Lower Respiratory Tract Infection Trends in East and South-East Asia: In the Light of Economic and Health Care Development

Abstract

This study explored to what degree economic development and improvement of healthcare are associated with lower respiratory tract infection (LRTI) mortality. A correlation analysis between LRTI mortality and Gross Domestic Product (GDP) per capita, and the Health Access and Quality Index (HAQI), respectively was conducted for 15 countries in East and South-East Asia. The results revealed a dramatic decrease in LRTI mortality in total populations for lower-middle income (LMI) countries but at the same time an increase in upper-middle income (UMI) and high-income (HI) countries. A highly significant (P < .001) growth-dependent relationship between LRTI mortality and economic growth was observed. Improvements in HAQI were significantly associated with a decrease in LRTI mortality in LMI countries, but an increase in UMI and HI countries. The decline of LRTI mortality amongst children in LMI countries is an encouraging trend and efforts against LRTI must be continued, though not at the expense of preparing health systems for the growing burden.

Keywords: South-East Asia; economic growth; epidemiology; health access; healthcare quality; mortality; respiratory tract infection.

Figure 1.

The lower respiratory infection (LRTI) mortality for all age groups has decreased in all low-middle income countries except the Philippines (A). An increase in LRTI mortality for all age groups was found in upper-middle and high income countries with the exception of China (B and C). The mortality of LRTIs amongst children <5 years has decreased for all countries except Brunei (D and F). The Health Access and Quality Index (HAQI) has increased for all countries (G and I).

Figure 2.

A strong significant correlation was found for all countries between Gross Domestic Product (GDP) per capita and LRTI mortality all ages (A-C). Countries characterized by a rapidly growing GDP revealed a negative correlation with LRTI mortality (A and B; Cambodia, Indonesia, Laos, Mongolia, Myanmar, Vietnam, China). Countries with a moderate growth in GDP revealed a positive correlation with LRTI mortality (B and C: Malaysia, Thailand, Brunei, Japan, Singapore, South-Korea, Taiwan). A significant correlation was also found between GDP and <5 LRTI mortality for all countries except Malaysia (D-F). These were all found to be negative correlations except for Brunei and Taiwan where a positive correlation was found showed a substantial growth in GDP that was correlated with a decrease LRTI mortality, whereas UMI countries and high income countries with a moderate growth in GDP correlated with an increase in LRTI mortality (A-C).

Figure 3.

A strong significant correlation between the Health Access and Quality Index (HAQI) and LRTI mortality all ages was found for all countries (A-C). Improvements of the HAQI in low-middle income countries Cambodia, Indonesia, Laos, Mongolia, Myanmar Vietnam, and upper-middle country China were correlated with a decrease in LRTI mortality (A and B). Improvements of the HAQI for Malaysia, Thailand, Brunei, Japan, Singapore, South-Korea, and Taiwan were correlated with an increase in LRTI mortality (B and C). The correlation was also found for LRTI mortality <5 years (except Malaysia), where all countries revealed a negative correlation between HAQI development and LRTI <5 mortality except for Brunei which revealed a positive correlation (D and F).