To What Extent Do Biological Markers Account for the Large Social Disparities in Health in Moscow?
The physiological factors underlying links between health and socioeconomic position in the Russian population are important to investigate. This population continues to face political and economic challenges, has experienced poor general health and high mortality for decades, and has exhibited widening health disparities. Dr. Dana A. Glei and colleagues used data from a population-based survey of Moscow residents 55 and older to investigate whether physiological dysregulation mediates the link between socioeconomic status and health. She will discuss the the results of their study, which revealed large educational disparities in health outcomes and physiological dysregulation, especially in men.
Dana A. Glei is a senior research investigator at Georgetown University and has worked on the Social Environment and Biomarkers of Aging Study (Taiwan) since 2001. From 2002 to 2009, she also served as project coordinator for the Human Mortality Database, a collaborative project involving research teams at the University of California, Berkeley and the Max Planck Institute for Demographic Research. Over the past 18 years, she has published articles on a variety of topics related to health, mortality, marriage and the family, and poverty. Her current research focuses on sex differences in health and mortality, the impact of stressors on subsequent health, and how bioindicators mediate the links between psychosocial factors and health outcomes. She has an MA from the University of Virginia and a PhD from Princeton University.
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Cost-effectiveness of a Modestly Effective HIV Vaccine in the United States
BACKGROUND: The recent RV144 clinical trial showed that an ALVAC/AIDSVAX prime-boost HIV vaccine regimen may confer partial immunity in recipients and reduce transmission by 31%. Trial data suggest that efficacy may initially exceed 70% but decline over the following 3.5 years. Estimating the potential health benefits associated with a one-time vaccination campaign, as well as the projected benefits of repeat booster vaccination, may inform future HIV vaccine research and licensing decisions.
METHODS: We developed a mathematical model to project the future course of the HIV epidemic in the United States under varying HIV vaccine scenarios. The model accounts for disease progression, infection transmission, antiretroviral therapy, and HIV-related morbidity and mortality. We projected HIV prevalence and incidence over time in multiple risk groups, and we estimated quality-adjusted life years (QALYs) and costs over a 10-year time horizon. We used an exponentially declining efficacy curve fit to trial data, and we assumed subsequent vaccine boosters confer similar immunity. Variations in vaccine parameters were examined in sensitivity analysis.
RESULTS: Under existing HIV prevention and treatment efforts, an estimated 590,000 HIV infections occur over 10 years. One-time vaccination achieving 60% coverage of adults could prevent 9.8% of projected new infections over 10 years (and prevent 34% of new infections in the first year) and cost approximately $91,000/QALY gained relative to the status quo, assuming a vaccination price of $500. Targeted vaccination of high-risk groups results in net cost savings for vaccines costing less than $750. One-time vaccination of 60% of all adults coupled with three-year boosters only for men who have sex with men and injection drug users could prevent 21% of infections for $81,000/QALY gained relative to vaccination of high-risk groups only. A program attaining 90% vaccination coverage prevents 15% of new HIV cases over 10 years (and approximately50% of infections in the first year).
CONCLUSIONS: A partially effective HIV vaccine with effectiveness similar to that observed in the RV144 trial would provide large health benefits in the United States and could meet conventionally accepted cost-effectiveness thresholds. Strategies that target high-risk groups are most efficient, but broader strategies provide greater total population health benefit.
Political Incentives for Health Improvements: Governance, the GOBI initiative, and the Child Survival Revolution
In partnership with the Center for Health Policy (CHPPCOR) at Stanford, this research initiative brings together medical doctors, health economists, and political scientists seeking to understand infant mortality declines in the post-War Era. The research initiative develops new measures of political incentives for population health improvement embedded in finely grained political institutions.
Diabetes Mellitus and Tuberculosis in Countries with High Tuberculosis Burdens: Individual Risks and Social Determinants
Methods We performed individual-level analyses using the World Health Survey (n = 124 607; 46 countries). We estimated the relationship between TB and diabetes, adjusting for gender, age, body mass index, education, housing quality, crowding and health insurance. We also performed a longitudinal country-level analysis using data on per-capita gross domestic product and TB prevalence and incidence and diabetes prevalence for 1990–95 and 2003–04 (163 countries) to estimate the relationship between increasing diabetes prevalence and TB, identifying countries at risk for disease interactions.
Results In lower income countries, individuals with diabetes are more likely than non-diabetics to have TB [univariable odds ratio (OR): 2.39; 95% confidence interval (CI): 1.84–3.10; multivariable OR: 1.81; 95% CI: 1.37–2.39]. Increases in TB prevalence and incidence over time were more likely to occur when diabetes prevalence also increased (OR: 4.7; 95% CI: 1.0–22.5; OR: 8.6; 95% CI: 1.9–40.4). Large populations, prevalent TB and projected increases in diabetes make countries like India, Peru and the Russia Federation areas of particular concern.
Conclusions Given the association between diabetes and TB and projected increases in diabetes worldwide, multi-disease health policies should be considered.
An Asian dimension to the Stanford Center for Population Research
The Shorenstein Asia-Pacific Research Center and its Asia Health Policy Program have joined with other centers and programs across the university as collaborative partners for the new Stanford Center for Population Research (SCPR). Supporting population research among faculty and students throughout Stanford, the SCPR is led by Professor Shripad Tuljapurkar, co-editor with Karen Eggleston of the book Aging Asia: Economic and Social Implications of Rapid Demographic Change in China, Japan, and South Korea.
The Stanford Center for Population Research, based in the Institute for Research in Social Sciences, has leadership and involvement across campus including the Humanities, Natural Sciences, Environmental programs, and the Medical School. The goal is to promote, support and develop population studies through collaboration among researchers and training for undergraduate and graduate students, serving as both a resource and nexus for faculty at Stanford across disciplines with interests in population studies, broadly defined.
The Asia Health Policy Program will work with the Stanford Center for Population Research in studying the implications of demographic change in the Asia-Pacific region. For example, Karen Eggleston is undertaking comparative study of population health trends in China and India with other Stanford faculty associated with SCRP.
AHPP will also support the mission of strengthening the teaching of population studies at the undergraduate, graduate and postdoctoral levels, by helping to make connections for students studying demographic change in Asia. The 2011 postdoctoral fellow in Asia health policy, Qiulin Chen, will be studying population aging in China in comparative perspective. Shorenstein APARC’s affiliation with the SCRP will also help to reinforce the new Shorenstein APARC initiative studying policy responses to population aging in East Asia, kicking off with a workshop in January 2011.
China Radio International interviews AHPP program director about China's health reforms
Potential Population Health Outcomes and Expenditures of HIV Vaccination Strategies in the United States
Estimating the potential health benefits and expenditures of a partially effective HIV vaccine is an important consideration in the debate about whether HIV vaccine research should continue. We developed an epidemic model to estimate HIV prevalence, new infections, and the cost-effectiveness of vaccination strategies in the U.S. Vaccines with modest efficacy could prevent 300,000-700,000 HIV infections and save $30 billion in healthcare expenditures over 20 years. Targeted vaccination of high-risk individuals is economically efficient, but difficulty in reaching these groups may mitigate these benefits. Universal vaccination is cost-effective for vaccines with 50% efficacy and price similar to other infectious disease vaccines.
Evidence on the Benefits of Primary Care: Implications for Asia
As part of health reforms announced in April 2009, China plans to expand and strengthen primary care (i.e., provision of first contact, person-focused, ongoing care over time, and coordinating care when people receive services from other providers). Other nations of Asia continue to grapple with how to promote population health and constrain healthcare spending. What is the evidence about the effectiveness of primary care in improving population health and making healthcare accessible and affordable?
In this talk, Dr. Starfield will speak about the robust evidence of the association between primary care and better health outcomes at lower cost; ways of measuring the effectiveness of primary care; how selected Asian countries compare in such rankings; and the broader implications of primary care research for health policy in Asia.
Dr. Starfield, a physician and health services researcher, is internationally known for her work in primary care; her books, Primary Care: Concept, Evaluation, and Policy and Primary Care: Balancing Health Needs, Services, and Technology, are widely recognized as the seminal works in the field. She has been instrumental in leading projects to develop important methodological tools, including the Primary Care Assessment Tool, the CHIP tools (to assess adolescent and child health status), and the Johns Hopkins Adjusted Clinical Groups (ACGs) for assessment of diagnosed morbidity burdens reflecting degrees of co-morbidity. She was the co-founder and first president of the International Society for Equity in Health, a scientific organization devoted to furthering knowledge about the determinants of inequity in health and ways to eliminate them. Her work thus focuses on quality of care, health status assessment, primary care evaluation, and equity in health. She is a member of the Institute of Medicine and has been on its governing council, and has been a member ofthe National Committee on Vital and Health Statistics and many other government and professional committees and groups. She has a BA from Swarthmore College, an MD from the State University of New York, Downstate Medical Center, and an MPH from Johns Hopkins University School of Public Health.
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