建立中国乙肝相关死亡模型，实现世卫组织的影响目标

IF 8.8 3区医学 Q1 Medicine

Infectious Disease Modelling Pub Date : 2025-02-15 DOI:10.1016/j.idm.2025.02.010

Wenjun Liu , Renjie Liu , Peng Li , Ruyi Xia , Zhuoru Zou , Lei Zhang , Mingwang Shen , Guihua Zhuang

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引用次数: 0

摘要

世界卫生组织（世卫组织）的目标是到2030年使乙型肝炎相关死亡人数比2015年减少65%，以消除作为主要公共卫生威胁的病毒性肝炎。尽管取得了重大的干预成就，但中国是否以及如何实现这一目标尚不清楚。我们的目的是预测中国乙型肝炎相关死亡，并确定实现这一目标所需的关键进展。方法建立基于年龄和时间的动态乙型肝炎病毒（HBV）传播区室模型，预测2015 - 2040年基本病例和后续情景下乙型肝炎相关死亡趋势。在基本情景中，我们假设按照世卫组织的建议，到2030年诊断和治疗（D&；T）率将达到72%。根据基本情况和单向敏感性分析的结果设置后续情景。结果与2015年相比，2030年和2040年乙肝相关死亡人数将分别下降23.89%和51.79%，在基本情景下，世界卫生组织提出的减少65%的影响目标最早要到2038年才能实现。HBV清除率和当前治疗效果是影响2015 - 2040年乙型肝炎相关死亡率下降的最敏感参数。在随后的情景中，到2030年，当D&；T率提高到90%，并从2016年开始优化目前的治疗效果和HBV清除率时，世卫组织的影响目标将在2038年实现。在2016-2030年期间，将清除率从2%进一步线性提高到2.8%，将如期实现减排目标。结论中国很难实现世界卫生组织提出的到2030年乙肝相关死亡率降低65%的影响目标，即使我们假设到2030年及以后乙肝相关死亡率将达到72%。全面扩大现有战略，特别是创新药物和技术，将确保中国如期实现这一目标。

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Modeling hepatitis B-related deaths in China to achieve the WHO's impact target

Background

The World Health Organization (WHO) targets a 65% reduction in hepatitis B-related deaths by 2030 compared to 2015 to eliminate viral hepatitis as a major public health threat. It is unknown whether and how China can achieve this target despite significant intervention achievements. We aimed to predict the hepatitis B-related deaths in China and identify key developments needed to achieve the target.

Methods

An age- and time-dependent dynamic hepatitis B virus (HBV) transmission compartmental model was developed to predict the trend of hepatitis B-related deaths under base-case and subsequent scenarios from 2015 to 2040. In base-case scenario, we assumed the diagnosis and treatment (D&T) rate would reach 72% in 2030, as proposed by WHO. Subsequent scenarios were set based on the results of base-case and one-way sensitivity analysis.

Results

Compared with 2015, hepatitis B-related deaths would be reduced by 23.89% in 2030 and 51.79% in 2040, respectively, and the WHO's impact target of 65% reduction would not be achieved until 2038 at the earliest under base-case scenario. HBV clearance rate and current treatment effectiveness were the most sensitive parameters that significantly influenced the decline of hepatitis B-related deaths from 2015 to 2040. In the subsequent scenario, when D&T rate improving to 90% by 2030, with the current treatment effectiveness and HBV clearance rate being optimized from 2016, the WHO's impact target would be achieved in 2038. Increasing the clearance rate further from 2% to 2.8% during 2016–2030 linearly, the impact target would be achieved on time.

Conclusions

It is difficult for China to achieve the WHO's impact target of 65% reduction in hepatitis B-related deaths by 2030 even we assumed the D&T rate would reach 72% in 2030 and beyond. A comprehensive scale-up of available strategies, especially innovative drugs and technologies will ensure that China achieves the target on schedule.

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来源期刊

Infectious Disease Modelling Mathematics-Applied Mathematics

CiteScore

17.00

自引率

3.40%

发文量

审稿时长

17 weeks

期刊介绍： Infectious Disease Modelling is an open access journal that undergoes peer-review. Its main objective is to facilitate research that combines mathematical modelling, retrieval and analysis of infection disease data, and public health decision support. The journal actively encourages original research that improves this interface, as well as review articles that highlight innovative methodologies relevant to data collection, informatics, and policy making in the field of public health.