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

• Autor(a) principal: Chandrashekhar t Sreeramareddy
• Data de Publicação: 2017
• Outros Autores: Vasiliki Stathopoulou, Nicholas Steel, Caitlyn Steiner, Sabine Steinke, Ellen Nolte, Carl Abelardo t Antonio, Mark Andrew Stokes, Saverio Stranges, Mark Strong, Konstantinos Stroumpoulis, Adrienne Chew, Mirriam Chibalabala, Chioma Ezinne Chibueze, Vesper Hichilombwe Chisumpa, Abdulaal a Chitheer, Rajiv Chowdhury, Hanne Christensen, Devasahayam Jesudas Christopher, Liliana g Ciobanu, Rafael Tabarés-seisdedos, Seok-jun Yoon, Massimo Cirillo, Semaw Ferede Abera, Megan s Coggeshall, Leslie Trumbull Cooper, Monica Cortinovis, John a Crump, Koustuv Dalal, Hadi Danawi, Lalit Dandona, Rakhi Dandona, Mustafa z Younis, Karen m Tabb, Paul i Dargan, Jose Das Neves, Biju Abraham, Gail Davey, Dragos v Davitoiu, Kairat Davletov, Diego de Leo, Liana c Del Gobbo, Borja Del Pozo-cruz, Chuanhua yu, Robert p Dellavalle, Getachew Redae Taffere, Kebede Deribe, Amare Deribew, Don c Des Jarlais, Girmatsion Fisseha Abreha, Subhojit Dey, Samath d Dharmaratne, Daniel Dicker, Eric l Ding, Zoubida Zaidi, Klara Dokova, e Ray Dorsey, Roberto Tchio Talongwa, Kerrie e Doyle, Manisha Dubey, Rebecca Ehrenkranz, Christian Lycke Ellingsen, Kelemework Adane, Iqbal Elyazar, Ahmadali Enayati, Maysaa el Sayed Zaki, Sergey Petrovich Ermakov, Babak Eshrati, Alireza Esteghamati, Musharaf Tarajia, Kara Estep, Thomas Fürst, Imad d a Faghmous, Fanuel Belayneh Bekele Fanuel, Emerito Jose Aquino Faraon, Ademola Lukman Adelekan, Sachin r Atre, Talha a Farid, Carla Sofia e sa Farinha, Andre Faro, Maryam s Farvid, Mohammad Tavakkoli, Farshad Farzadfar, Valery l Feigin, Andrea b Feigl, Seyed-mohammad Fereshtehnejad, Jefferson g Fernandes, Carlos Zambrana-torrelio, João c Fernandes, Ifedayo Morayo o Adetifa, Tesfaye Regassa Feyissa, Florian Fischer, Christina Fitzmaurice, Nuno Taveira, Thomas d Fleming, Nataliya Foigt, Kyle j Foreman, Mohammad h Forouzanfar, Tomas Zapata, Richard c Franklin, Joseph Frostad, Tsegaye Tewelde G/hiwot, Nancy Fullman, Ashkan Afshin, Emmanuela Gakidou, Stephanie Teeple, Ketevan Gambashidze, Amiran Gamkrelidze, Wayne Gao, Zerihun Menlkalew Zenebe, Alberto l Garcia-basteiro, Teshome Gebre, Amanuel Tesfay Gebremedhin, Mengistu Welday Gebremichael, Alemseged Aregay Gebru, Amha Admasie Gelaye, Arnav Agarwal, Teketo Kassaw Tegegne, Johanna m Geleijnse, Ricard Genova-maleras, Sanjay Zodpey, Katherine b Gibney, Ababi Zergaw Giref, Melkamu Dedefo Gishu, Giorgia Giussani, William w Godwin, Audra Gold, Ellen m Goldberg, Philimon n Gona, al Artaman, Sanjay Kumar Agarwal, Lela Sturua, Amador Goodridge, Sameer Vali Gopalani, Atsushi Goto, Nicholas Graetz, Felix Greaves, Max Griswold, Peter Imre Guban, Harish Chander Gugnani, Prakash c Gupta, Arash Tehrani-banihashemi, Leo Zoeckler, Rahul Gupta, Sunilkumar Agarwal, Rajeev Gupta, Tanush Gupta, Vipin Gupta, Tesfa Dejenie Habtewold, Nima Hafezi-nejad, Demewoz Haile, Alemayehu Desalegne Hailu, Gessessew Bugssa Hailu, Liesl Joanna Zuhlke, Tesfalidet Tekelab, Alex Hakuzimana, Randah Ribhi Hamadeh, Anurag Agrawal, Mitiku Teshome Hambisa, Samer Hamidi, Mouhanad Hammami, Graeme j Hankey, Yuantao Hao, Hilda l Harb, Christopher j l Murray, Habtamu Abera Hareri, Dejen Yemane Tekle, Josep Maria Haro, Mohammad Sadegh Hassanvand, Rasmus Havmoeller, Aliasghar Ahmad Kiadaliri, Roderick j Hay, Simon i Hay, Delia Hendrie, Ileana Beatriz Heredia-pi, Amanuel Alemu Abajobir, Hans w Hoek, Masako Horino, Girma Temam Shifa, Nobuyuki Horita, h Dean Hosgood, Aung Soe Htet, Guoqing hu, Alireza Ahmadi, Hsiang Huang, John j Huang, Leticia Avila-burgos, Bethany m Huntley, Chantal Huynh, Kim Moesgaard Iburg, Abdullah Sulieman Terkawi, Bogdan Vasile Ileanu, Kaire Innos, Asnake Ararsa Irenso, Nader Jahanmehr, Mihajlo b Jakovljevic, Kedir Yimam Ahmed, Euripide Frinel g Arthur Avokpaho, Peter James, Spencer Lewis James, Mehdi Javanbakht, Sudha p Jayaraman, Azeb Gebresilassie Tesema, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Vivekanand Jha, Denny John, Catherine Johnson, Beatriz Paulina Ayala Quintanilla, Sarah c Johnson, Muktar Beshir Ahmed, Jost b Jonas, Knud Juel, Zubair Kabir, js Thakur, Yogeshwar Kalkonde, Ritul Kamal, Haidong Kan, Andre Karch, Ashish Awasthi, Corine Kakizi Karema, Seyed m Karimi, Amir Kasaeian, Rufus Olusola Akinyemi, Nicholas j Kassebaum, Anshul Kastor, Alan j Thomson, Srinivasa Vittal Katikireddi, Konstantin Kazanjan, Peter Njenga Keiyoro, Nebiyu Negussu Ayele, Laura Kemmer, Andrew Haddon Kemp, Andre Pascal Kengne, Amene Abebe Kerbo, Maia Kereselidze, Reed j d Sorensen, Tomi f Akinyemiju, Taavi Tillmann, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Peter Azzopardi, Ibrahim Khalil, Abdur Rahman Khan, Ejaz Ahmad Khan, Gulfaraz Khan, Young-ho Khang, Abdullah Tawfih Abdullah Khoja, Irma Khonelidze, Jagdish Khubchandani, Tenaw Yimer Tiruye, Nadia Akseer, Muawiyyah Babale Sufiyan, Getiye Dejenu Kibret, Daniel Kim, Pauline Kim, Yun Jin Kim, Ruth w Kimokoti, Yohannes Kinfu, Niranjan Kissoon, Miia Kivipelto, Yoshihiro Kokubo, Hamid Asayesh, Huda Omer ba Saleem, Anneli Kolk, Ziyad Al-aly, Dhaval Kolte, Jacek a Kopec, Soewarta Kosen, Parvaiz a Koul, ai Koyanagi, Michael Kravchenko, Sanjay Krishnaswami, Kristopher j Krohn, Till Bärnighausen, Ruoyan Tobe-gai, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Khurshid Alam, Ernst j Kuipers, Veena s Kulkarni, g Anil Kumar, Fekede Asefa Kumsa, Michael Kutz, Hmwe h Kyu, Umar Bacha, Anton Carl Jonas Lager, Marcello Tonelli, Aparna Lal, Dharmesh Kumar Lal, Ratilal Lalloo, Noore Alam, Tea Lallukka, Qing Lan, Sinead m Langan, Van c Lansingh, Alaa Badawi, Heidi j Larson, Anders Larsson, Roman Topor-madry, Dennis Odai Laryea, Asma Abdul Latif, Alicia Elena Beatriz Lawrynowicz, Janet l Leasher, Sayed Saidul Alam, James Leigh, Mall Leinsalu, Kalkidan Hassen Abate, Cheru Tesema Leshargie, Janni Leung, Ricky Leung, Miguel Tortajada, Miriam Levi, Xiaofeng Liang, Stephen s Lim, Margaret Lind, Shai Linn, Zewdie Aderaw Alemu, Amitava Banerjee, Steven e Lipshultz, Patrick Liu, Yang Liu, Loon-tzian lo, Christopher Troeger, Giancarlo Logroscino, Alan d Lopez, Scott a Lorch, Paulo a Lotufo, Rafael Lozano, Aleksandra Barac, Raimundas Lunevicius, Kefyalew Addis Alene, Ronan a Lyons, Erlyn Rachelle King Macarayan, Mark t Mackay, Thomas Truelsen, Hassan Magdy Abd el Razek, Mohammed Magdy Abd el Razek, Mahdi Mahdavi, Azeem Majeed, Miguel a Barboza, Reza Malekzadeh, Deborah Carvalho Malta, Lorenzo g Mantovani, Lily Alexander, Tsegahun Manyazewal, Chabila c Mapoma, Abera Kenay Tura, Wagner Marcenes, Guy b Marks, Neal Marquez, Suzanne l Barker-collo, Jose Martinez-raga, Melvin Barrientos Marzan, João Massano, Manu Raj Mathur, Pallab k Maulik, Raghib Ali, Mohsen Mazidi, Uche s Uchendu, Colm Mcalinden, John j Mcgrath, Lope h Barrero, Claire Mcnellan, Peter a Meaney, Alem Mehari, Man Mohan Mehndiratta, Toni Meier, Alemayehu b Mekonnen, Kidanu Gebremariam Meles, Thomas Bollyky, Kingsley n Ukwaja, Syed Danish Ali, Rizwan Abdulkader Suliankatchi, Ziad a Memish, Melkamu Merid Mengesha, Desalegn Tadese Mengiste, Mubarek Abera Mengistie, Bereket Gebremichael Menota, George a Mensah, Seid Tiku Mereta, Atte Meretoja, Tuomo j Meretoja, Eduardo a Undurraga, Sanjay Basu, Haftay Berhane Mezgebe, Reza Alizadeh-navaei, Renata Micha, Anoushka Millear, Edward j Mills, Shawn Minnig, Mojde Mirarefin, Erkin m Mirrakhimov, Charles n Mock, Karzan Abdulmuhsin Mohammad, Bernhard t Baune, Reza Assadi, Shafiu Mohammed, Sanjay k Mohanty, Ala'a Alkerwi, Ali h Mokdad, Glen Liddell d Mola, Mariam Molokhia, Lorenzo Monasta, Marcella Montico, Maziar Moradi-lakeh, Kaleab Baye, Paula Moraga, Chigozie Jesse Uneke, Lidia Morawska, Rintaro Mori, Mark Moses, François Alla, Ulrich o Mueller, Srinivas Murthy, Kamarul Imran Musa, Jean b Nachega, Yibeltal Tebekaw Bayou, Chie Nagata, Gabriele Nagel, Olalekan a Uthman, Mohsen Naghavi, Aliya Naheed, Luigi Naldi, Vinay Nangia, Peter Allebeck, Bruno Ramos Nascimento, Ionut Negoi, Shahrzad Bazargan-hejazi, Sudan Prasad Neupane, Charles r Newton, Marie ng, Job f m Van Boven, Frida Namnyak Ngalesoni, Josephine Wanjiku Ngunjiri, Grant Nguyen, Dina Nur Anggraini Ningrum, Sandra Nolte, Christine Allen, Cristiana Abbafati, Marika Nomura, Ole f Norheim, bo Norrving, Jean Jacques n Noubiap, Rita Van Dingenen, Carla Makhlouf Obermeyer, Felix Akpojene Ogbo, In-hwan oh, Anselm Okoro, Olanrewaju Oladimeji, Neeraj Bedi, Andrew Toyin Olagunju, Rajaa Al-raddadi, Pedro r Olivares, Helen e Olsen, Bolajoko Olubukunola Olusanya, Santosh Varughese, Jacob Olusegun Olusanya, John Nelson Opio, Eyal Oren, Alberto Ortiz, Ettore Beghi, Richard h Osborne, Majdi Osman, Mayowa o Owolabi, Ubai Alsharif, Mahesh pa, Amanda w Pain, Tommi Vasankari, Smita Pakhale, Elizabeth Palomares Castillo, Adrian Pana, Yannick Béjot, Christina Papachristou, Mahboubeh Parsaeian, Tejas Patel, George c Patton, Deepak Paudel, Khalid a Altirkawi, Vinod k Paul, Narayanaswamy Venketasubramanian, Neil Pearce, David m Pereira, Aminu k Bello, Rogelio Perez-padilla, Fernando Perez-ruiz, Norberto Perico, Konrad Pesudovs, Max Petzold, Michael Robert Phillips, David m Pigott, Elena Alvarez Martin, Francesco s Violante, Julian David Pillay, Jiandong Sun, Christine Pinho, Suzanne Polinder, Constance d Pond, v Prakash, Manorama Purwar, Mostafa Qorbani, d Alex Quistberg, Amir Radfar, Anwar Rafay, Sergey k Vladimirov, Derrick a Bennett, Martin Mckee, Nelson Alvis-guzman, Kazem Rahimi, Vafa Rahimi-movaghar, Mahfuzar Rahman, Mohammad Hifz ur Rahman, Rajesh Kumar Rai, Usha Ram, Saleem m Rana, Zane Rankin, Isabela m Bensenor, Vasiliy Victorovich Vlassov, Paturi Vishnupriya Rao, Puja c Rao, Azmeraw t Amare, Salman Rawaf, Maria Albertina Santiago Rego, Marissa Reitsma, Giuseppe Remuzzi, Andre m n n Renzaho, Serge Resnikoff, Adugnaw Berhane, Satar Rezaei, Ayalew Astatkie, Mohammad Sadegh Rezai, Antonio Luiz Pinho Ribeiro, Hirbo Shore Roba, Erfan Amini, Mohammad Bagher Rokni, Luca Ronfani, Gholamreza Roshandel, Gregory a Roth, Eduardo Bernabé, Dietrich Rothenbacher, Nawal k Roy, Stein Emil Vollset, Perminder s Sachdev, Ben Benasco Sackey, Mohammad Yahya Saeedi, Saeid Safiri, Walid Ammar, Rajesh Sagar, Mohammad Ali Sahraian, Oscar Alberto Bernal, Muhammad Muhammad Saleh, Joshua a Salomon, Abdallah m Samy, Theo Vos, Juan Ramon Sanabria, Maria Dolores Sanchez-niño, Logan Sandar, Itamar s Santos, João Vasco Santos, Joshu Amo-adjei, Addisu Shunu Beyene, Milena m Santric Milicevic, Rodrigo Sarmiento-suarez, Benn Sartorius, Maheswar Satpathy, Joseph a Wagner, Miloje Savic, Monika Sawhney, Mete i Saylan, Ben Schöttker, Aletta e Schutte, Ryan Mbarber, David c Schwebel, Yaw Ampem Amoako, Soraya Seedat, Abdulbasit Musa Seid, Canaan Negash Seifu, Tolassa Wakayo, Sadaf g Sepanlou, Berrin Serdar, Edson e Servan-mori, Tesfaye Setegn, Kaja m Abbas, Katya Anne Shackelford, Amira Shaheen, Saeid Shahraz, Benjamin o Anderson, Masood Ali Shaikh, Marina Shakh-nazarova, Stephen g Waller, Mansour Shamsipour, Sheikh Mohammed Shariful Islam, Jayendra Sharma, Tariku Jibat Beyene, Rajesh Sharma, Jun She, Sara Sheikhbahaei, Jiabin Shen, Peilin Shi, Sofia Androudi, Mika Shigematsu, Judd l Walson, Min-jeong Shin, Rahman Shiri, Zulfiqar a Bhutta, Haitham Shoman, Mark g Shrime, Ephrem Lejore Sibamo Sibamo, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Dayane Gabriele Alves Silveira, Shireen Sindi, Hossein Ansari, Haidong Wang, Abhishek Singh, Patrick Sur, Jasvinder a Singh, om Prakash Singh, Prashant Kumar Singh, Virendra Singh, Abiy Hiruye Sinke, Aklilu Endalamaw Sinshaw, Vegard Skirbekk, Karen Sliwa, Alison Smith, Yuan-pang Wang, Sibhatu Biadgilign, Mustafa Geleto Ansha, Eugene Sobngwi, Samir Soneji, Joan b Soriano, Tatiane Cristina Moraes Sousa, Luciano a Sposato, David a Watkins, Elisabete Weiderpass, Tesfay Mehari Atey, Robert g Weintraub, Boris Bikbov, Chi-pang Wen, Andrea Werdecker, Joshua Wesana, Ronny Westerman, Harvey a Whiteford, James d Wilkinson, Charles Shey Wiysonge, Belete Getahun Woldeyes, Charles d a Wolfe, Suleman Atique, Sait Mentes Birlik, Sungho Won, Abdulhalik Workicho, Shimelash Bitew Workie, Mamo Wubshet, Denis Xavier, Gelin xu, Ajit Kumar Yadav, Mohsen Yaghoubi, Bereket Yakob, Lijing l Yan, Charles Birungi, Niguse Tadele Atnafu, Yuichiro Yano, Mehdi Yaseri, Hassen Hamid Yimam, Paul Yip, Naohiro Yonemoto, Stan Biryukov, Donal Bisanzio, Habtamu Mellie Bizuayehu, Dipan Bose, Foad Abd-allah, Michael Brainin, Soumya Swaminathan, Michael Brauer, Alexandra Brazinova, Nicholas j k Breitborde, Hermann Brenner, Zahid a Butt, Rosario Cárdenas, Lucero Cahuana-hurtado, Ismael Ricardo Campos-nonato, Josip Car, Abdishakur m Abdulle, Johan Ärnlöv, Juan Jesus Carrero, Daniel Casey, Valeria Caso, Carlos a Castañeda-orjuela, Jacqueline Castillo Rivas, Ferrán Catalá-lópez, Pedro Cecilio, Kelly Cercy, Fiona j Charlson, Alan z Chen, Bryan l Sykes, Ahmed Abdulahi Abdurahman
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: https://doi.org/10.1016/S0140-6736(17)30818-8; http://hdl.handle.net/1843/55521; https://orcid.org/0000-0001-5689-3870
• topic: Global Burden of Disease; Mortality; Personal Health; Carga Global da Doença; Registros de Mortalidade; Registros de Saúde Pessoal

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-system haracteristics 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.