Burden of emergency conditions and emergency care usage: new estimates from 40 countries

Abstract

Objective: To estimate the global and national burden of emergency conditions, and compare them to emergency care usage rates.

Methods: We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care usage rates were obtained from a systematic literature review on emergency care facilities in low-income and middle-income countries (LMICs), supplemented by national health system reports.

Findings: All 15 leading causes of death and disability-adjusted life years (DALYs) globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency usage. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47 728 per 100 000 population (IQR 45 253-50 085) in low-income, 25 186 (IQR 21 982-40 480) in middle-income and 15 691 (IQR 14 649-16 382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency usage rates were the lowest in low-income countries, with median 8 visits per 1000 population (IQR 6-10), 78 (IQR 25-197) in middle-income and 264 (IQR 177-341) in high-income countries.

Conclusions: Despite higher burden of emergency conditions, emergency usage rates are substantially lower in LMICs, likely due to limited access to emergency care.

Keywords: access to care; emergency care systems; emergency department utilisation; global health.

Figure 1

Flowchart of the modified Delphi classification and external validation processes

Figure 2

DALYs per 100,000 population attributable to emergency conditions, by etiology: separated by income level (a) and region (b). Distribution of deaths was similar. Abbreviations: non-communicable diseases (NCDs), communicable-diseases (CDs), disability-adjusted life years (DALYs).

Figure 3

Comparison of national emergency utilization rates with burden of emergency conditions, as measured by deaths and DALYs per 100,000 population.