(精编)【高血压英文教学精品课件】 Anti-Hypertensive Drug Demand in Latin America.pptVIP

Anti-Hypertensive Drug Demand in Latin America William H. Dow University of California, Berkeley January 2009 What Do We Know About Drug Use Rates? Latin America has ~8% of world pharmaceutical market Child vaccines: 75% of world children receive, but requires major campaigns. Hib vaccine: Slow to disseminate to LDCs. Deworming drugs: Cheap, but low use rates. Antibiotics: Widely used, misused. Hypertension Drugs Little publicity, no quick benefit. Hypertension prevalence 50%, leading cause of death. Drugs effective if used properly. 1/3 U.S. adults over 50 use. Cheap generics available for most classes. Key Questions Comparative: What are hypertension drug use rates in Latin America? Do rates vary by country attributes (Cuba vs. Mexico)? Disparities: How big are disparities in drug use rates by education, wealth, urbanicity? Policy: Does insurance improve hypertension awareness, drug use rates, and hypertension control? U.S.: Significant effects in RAND HIE and Medicaid populations. Evidence base in middle-income countries is weak. Bleich et al. find compelling associations with Mexico’s Seguro Popular expansion, but call for further research with stronger causal designs. Costa Rican CRELES Data Nationally representative survey in 2005 of 2,800 Costa Ricans ages 60+. 2005 data may be slightly higher drug use from secular trends, but not by much. Only use urban sample for this paper. Drug utilization measured from “medicine cabinet” (may bias up or down). Modify drug coding to exclude drugs from anti-hypertensive definition if person did not self-report a hypertension diagnosis. United States NHANES Data, 1999-2004 Nationally representative, with objective measures. Use only ages 60+ Use both urban and rural Higher power from larger sample. Education coded only as HS, HS, HS Mexican Health and Aging Study (MHAS) Data Nationally representative ages 50+, both urban and rural. Higher power from larger sample. Did not measure blood pressure. D