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Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015

Authors
Barber, Ryan M.Fullman, NancySorensen, Reed J. D.Bollyky, ThomasMcKee, MartinNolte, EllenAbajobir, Amanuel AlemuAbate, Kalkidan HassenAbbafati, CristianaAbbas, Kaja M.Abd-Allah, FoadAbdulle, Abdishakur M.Abdurahman, Ahmed AbdulahiAbera, Semaw FeredeAbraham, BijuAbreha, Girmatsion FissehaAdane, KelemeworkAdelekan, Ademola LukmanAdetifa, Ifedayo Morayo O.Afshin, AshkanAgarwal, ArnavAgarwal, Sanjay KumarAgarwal, SunilkumarAgrawal, AnuragKiadaliri, Aliasghar AhmadAhmadi, AlirezaAhmed, Kedir YimamAhmed, Muktar BeshirAkinyemi, Rufus OlusolaAkinyemiju, Tomi F.Akseer, NadiaAl-Aly, ZiyadAlam, KhurshidAlam, NooreAlam, Sayed SaidulAlemu, Zewdie AderawAlene, Kefyalew AddisAlexander, LilyAli, RaghibAli, Syed DanishAlizadeh-Navaei, RezaAlkerwi, Ala'aAlla, FrancoisAllebeck, PeterAllen, ChristineAl-Raddadi, RajaaAlsharif, UbaiAltirkawi, Khalid A.Martin, Elena AlvarezAlvis-Guzman, NelsonAmare, Azmeraw T.Amini, ErfanAmmar, WalidAmo-Adjei, JoshuAmoako, Yaw AmpemAnderson, Benjamin O.Androudi, SofiaAnsari, HosseinAnsha, Mustafa GeletoAntonio, Carl Abelardo T.Aernloev, JohanArtaman, AlAsayesh, HamidAssadi, RezaAstatkie, AyalewAtey, Tesfay MehariAtique, SulemanAtnafu, Niguse TadeleAtre, Sachin R.Avila-Burgos, LeticiaAvokpaho, Euripide Frinel G. ArthurQuintanilla, Beatriz Paulina AyalaAwasthi, AshishAyele, Nebiyu NegussuAzzopardi, PeterSaleem, Huda Omer BaBaernighausen, TillBacha, UmarBadawi, AlaaBanerjee, AmitavaBarac, AleksandraBarboza, Miguel A.Barker-Collo, Suzanne L.Barrero, Lope H.Basu, SanjayBaune, Bernhard T.Baye, KaleabBayou, Yibeltal TebekawBazargan-Hejazi, ShahrzadBedi, NeerajBeghi, EttoreBejot, YannickBello, Aminu K.Bennett, Derrick A.Bensenor, Isabela M.Berhane, AdugnawBernabe, EduardoBernal, Oscar AlbertoBeyene, Addisu ShunuBeyene, Tariku JibatBhutta, Zulfiqar A.Biadgilign, SibhatuBikbov, BorisBirlik, Sait MentesBirungi, CharlesBiryukov, StanBisanzio, DonalBizuayehu, Habtamu MellieBose, DipanBrainin, MichaelBrauer, MichaelBrazinova, AlexandraBreitborde, Nicholas J. K.Brenner, HermannButt, Zahid A.Cardenas, RosarioCahuana-Hurtado, LuceroCampos-Nonato, Ismael RicardoCar, JosipCarrero, Juan JesusCasey, DanielCaso, ValeriaCastaneda-Orjuela, Carlos A.Rivas, Jacqueline CastilloCatala-Lopez, FerranCecilio, PedroCercy, KellyCharlson, Fiona J.Chen, Alan Z.Chew, AdrienneChibalabala, MirriamChibueze, Chioma EzinneChisumpa, Vesper HichilombweChitheer, Abdulaal A.Chowdhury, RajivChristensen, HanneChristopher, Devasahayam JesudasCiobanu, Liliana G.Cirillo, MassimoCoggeshall, Megan S.Cooper, Leslie TrumbullCortinovis, MonicaCrump, John A.Dalal, KoustuvDandona, LalitDandona, RakhiDargan, Paul I.das Neves, JoseDavey, GailDavitoiu, Dragos V.Davletov, KairatDe Leo, DiegoDel Gobbo, Liana C.del Pozo-Cruz, BorjaDellavalle, Robert P.Deribe, KebedeDeribew, AmareJarlais, Don C. DesDey, SubhojitDharmaratne, Samath D.Dicker, DanielDing, Eric L.Dokova, KlaraDorsey, E. RayDoyle, Kerrie E.Dubey, ManishaEhrenkranz, RebeccaEhrenkranz, RebeccaEllingsen, Christian LyckeElyazar, IqbalEnayati, AhmadaliErmakov, Sergey PetrovichEshrati, BabakEsteghamati, AlirezaEstep, KaraFuerst, ThomasFaghmous, Imad D. A.Fanuel, Fanuel Belayneh BekeleFaraon, Emerito Jose AquinoFarid, Talha A.Farinha, Carla Sofia e SaFaro, AndreFarvid, Maryam S.Farzadfar, FarshadFeigin, Valery L.Feigl, Andrea B.Fereshtehnejad, Seyed-MohammadFernandes, Jefferson G.Fernandes, Joao C.Feyissa, Tesfaye RegassaFischer, FlorianFitzmaurice, ChristinaFleming, Thomas D.Foigt, NataliyaForeman, Kyle J.Forouzanfar, Mohammad H.Franklin, Richard C.Frostad, Josephhiwot, Tsegaye Tewelde G.Gakidou, EmmanuelaGambashidze, KetevanGamkrelidze, AmiranGao, WayneGarcia-Basteiro, Alberto L.Gebre, TeshomeGebremedhin, Amanuel TesfayGebremichael, Mengistu WeldayGebru, Alemseged AregayGelaye, Amha AdmasieGeleijnse, Johanna M.Genova-Maleras, RicardGibney, Katherine B.Giref, Ababi ZergawGishu, Melkamu DedefoGiussani, GiorgiaGodwin, William W.Gold, AudraGoldberg, Ellen M.Gona, Philimon N.Goodridge, AmadorGopalani, Sameer ValiGoto, AtsushiGraetz, NicholasGreaves, FelixGriswold, MaxGuban, Peter ImreGugnani, Harish ChanderGupta, Prakash C.Gupta, RahulGupta, RajeevGupta, TanushGupta, VipinHabtewold, Tesfa DejenieHafezi-Nejad, NimaHaile, DemewozHailu, Alemayehu DesalegneHailu, Gessessew BugssaHakuzimana, AlexHamadeh, Randah RibhiHambisa, Mitiku TeshomeHamidi, SamerHammami, MouhanadHankey, Graeme J.Hao, YuantaoHarb, Hilda L.Hareri, Habtamu AberaHaro, Josep MariaHassanvand, Mohammad SadeghHavmoeller, RasmusHay, Roderick J.Hay, Simon I.Hendrie, DeliaHeredia-Pi, Ileana BeatrizHoek, Hans W.Horino, MasakoHorita, NobuyukiHosgood, H. DeanHtet, Aung SoeHu, GuoqingHuang, HsiangHuang, John J.Huntley, Bethany M.Huynh, ChantalIburg, Kim MoesgaardIleanu, Bogdan VasileInnos, KaireIrenso, Asnake ArarsaJahanmehr, NaderJakovljevic, Mihajlo B.James, PeterJames, Spencer LewisJavanbakht, MehdiJayaraman, Sudha P.Jayatilleke, Achala UpendraJeemon, PanniyammakalJha, VivekanandJohn, DennyJohnson, CatherineJohnson, Sarah C.Jonas, Jost B.Juel, KnudKabir, ZubairKalkonde, YogeshwarKamal, RitulKan, HaidongKarch, AndreKarema, Corine KakiziKarimi, Seyed M.Kasaeian, AmirKassebaum, Nicholas J.Kastor, AnshulKatikireddi, Srinivasa VittalKazanjan, KonstantinKeiyoro, Peter NjengaKemmer, LauraKemp, Andrew HaddonKengne, Andre PascalKerbo, Amene AbebeKereselidze, MaiaKesavachandran, Chandrasekharan NairKhader, Yousef SalehKhalil, IbrahimKhan, Abdur RahmanKhan, Ejaz AhmadKhan, GulfarazKhang, Young-HoKhoja, Abdullah Tawfih AbdullahKhonelidze, IrmaKhubchandani, JagdishKibret, Getiye DejenuKim, DanielKim, PaulineKim, Yun JinKimokoti, Ruth W.Kinfu, YohannesKissoon, NiranjanKivipelto, MiiaKokubo, YoshihiroKolk, AnneliKolte, DhavalKopec, Jacek A.Kosen, SoewartaKoul, Parvaiz A.Koyanagi, AiKravchenko, MichaelKrishnaswami, SanjayKrohn, Kristopher J.Defo, Barthelemy KuateBicer, Burcu KucukKuipers, Ernst J.Kulkarni, Veena S.Kumar, G. AnilKumsa, Fekede AsefaKutz, MichaelKyu, Hmwe H.Lager, Anton Carl JonasLal, AparnaLal, Dharmesh KumarLalloo, RatilalLallukka, TeaLan, QingLangan, Sinead M.Lansingh, Van C.Larson, Heidi J.Larsson, AndersLaryea, Dennis OdaiLatif, Asma AbdulLawrynowicz, Alicia Elena BeatrizLeasher, Janet L.Leigh, JamesLeinsalu, MallLeshargie, Cheru TesemaLeung, JanniLeung, RickyLevi, MiriamLiang, XiaofengLim, Stephen S.Lind, MargaretLinn, ShaiLipshultz, Steven E.Liu, PatrickLiu, YangLo, Loon-TzianLogroscino, GiancarloLopez, Alan D.Lorch, Scott A.Lotufo, Paulo A.Lozano, RafaelLunevicius, RaimundasLyons, Ronan A.Macarayan, Erlyn Rachelle KingMackay, Mark T.El Razek, Hassan Magdy AbdEl Razek, Mohammed Magdy AbdMahdavi, MahdiMajeed, AzeemMalekzadeh, RezaMalta, Deborah CarvalhoMantovani, Lorenzo G.Manyazewal, TsegahunMapoma, Chabila C.Marcenes, WagnerMarks, Guy B.Marquez, NealMartinez-Raga, JoseMarzan, Melvin BarrientosMassano, JoaoMathur, Manu RajMaulik, Pallab K.Mazidi, MohsenMcAlinden, ColmMcGrath, John J.McNellan, ClaireMeaney, Peter A.Mehari, AlemMehndiratta, Man MohanMeier, ToniMekonnen, Alemayehu B.Meles, Kidanu GebremariamMemish, Ziad A.Mengesha, Melkamu MeridMengiste, Desalegn TadeseMengistie, Mubarek AberaMenota, Bereket GebremichaelMensah, George A.Mereta, Seid TikuMeretoja, AtteMeretoja, Tuomo J.Mezgebe, Haftay BerhaneMicha, RenataMillear, AnoushkaMills, Edward J.Minnig, ShawnMirarefin, MojdeMirrakhimov, Erkin M.Mock, Charles N.Mohammad, Karzan AbdulmuhsinMohammed, ShafiuMohanty, Sanjay K.Mokdad, Ali H.Mola, Glen Liddell D.Molokhia, MariamMonasta, LorenzoMontico, MarcellaMoradi-Lakeh, MaziarMoraga, PaulaMorawska, LidiaMori, RintaroMoses, MarkMueller, Ulrich O.Murthy, SrinivasMusa, Kamarul ImranNachega, Jean B.Nagata, ChieNagel, GabrieleNaghavi, MohsenNaheed, AliyaNaldi, LuigiNangia, VinayNascimento, Bruno RamosNegoi, IonutNeupane, Sudan PrasadNewton, Charles R.Ng, MarieNgalesoni, Frida NamnyakNgunjiri, Josephine WanjikuNguyen, GrantNingrum, Dina Nur AnggrainiNolte, SandraNomura, MarikaNorheim, Ole F.Norrving, BoNoubiap, Jean Jacques N.Obermeyer, Carla MakhloufOgbo, Felix AkpojeneOh, In-HwanOkoro, AnselmOladimeji, OlanrewajuOlagunju, Andrew ToyinOlivares, Pedro R.Olsen, Helen E.Olusanya, Bolajoko OlubukunolaOlusanya, Jacob OlusegunOpio, John NelsonOren, EyalOrtiz, AlbertoOsborne, Richard H.Osman, MajdiOwolabi, Mayowa O.Mahesh, P. A.Pain, Amanda W.Pakhale, SmitaCastillo, Elizabeth PalomaresPana, AdrianPapachristou, ChristinaParsaeian, MahboubehPatel, TejasPatton, George C.Paudel, DeepakPaul, Vinod K.Pearce, NeilPereira, David M.Perez-Padilla, RogelioPerez-Ruiz, FernandoPerico, NorbertoPesudovs, KonradPetzold, MaxPhillips, Michael RobertPigott, David M.Pillay, Julian DavidPinho, ChristinePolinder, SuzannePond, Constance D.Prakash, V.Purwar, ManoramaQorbani, MostafaQuistberg, D. AlexRadfar, AmirRafay, AnwarRahimi, KazemRahimi-Movaghar, VafaRahman, MahfuzarRahman, Mohammad Hifz UrRai, Rajesh KumarRam, UshaRana, Saleem M.Rankin, ZaneRao, Paturi VishnupriyaRao, Puja C.Rawaf, SalmanRego, Maria Albertina SantiagoReitsma, MarissaRemuzzi, GiuseppeRenzaho, Andre M. N. N.Resnikoff, SergeRezaei, SatarRezai, Mohammad SadeghRibeiro, Antonio L.Roba, Hirbo ShoreRokni, Mohammad BagherRonfani, LucaRoshandel, GholamrezaRoth, Gregory A.Rothenbacher, DietrichRoy, Nawal K.Sachdev, Perminder S.Sackey, Ben BenascoSaeedi, Mohammad YahyaSafiri, SaeidSagar, RajeshSahraian, Mohammad AliSaleh, Muhammad MuhammadSalomon, Joshua A.Samy, Abdallah M.Sanabria, Juan RamonSanchez-Nino, Maria DoloresSandar, LoganSantos, Itamar S.Santos, Joao VascoMilicevic, Milena M. SantricSarmiento-Suarez, RodrigoSartorius, BennSatpathy, MaheswarSavic, MilojeSawhney, MonikaSaylan, Mete I.Schoettker, BenSchutte, Aletta E.Schwebel, David C.Seedat, SorayaSeid, Abdulbasit MusaSeifu, Canaan NegashSepanlou, Sadaf G.Serdar, BerrinServan-Mori, Edson E.Setegn, TesfayeShackelford, Katya AnneShaheen, AmiraShahraz, SaeidShaikh, Masood AliShakh-Nazarova, MarinaShamsipour, MansourIslam, Sheikh Mohammed SharifulSharma, JayendraSharma, RajeshShe, JunSheikhbahaei, SaraShen, JiabinShi, PeilinShigematsu, MikaShin, Min-JeongShiri, RahmanShoman, HaithamShrime, Mark G.Sibamo, Ephrem Lejore SibamoSigfusdottir, Inga DoraSilva, Diego Augusto SantosSilveira, Dayane Gabriele AlvesSindi, ShireenSingh, AbhishekSingh, Jasvinder A.Singh, Om PrakashSingh, Prashant KumarSingh, VirendraSinke, Abiy HiruyeSinshaw, Aklilu EndalamawSkirbekk, VegardSliwa, KarenSmith, AlisonSobngwi, EugeneSoneji, SamirSoriano, Joan B.Sousa, Tatiane Cristina MoraesSposato, Luciano A.Sreeramareddy, Chandrashekhar T.Stathopoulou, VasilikiSteel, NicholasSteiner, CaitlynSteinke, SabineStokes, Mark AndrewStranges, SaverioStrong, MarkStroumpoulis, KonstantinosSturua, LelaSufiyan, Muawiyyah BabaleSuliankatchi, Rizwan AbdulkaderSun, JiandongSur, PatrickSwaminathan, SoumyaSykes, Bryan L.Tabares-Seisdedos, RafaelTabb, Karen M.Taffere, Getachew RedaeTalongwa, Roberto TchioTarajia, MusharafTavakkoli, MohammadTaveira, NunoTeeple, StephanieTegegne, Teketo KassawTehrani-Banihashemi, ArashTekelab, TesfalidetTekle, Dejen YemaneShifa, Girma TemamTerkawi, Abdullah SuliemanTesema, Azeb GebresilassieThakur, J. S.Thomson, Alan J.Tillmann, TaaviTiruye, Tenaw YimerTobe-Gai, RuoyanTonelli, MarcelloTopor-Madry, RomanTortajada, MiguelTroeger, ChristopherTruelsen, ThomasTura, Abera KenayUchendu, Uche S.Ukwaja, Kingsley N.Undurraga, Eduardo A.Uneke, Chigozie JesseUthman, Olalekan A.van Boven, Job F. M.Van Dingenen, RitaVarughese, SantoshVasankari, TommiVenketasubramanian, NarayanaswamyViolante, Francesco S.Vladimirov, Sergey K.Vlassov, Vasiliy VictorovichVollset, Stein EmilVos, TheoWagner, Joseph A.Wakayo, TolassaWaller, Stephen G.Walson, Judd L.Wang, HaidongWang, Yuan-PangWatkins, David A.Weiderpass, ElisabeteWeintraub, Robert G.Wen, Chi-PangWerdecker, AndreaWesana, JoshuaWesterman, RonnyWhiteford, Harvey A.Wilkinson, James D.Wiysonge, Charles SheyWoldeyes, Belete GetahunWolfe, Charles D. A.Won, SunghoWorkicho, AbdulhalikWorkie, Shimelash BitewWubshet, MamoXavier, DenisXu, GelinYadav, Ajit KumarYaghoubi, MohsenYakob, BereketYan, Lijing L.Yano, YuichiroYaseri, MehdiYimam, Hassen HamidYip, PaulYonemoto, NaohiroYoon, Seok-JunYounis, Mustafa Z.Yu, ChuanhuaZaidi, ZoubidaZaki, Maysaa El SayedZambrana-Torrelio, CarlosZapata, TomasZenebe, Zerihun MenlkalewZodpey, SanjayZoeckler, LeoZuhlke, Liesl JoannaMurray, Christopher J. L.
Issue Date
15-7월-2017
Publisher
ELSEVIER SCIENCE INC
Citation
LANCET, v.390, no.10091, pp.231 - 266
Indexed
SCIE
SCOPUS
Journal Title
LANCET
Volume
390
Number
10091
Start Page
231
End Page
266
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/82823
DOI
10.1016/S0140-6736(17)30818-8
ISSN
0140-6736
Abstract
Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.
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