ABSTRACT
Resumen Introducción: Chile lidera el porcentaje de aumento de nuevas infecciones de VIH en Latinoamérica. Objetivo: Caracterizar los nuevos diagnósticos de infección por VIH/SIDA y describir la evolución de las tasas en las regiones durante el período 2010-2019. Métodos: Diseño ecológico. Se utilizó los casos de infección por VIH/SIDA obtenidos del ISP y las estimaciones de población del INE. Las variables fueron año, sexo, edad, nacionalidad y región. Se describió la muestra en número y porcentajes, se estimó la incidencia y se evaluó la tendencia con el modelo Prais Winsten. Se utilizó Stata V.14 y ArcGis versión 10 en los mapas. Resultados: El 84,3% (38.863/46.125) fueron hombres. La mediana de edad fue 30 y 34 años en hombres y mujeres, respectivamente. La incidencia aumentó hasta el año 2018, y presentó una leve disminución en el 2019. Las tasas aumentaron, en ambos sexos, en todas las edades y regiones. A diferencia de la población nacional, los casos en inmigrantes aumentaron y alcanzaron a 40% en el 2019, evidenciando un franco incremento en adultos jóvenes, con predominio de la nacionalidad venezolana 35,2% y haitiana 22%. La tendencia de las tasas mostró un aumento significativo en hombres y una distribución heterogénea en magnitud en todas las regiones. Conclusiones: Existen cambios en la epidemiología del VIH y especial vulnerabilidad en jóvenes, mujeres, inmigrantes y adultos mayores.
Abstract Background: Chile leads the percentage increase of new HIV infections in Latin America. Aim: To characterize new diagnosis of HIV/AIDS and describe the rates evolution in the regions during the 2010-2019 period. Methods: Ecological design. The HIV/AIDS cases used were obtained from the ISP (Instituto de Salud Pública de Chile) and the population estimates from the INE (Instituto Nacional de Estadísticas). The variables studied were year, sex, age, nationality, and region. The sample was described in numbers and percentages, then, the incidence was estimated and the trend was evaluated with the Prais Winsten model. Stata V.14 and ArcGis version 10 were used for the maps. Results: 84.3% (38,863/46,125) were men. The median for age were 30 and 34 years for men and women, respectively. The incidence increased until 2018 and showed a slight decrease in 2019. The rates increased for both sexes and all ages. Unlike the national population, immigrant's cases increased and reached 40% in 2019, with a frank increase in young adults, with a predominance for Venezuelan (35,2) and Haitian (22%) nationals. According to region, all the samples showed a rate increase with a heterogeneous distribution in statistically significant magnitude in men. Conclusions: There are changes in the epidemiology of HIV and special vulnerability in young people, women, immigrants and the elderly.
ABSTRACT
Background: The Chilean health reform aimed to expand universal health coverage (UHC) with equity. Aim: To analyze progress in health system affiliation, attended health needs (health visit for a recent problem) and direct payment for services, between 2000 and 2011. Material and Methods: We evaluated these outcomes for adults aged 20 years or older, analyzing databases of five National Socioeconomic Characterization Surveys. Using logistic regression models for no affiliation and unattended needs, we estimated odds ratios (OR) and prevalences, adjusted for socio-demographic characteristics. Results: The unaffiliated population decreased from 11.0% (95% confidence interval (CI) 10.6-11.4) in 2000 to 3.0% (95% CI 2.8-3.2) in 2011. According to the model, self-employed workers had a higher adjusted prevalence of no affiliation: 27.4% (95% CI 24.1-30.6) in 2000 and 7.8% (95% CI: 5.9-9.7) in 2011. The level of unmet needs decreased from 33.5% (95% CI 31.8-35.1) to 9.1% (95% CI 8.1-10.1) in this period. Not being affiliated to the health system was associated with higher unmet needs in the adjusted model. Indigent affiliates, entitled to free care in the public system, reported payments for general and specialist visits in a much lower proportion than other groups. However, direct payments for visits increased for this group during the decade. Conclusions: Concurrent with the introduction of new health and social policies, we observed significant progress in health system enrolment and attended health needs. However, the percentage of impoverished people who made direct payments for services increased.