through 2016. The magnitude of income-related inequality was measured using the slope index of inequality and relative index of inequality. Interprovincial inequality was examined using a number of indexes including the Theil index. RESULTS: Income-related inequality in dental visits was present in all survey years, with people in higher income groups reporting higher dental visit prevalence rates. However, results from the slope index of inequality and relative index of inequality showed a steady decline, meaning there was a decrease in the magnitude of inequality over time. Absolute and relative inequality decreased by 7.2% and 22.9% from 2000 through 2016, respectively. A similar decline was observed across most Canadian provinces. Interprovincial differences in dental visits also decreased over time. CONCLUSIONS: There appears to be persistent but narrowing income-related inequality in dental visits in Canada and across its provinces over time. In addition, it appears that Canadian provinces are becoming more equal in terms of dental services use. PRACTICAL IMPLICATIONS: Narrowing income-related inequality in dental visits in Canada is promising, suggesting a more equal distribution of dental visits. However, unequal use of dental services remains an issue affecting the Canadian population.


Asunto(s)
Disparidades en Atención de Salud , Renta , Canadá , Atención Odontológica , Disparidades en el Estado de Salud , Encuestas Epidemiológicas , Humanos , Salud Bucal , Factores Socioeconómicos , Estados Unidos
11.
Am J Surg ; 219(4): 571-577, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32147020

RESUMEN

INTRODUCTION: Bariatric surgery is an effective treatment for obesity resulting in both sustained weight loss and reduction in obesity-related comorbidities. It is uncertain how sociodemographic factors affect postoperative outcomes. METHODS: The National Inpatient Sample was queried for patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2005 to 2014. Factors associated with selection of SG over RYGB, increased postoperative length of stay (LOS) greater than 3 days, and inpatient mortality were compared by race, insurance status, and other clinical and hospital factors. RESULTS: The database captured 781,413 patients, of which 525,986 had a RYGB and 255,428 had SG. There was an increase in the incidence of SG over RYGB over time. Among the self-pay/uninsured, the increased incidence began several years earlier than other groups. Black patients had greater odds of increased postoperative LOS (OR 1.40) and in-hospital mortality (OR 2.11). CONCLUSION: Sociodemographic factors are associated with differences in temporal trends in the adoption of SG versus RYGB for surgical weight loss.


Asunto(s)
Gastrectomía/tendencias , Derivación Gástrica/tendencias , Mortalidad Hospitalaria , Tiempo de Internación/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Comorbilidad , Grupos de Población Continentales/estadística & datos numéricos , Conjuntos de Datos como Asunto , Femenino , Financiación Personal/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Masculino , Medicaid/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Sector Privado , Factores Raciales , Factores Sexuales , Estados Unidos/epidemiología , Adulto Joven
13.
JAMA ; 323(9): 834-843, 2020 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-32125401

RESUMEN

Importance: Understanding the profitability of pharmaceutical companies is essential to formulating evidence-based policies to reduce drug costs while maintaining the industry's ability to innovate and provide essential medicines. Objective: To compare the profitability of large pharmaceutical companies with other large companies. Design, Setting, and Participants: This cross-sectional study compared the annual profits of 35 large pharmaceutical companies with 357 companies in the S&P 500 Index from 2000 to 2018 using information from annual financial reports. A statistically significant differential profit margin favoring pharmaceutical companies was evidence of greater profitability. Exposures: Large pharmaceutical vs nonpharmaceutical companies. Main Outcomes and Measures: The main outcomes were revenue and 3 measures of annual profit: gross profit (revenue minus the cost of goods sold); earnings before interest, taxes, depreciation, and amortization (EBITDA; pretax profit from core business activities); and net income, also referred to as earnings (difference between all revenues and expenses). Profit measures are described as cumulative for all companies from 2000 to 2018 or annual profit as a fraction of revenue (margin). Results: From 2000 to 2018, 35 large pharmaceutical companies reported cumulative revenue of $11.5 trillion, gross profit of $8.6 trillion, EBITDA of $3.7 trillion, and net income of $1.9 trillion, while 357 S&P 500 companies reported cumulative revenue of $130.5 trillion, gross profit of $42.1 trillion, EBITDA of $22.8 trillion, and net income of $9.4 trillion. In bivariable regression models, the median annual profit margins of pharmaceutical companies were significantly greater than those of S&P 500 companies (gross profit margin: 76.5% vs 37.4%; difference, 39.1% [95% CI, 32.5%-45.7%]; P < .001; EBITDA margin: 29.4% vs 19%; difference, 10.4% [95% CI, 7.1%-13.7%]; P < .001; net income margin: 13.8% vs 7.7%; difference, 6.1% [95% CI, 2.5%-9.7%]; P < .001). The differences were smaller in regression models controlling for company size and year and when considering only companies reporting research and development expense (gross profit margin: difference, 30.5% [95% CI, 20.9%-40.1%]; P < .001; EBITDA margin: difference, 9.2% [95% CI, 5.2%-13.2%]; P < .001; net income margin: difference, 3.6% [95% CI, 0.011%-7.2%]; P = .05). Conclusions and Relevance: From 2000 to 2018, the profitability of large pharmaceutical companies was significantly greater than other large, public companies, but the difference was less pronounced when considering company size, year, or research and development expense. Data on the profitability of large pharmaceutical companies may be relevant to formulating evidence-based policies to make medicines more affordable.


Asunto(s)
Comercio/economía , Industria Farmacéutica/economía , Renta/estadística & datos numéricos , Gastos de Capital/estadística & datos numéricos , Estudios Transversales , Costos de los Medicamentos , Desarrollo de Medicamentos/economía , Industria Farmacéutica/estadística & datos numéricos , Análisis de Regresión , Tecnología/economía , Estados Unidos
15.
Rev Bras Epidemiol ; 23: e200001, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32130390

RESUMEN

INTRODUCTION: In high-income countries, persons of high socioeconomic status (SES) have a lower cardiovascular risk. However, in middle and low-income countries, the results are controversial. OBJECTIVE: To evaluate the association between family income and cardiovascular risk factors in young adults. METHODS: A total of 2,063 individuals of a birth cohort initiated in 1978/79 in the city of Ribeirão Preto, Brazil, were evaluated at age of 23/25 years. Cardiovascular risk factors (hypertension, sedentary lifestyle, smoking, low high-density lipoprotein (HDL)-cholesterol, high low-density lipoprotein (LDL)-cholesterol, high fibrinogen, insulin resistance, diabetes, abdominal and total obesity, and metabolic syndrome) were evaluated according to family income. Income was assessed in multiples of the minimum wage. Simple Poisson regression models were used to estimate the prevalence ratios (PR) with robust estimation of the variance. RESULTS: High-income women showed lower prevalences of low HDL-cholesterol (PR = 0.47), total obesity (PR = 0.22), abdominal obesity (PR = 0.28), high blood pressure (PR = 0.28), insulin resistance (PR = 0.57), sedentary lifestyle (PR = 0.47), metabolic syndrome (PR = 0.24), and high caloric intake (PR = 0.71) (p < 0.05). High-income men showed lower prevalences of low HDL-cholesterol (PR = 0.73) and sedentarism (PR = 0.81) (p < 0.05). These results may be explained by the fact that high-income women pay more attention to healthy habits and those with the lowest family income are least likely to access health services resources and treatments. CONCLUSION: Women were in the final phase of the epidemiologic transition, whereas men were in the middle phase.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Renta/estadística & datos numéricos , Adulto , Análisis de Varianza , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Valores de Referencia , Medición de Riesgo , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Estadísticas no Paramétricas , Adulto Joven
16.
Rev Bras Epidemiol ; 23: e200002, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32130391

RESUMEN

OBJECTIVES: To estimate the magnitude of gender differences in disability among adults aged 60 and older and to evaluate whether they can be associated with social gender inequality and socioeconomic contextual factors at the level of Brazilian federative units. METHODS: This is a multilevel study that used data from 23,575 older adults of 27 federative units who participated in the 2013 Brazilian Health Survey. The activity limitation index was developed from the item response theory, using activities of daily living and instrumental activities of daily living variables. The association of individual and contextual variables with disability was estimated by assessing the magnitude of differences between genders, using cross-level interaction effects in multilevel generalized linear models, including only the variables that were statistically significant in the final model. RESULTS: The prevalence of disability was higher among women (37.6%) than among men (26.5%), totaling 32.7% of the older adults. In the adjusted multilevel analysis, disability was influenced by income inequality (γgini = 0.022, p < 0.001) among federative units. In addition, gender differences in disability were associated with social gender inequalities (γmgiiXsex = 0.020, p = 0.004). CONCLUSION: Women had higher disability disadvantages compared to men, and those differences were associated with social gender inequalities among the Brazilian federative units influenced by income inequality.


Asunto(s)
Evaluación de la Discapacidad , Personas con Discapacidad/estadística & datos numéricos , Encuestas Epidemiológicas/estadística & datos numéricos , Renta/estadística & datos numéricos , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Femenino , Disparidades en el Estado de Salud , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multinivel , Distribución por Sexo , Factores Sexuales , Factores Socioeconómicos
19.
JAMA ; 323(9): 829-830, 2020 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-32125384
20.
Lancet ; 395(10224): 575-590, 2020 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-32007141

RESUMEN

BACKGROUND: The WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination. METHODS: The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years (with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% (2023) to 90% (2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median (range) of model predictions. FINDINGS: Girls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 (range 19·4-19·8) to 2·1 (2·0-2·6) cases per 100 000 women-years over the next century (89·4% [86·2-90·1] reduction), and to avert 61·0 million (60·5-63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 (0·6-1·6) cases per 100 000 women-years (96·7% [91·3-96·7] reduction) and averted an extra 12·1 million (9·5-13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% (58-65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% (89-100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% (37-99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% (71-100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11-31 years. Long-term vaccine protection was required for elimination. INTERPRETATION: Predictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden. FUNDING: WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec-Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.


Asunto(s)
Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino/prevención & control , Adulto , Países en Desarrollo , Detección Precoz del Cáncer/métodos , Estudios de Factibilidad , Femenino , Humanos , Incidencia , Renta , Tamizaje Masivo/métodos , Modelos Biológicos , Infecciones por Papillomavirus/complicaciones , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/virología , Vacunación
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