Chronic Disease Drug Demand in Latin America课件.ppt

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. SABE data PAHO multicenter study of Health, Well-Being and Aging in Latin America and the Caribbean (SABE). Standardized in 7 countries: Argentina, Barbados, Brazil, Chile, Cuba, Mexico, and Uruguay. Sample frame: Ages 60+, urban only. Self-reported hypertension and drug use (verified by medicine cabinet), and measured blood pressure. Has a doctor ever told you that you have high blood pressure or hypertension? If yes: Are you now taking any medication to lower your blood pressure? Dependent Variables Self-reports: DV1. Current use of hypertensive drugs. DV2. Self-report of hypertension diagnosis. DV3. Use of drugs, conditional on diagnosis (from DV2). Objective: DV4. Measured high blood pressure (average of two readings above 140 diastolic or 90 systolic). DV5. Hypertension