Salomon Joshua A, Weinstein Milton C, Hammitt James K, Goldie Sue J
Global Programme on Evidence for Health Policy, World Health Organization, Geneva, Switzerland.
Am J Epidemiol. 2002 Oct 15;156(8):761-73. doi: 10.1093/aje/kwf100.
This study presents a comprehensive epidemiologic model of hepatitis C in the United States. Through empirical calibration of model parameter values, the objectives were to gain insights into uncertain aspects of the natural history of hepatitis C and to improve the basis for projecting the future course of the epidemic. A systematic review of the published literature was conducted to define plausible ranges around model parameters, and multiple simulations of the model were undertaken using sampled values from these ranges. Model predictions produced by each set of sampled values were compared with available epidemiologic data on infection prevalence and mortality from liver cancer, and various goodness-of-fit criteria were used to identify the range of parameter values that were consistent with these data. The results of the study indicate that rates of progression to advanced liver disease may be lower than previously assumed. The authors also found that a wide range of plausible assumptions about heterogeneity in these rates, beyond that explained by age and sex, is consistent with observed epidemiologic trends. These findings have important implications both for individual clinical decisions and for broader public health policy.
本研究提出了美国丙型肝炎的综合流行病学模型。通过对模型参数值进行实证校准，目标是深入了解丙型肝炎自然史中不确定的方面，并改善预测该流行病未来进程的依据。对已发表文献进行了系统综述，以确定模型参数周围的合理范围，并使用这些范围内的抽样值对模型进行了多次模拟。将每组抽样值产生的模型预测与关于感染患病率和肝癌死亡率的现有流行病学数据进行比较，并使用各种拟合优度标准来确定与这些数据一致的参数值范围。研究结果表明，进展为晚期肝病的速率可能低于先前的假设。作者还发现，除了年龄和性别所解释的之外，关于这些速率异质性的广泛合理假设与观察到的流行病学趋势一致。这些发现对个体临床决策和更广泛的公共卫生政策都具有重要意义。
