Population: 519,200,000 GNI: 3550 dollars per capita Life expectancy: 70.5 years Human development...
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Transcript of Population: 519,200,000 GNI: 3550 dollars per capita Life expectancy: 70.5 years Human development...
Population 519,200,000
Population > 65 years old 5.6%
Mean GNI 3,550 dollars per capita
Life expectancy 70.5 years
Human development index 0.777
Population increase 1.5% annually
Latin America
End stage renal disease prevention strategies in Latin America
B.Rodriguez-Iturbe, E, Bellorin-Font
Population: 519,200,000
GNI: 3550 dollars per capitaLife expectancy: 70.5 years
Human development index; 0.777Increase population; 1.5% annually
Population > 65 years old: 5.6%
END STAGE RENAL DISEASE AND PREVENTION STRATEGIES
IN LATIN AMERICA
Latin America
GDP and Population in LA
Mex
ico
Brasi
l
Argen
tina
Venez
uelaChile
Colom
biaPer
u
Rep D
omin
Guatem
aia
Uruguay
Ecuad
or
Costa
Rica
Panam
a
Trinid
ad/T
obago
Jam
aica
Bolivia
Parag
uay
Honduras
Nicar
agua
Beliz
e
Guyana
0
50
100
150
200
250
300
350
400
450
500
550
600
650
GDP(US$ billions Population (millions)
0
25
50
75
100
125
150
175
Life and healthy expectancy at birth in countries of South and Central America and Caribbean
40
50
60
70
80
Industrialized countries (Mean 95%CI)
Life expectancyat birth
Healthy Lifeexpectancy
Yea
rs
Annual GDP/capita vs Life ExpectancySouth and Central America and Caribbean
1000 10000 10000060
65
70
75
80
85
26401
Developed countries(Mean 95%CI)
Annual GDP/capita
Lif
e ex
pec
tan
cy (
year
s)
MD+Nurses vs Life Expectancy
South and Central America and Caribbean
0 250 500 750 1000 1250 150060
65
70
75
80
85
LA countries Industrialized nationsMean 95%CI
MD+Nurses/100.000 inhabitants
Lif
e ex
pec
tan
cy (
year
s)
Annual expenditure in health per capita
0 100 200 300 400 500 600 700 800 900 1000 1100
ArgentinaUruguay
ChileBrasil
ColombiaMexico
Costa RicaPanama
Trinidad TobagoParaguay
El SalvadorRep.Domin
GrenadaVenezuela
CubaPeru
JamaicaGuyana
GuatemalaHonduras
BoliviaEcuador
HaitiPrivateGovernment
US dollars/year/capita
Life Expectancy vs % GDP in HealthSouth and Central America and Caribbean
0 1 2 3 4 5 6 7 8 9 10 11 1260
65
70
75
80
85
Developed countries (Mean 95%CI)
% GDP in Health
Lif
e E
xp
ec
tan
cy
(ye
ars
)
Annual expenditure in health per capita
0 500 1000 1500 2000 2500 3000
ArgentinaUruguay
ChileBrasil
ColombiaMexico
Costa RicaPanama
Trinidad TobagoParaguay
El SalvadorRep.Domin
GrenadaVenezuela
CubaPeru
JamaicaGuyana
GuatemalaHonduras
BoliviaEcuador
HaitiPrivateGovernment
Industrialized nations(Mean 95%CI)
US dollars/year/capita
SLANH: 20 countries, population
509,565,697
Report 2000-2001: Dialysis: 14/20 countries (90% of LA population)Kidney Transplants from 18/20 countries, (96 % of LA population)
LA Registry of Dialysis and Transplantation Reports: 1991-2001
17.4
2.4
19.5
2.5
22.2
2.7
24.7
2.5
29.0
4.3
33.3
4.3
37.6
4.3
43.1
5.5
49
6.4
56
6.5
0
10
20
30
40
50
60
70
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Total since 1992 During the year
Transplants(x 1000)
55% Living donor (except Argentina, Chile, Colombia, Cuba, Puerto Rico, Uruguay and Venezuela)
335 349
129 131 147173 199174
258278
R2 = 0,9383
0
100
200
300
400
500
Patients pmp
Latin American Registrty:
Treatment of ESRD, all modalities, 1992-2001
(Courtesy Dr. Cusumano 2003)
461
275
528
185
32
111
122
124
305
61
141
843
689
224
110
79
32
122
72
14
30,4
72
14
13
146
89
44
135
0 200 400 600 800 1000 1200
Argentina
Brazil
Chile
Colombia
Costa Rica
Cuba
Ecuador
Guatemala
Mexico
Paraguay
Peru
Puerto Rico
Uruguay
Venezuela
Dialysis
Transplantation
Latin America RegistryPrevalence all treatments pmp 31/12/01
(Courtesy Dr. Cusumano 2003)
Prevalence inLatin America
349 pmp
447
246
506
99
26
102
109
51
43
61
122
733
652
204
14
29
22
85
6
9
14
73
262
18
110
37
20
0 100 200 300 400 500 600 700 800 900
Argentina
Brasil
Chile
Colombia
Costa Rica
Cuba
Ecuador
Guatemala
Mexico
Paraguay
Peru
Puerto Rico
Uruguay
Venezuela
HD DP
Population: 461913654
Dialysis Prevalence in Latin America
277.1 pmpHD 197 DP 80.1
Number of patients (14 countries, 90% LA pop.): HDC 92767; DP 37727 (México 86%), Living with functioning kidney Tx: 34044
LATIN AMERICAN REGISTRY Prevalence by dialysis modality, pmp, 31/12/01
0
50
100
150
200
250
300P
atie
nts
pm
p
Dialysis incidence in LA 91.4 pmp
Theoretical Incidence: 130 ppmUnmet demand 40 ppmNot getting dialysis: 18842 ptsOnly 1/14 countries over the theoretical incidence
Diabetic nephropathy:SLANH 2001: 33% USRDS 2000: 45%Australia 2001: 25% New Zealand: 37% EDTA-ERA 2000: 22.4% Japan 2000: 36.6%
Etiology ESRD
Diabetic nephropathy
33%
Hypertension32%
Chronic GN9%
Not defined11%
Others15%
R2 = 0,9265
0
20
40
60
1991 1992 1993 1994/95 1996/97 1998/99 2000 2001 2005
without PR
Latin American Registry: Progressive increase of diabetic patients (1991-2001)
n= 18486
%
Some risk factors of ESRD in Latin America
• Diabetes
• Hypertension
• Low birth weight
The cost of diabetes in Latin America and the Caribbean. Bull World Health Org 81:20-23, 2003
Direct Health costs of Diabetes in LA
0 250 500 750 1000
Argentina
Uruguay
Chile
Panama
Venezuela
Costa Rica
Brazil
Mexico
Colombia
Paraguay
Trinidad
El Salvador
Jamaica
Cuba
Peru
Domin Rep
Guatemala
Ecuador
Honduras
Bolivia
Nicaragua
Haiti
Per capita annualhealth expenditure
Per capita annualdirect costs ofdiabetes
US Dollars
Excess cost of diabetes114 - 2517%
Prevalence(%)
Known (%)
Treated(%)
Controlled(%)
Argentina 28.1 54 42 14.3
Brazil 26.8 50 30 10
Chile 22.8 43 26.1 8.2
Ecuador 28.7 41 23 6.7
Mexico 30.5 28 38 22
Paraguay 30.5 33.5 18.3 7.8
Peru 22 40 20 10
Uruguay 33 68 42 11
Venezuela 32.4 47 37 8.5
Cuba prevalence ~ 30% (50% >60 años) known in 75% (**)
Hypertension In Latin America (*)
(*) Consenso Latinoamericano sobre hipetensión arterial. J Hypertens (Edición en Español) 6:1-27, 2001(**) De la Osa JA. Hipertension arterial. // consulta.cuba.cu; Salazar J, Aguilar J. Prevalencia de la hipetensión arterial en un consultorio médico de familia. www.informed.sld.cu/revistas/san (°) Velazquez-Monroy et al. Arch Cardiol de México. 73:62-77, 2003
Low birth weight in LA
0.0 2.5 5.0 7.5 10.0 12.5 15.0
ChileParaguay
Costa RicaArgentina
MexicoUruguay
CubaHondurasPanamá
VenezuelaColombia
JamaicaTrinidad
BrasilEl Salvador
Peru Rep Dominicana
BoliviaEcuador
GuatemalaHaiti
NIcaraguamean LA
mean industrializedcountries
% live births with <2500g//utal.org/segsocial/index.htm 1998
Prevention Strategies:
• To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention
• Reduce cost of medications with the potential to retard progression of ESRD
• Free access to full text publications to strengthen academic nephrology.
• Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia)
• Support and advise in the design of epidemiologic studies
COMGAN hassupported events in allLA countries
• Invited speakers• Simposia• Side visits• Fact finding trips
• To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention
“Only 48% of the studies published between 1966 and 2000 to estimate the prevalence of hypertension
in Latin America meet a critical thereshold to be useful for surveillance purposes”
Ordúñez P, Silva LC, Paz M, Robles S. Prevalence estimates for hypertension in Latin America and the Caribbean: Are they useful for surveillance? Pan Am J Public
Health 10:226-230, 2001
• Support and advise in the design of epidemiologic studies
Conjunto deAcciones para laReducciónMultifactorial de lasEnfermedadesNo transmisibles
PAHO
Rafael Burgos & Santos Delpine
Sustenable and tenable renal health model. A
Latin American proposal
• Support efforts to engage the government in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia)
Prevention Strategies:
• To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention
• Reduce cost of medications with the potential to retard progression of ESRD
• Free access to full text publications to strengthen academic nephrology.
• Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia)
• Support and advise in the design of epidemiologic studies
182.67 millions
33.35 millions 6.31 millions
190.91 millions
5.12 millions187.24 millions
World Total of Internet Users 605.6 million
Source: Jupitermedia CorporationNua Internet surveys, Sept 2002
Percent of population with Internet access
0 10 20 30 40 50 60
ChileUruguay
PeruTrinidad/Tobago
ArgentinaCosta Rica
BrasilGranada
VenezuelaJamaica
El SalvadorParaguay
Mexico Colombia
EcuadorDom Rep
PanamaGuatemala
GuyanaCuba
Bolivia Industrialized nations(Mean 95%CI)
% of population with Internet Access
Source: Nielsen/Net Ratings. Cyber Atlas September 2003
90% of users are profesionals
8/10 individuals with academic
positions have Internet access
(except Cuba)
0 1000 2000 3000 4000 5000
Mexico
Chile
Brazil
Venezuela
Argentina
Paraguay
Individual annual subscription to5 leading nephrology journals (*)
Annual membership to the5 corresponding societies( **)
(*) Alphabetically : Am J Kidney Dis, Am J Physiol Renal Physiol,J Am Soc Nephrol, Kidney Int, Nephrol Dial Transplant(**) subscription to the journal included
Basic Salary Associate Professor (Full time)in US dollars/month
Prevention Strategies:
• To continue and increment COMGAN participation in LA Nephrological activities with emphasis on prevention
• Reduce cost of medications with the potential to retard progression of ESRD
• Free access to full text publications to strengthen academic nephrology.
• Support efforts to engage governments in prevention of ESRD (ej. Renal health model beeing implemented in Valdivia)
• Support and advise in the design of epidemiologic studies
Source: www.uniceflac.org 2000/indicadores)
0 5 10 15 20 25 30 35 40 45 50 55
Guatemala
Honduras
Nicaragua
Ecuador
Panamá
Brasil
Rep Dominicana
Costa Rica
Chile
México
Venezuela
Colombia
% of the population that lives on less than 1 USA $ per day
(International Poverty Line)
POPULATION BELOW POVERTY LINE IN LATIN AMERICA
POPULATION WITHOUT ADEQUATE SANITATION IN LATIN AMERICA
In Latin América/Caribbean 104.316.814 inhabitants (21.9% of the total population) do not have adequate sanitation services. (Cidutal Estadísticas Abril 15, 2003)
In Canada and USA 0.16%
0 5 10 15 20 25 30 35 40 45
EcuadorBolivia
ParaguayEl Salvador
VenezuelaHonduras
Mexico Perú
NicaraguaGuatemalaColombia Argentina
BrasilPanamá
Chile Costa Rica
Cuba Uruguay
Mean LA
% Population without adequate sanitation
Canada, USA) = 0.02%
In Latin América/Caribbean 72.968.187 inhabitants (15.3% of the total population) do not have access to drinkable water. (Cidutal Estadísticas April 15, 2003
POPULATION WITHOUT POTABLE WATER IN LATIN AMERICA
0 10 20 30 40 50 60
ParaguayEL Salvador
NIcaraguaEcuador
BoliviaParú
ArgentinaGuatemalaHondurasVenezuela
MéxicoPanamá
BrasilColombia
Cuba Chile
Costa Rica Uruguay
Mean LA
% of the population without potable water
3.7
5.25.4 5.7
6.9 5.97.4
6.4
9.810.5
9.510.2 10.8
13.613.7
0
3
6
9
12
15
Tran
spla
nts
pmp
87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01
Leading 10 selected risk factors as percentage causes of disease burden measured in DALYs
WHO. WHR 2002
(LA nations)