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. 2022 Dec;10(12):e1715-e1743.
doi: 10.1016/S2214-109X(22)00429-6. Epub 2022 Oct 6.

Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

GBD 2019 Healthcare Access and Quality Collaborators
Collaborators

Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

GBD 2019 Healthcare Access and Quality Collaborators. Lancet Glob Health. 2022 Dec.

Erratum in

  • Correction to Lancet Glob Health 2022; 10: 1715-43.
    [No authors listed] [No authors listed] Lancet Glob Health. 2024 Mar;12(3):e381. doi: 10.1016/S2214-109X(24)00036-6. Epub 2024 Jan 17. Lancet Glob Health. 2024. PMID: 38244560 Free PMC article. No abstract available.

Abstract

Background: Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019.

Methods: We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development.

Findings: Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9-21·3), as well as among the young (22·5, 19·9-24·7), working (17·2, 15·2-19·1), and post-working (15·1, 13·2-17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6-33·0) on average in low-SDI countries to 83·4 (82·4-84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4-89·0), working (33·8-82·8), and post-working (30·4-79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries.

Interpretation: Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young.

Funding: Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests S Afzal reports participation on a Data Safety Monitoring Board or Advisory Board with the Corona Expert Advisory Group and Infectious Diseases Expert Advisory Group and is a Fellow of Faculty of Public Health, UK and the Dean of Public Health and Preventive Medicine and a chairperson for Community Medicine at King Edward Medical University, Pakistan. R Ancuceanu reports payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing or educational events from Abbvie, B. Braun, Sandoz, and Laropharm. S Bhaskar is the Board Director of the Rotary Club of Sydney, chair of Rotary District 9675, Diversity, Equity, and Inclusion, and is the chair/co-manager, Global Health and Migration Community Hub at the Global Health Hub Germany. B Bikbov reports support for the present manuscript from the European Union's Horizon 2020 Marie Sklodowska-Curie research and innovation programme grant number 703226, and reports grants or contracts from the Lombardy Region, paid to their institution, outside of the submitted work. J S Chandan reports grants or contracts from the National Institute for Health and Care Research as well as the Youth Endowment Fund, outside of the submitted work. N Fullman reports funding from WHO and Gates ventures, outside of the submitted work. C Herteliu reports grants or contracts from the Romanian Ministry of Research Innovation and Digitalization (ID-585-CTR-42-PFE-2021), outside the submitted work. C Herteliu and A Pana report grants or contracts from Romanian National Authority for Scientific Research and Innovation (PN-III-P4-ID-PCCF-2016-0084, PN-III-P2-2.1-SOL-2020-2-0351), outside the submitted work. S V Katikireddi reports support for the current manuscript from the Medical Research Council (MC_UU_00022/2)) and Scottish Government Chief Scientist Office (MC_UU_00022/2), payments made to their institution. S Mohammed reports support for the present manuscript from the Bill & Melinda Gates Foundation and reports a fellowship grant from Alexander von Humboldt Foundation, outside of the submitted work. L Monasta reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to their institution. J Mosser reports support for the present manuscript from the Bill & Melinda Gates Foundation and report grants from Gavi, outside of the submitted work. S Sacco reports grants for contracts from Novartis, and Uriach as payments to their institution; personal consulting fees from Pfizer, AstraZeneca, Lilly, Novartis, Teva, Lundbeck, Abbott, and Novo Nordisk; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Allerga-Abbvie, Abbott, Norvartis, Lilly, Lundbeck, and Teva as personal payments; support for attending meetings or travel from Lilly; and is president elect of the European Stroke Organisation and second vice president of the European Headache Federation. S Sacco also reports receipt of equipment, materials, drugs, medical writing, gifts, or other services from Allergan-Abbvie, Novartis, and Novo Nordisk, all outside the submitted work. J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, Jupiter Life, UBM, Trio Health, Medscape, WebMD, and Practice Point communications, and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for participating in the speakers bureau for Simply Speaking; support for attending meetings or travel from the steering committee of OMERACT, to attend their meeting every 2 years; participation on a data safety monitoring board or advisory board as an unpaid member of the FDA Arthritis Advisory Committee; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as a member of the steering committee of OMERACT, an international organisation that develops measures for clinical trials and receives arms length funding from 12 pharmaceutical companies, with the Veterans Affairs Rheumatology Field Advisory Committee as Chair, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as a director and editor; stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Series Therapeutics, Tonix Pharmaceuticals, and Charlotte's Web Holdings and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals; all outside the submitted work. D R Uezono is an employee of Roche Philippines, and their involvement in this article is done outside of their scope as an employee of Roche.

Figures

Figure 1
Figure 1
HAQ Index, overall and by select age group, 2019, by country and territory HAQ=Healthcare Access and Quality.
Figure 1
Figure 1
HAQ Index, overall and by select age group, 2019, by country and territory HAQ=Healthcare Access and Quality.
Figure 2
Figure 2
Change over time in HAQ Index, 1990–2019, overall and by select age group HAQ=Healthcare Access and Quality. SDI=Socio-demographic Index.
Figure 3
Figure 3
Percentage change in HAQ Index by select age group and SDI quintile between 1990 and 2019 Values in parentheses are 95% uncertainty intervals. HAQ=Healthcare Access and Quality. SDI=Socio-demographic Index.
Figure 4
Figure 4
Testing for convergence: absolute and relative change in HAQ Index, 1990–2019, versus 1990 HAQ Index, overall and by select age group Bars represent the coefficients estimated from a linear regression of the absolute or relative (annual average percent) change in the HAQ Index between 1990 and 2019 on the 1990 HAQ Index value, conducted for each group separately. Black error bars represent the coefficients' 95% uncertainty intervals. HAQ=Healthcare Access and Quality.
Figure 5
Figure 5
Change in gap in HAQ Index score between high-SDI quintile and other quintiles, overall and by select age group, 1990–2019 Black error bars represent 95% uncertainty intervals. HAQ=Healthcare Access and Quality. SDI=Socio-demographic Index.
See this image and copyright information in PMC

Comment in

  • Ensuring the right to health along the life course.
    Nabyonga-Orem J, Asamani JA. Nabyonga-Orem J, et al. Lancet Glob Health. 2022 Dec;10(12):e1689-e1690. doi: 10.1016/S2214-109X(22)00458-2. Lancet Glob Health. 2022. PMID: 36400071 Free PMC article. No abstract available.

References

    1. Vollset SE, Goren E, Yuan CW, et al. Fertility, mortality, migration, and population scenarios for 195 countries and territories from 2017 to 2100: a forecasting analysis for the Global Burden of Disease Study. Lancet. 2020;396:1285–1306. - PMC - PubMed
    1. Wang H, Abbas KM, Abbasifard M, et al. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1160–1203. - PMC - PubMed
    1. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569–624. - PubMed
    1. Stephenson T. How children's responses to drugs differ from adults. Br J Clin Pharmacol. 2005;59:670–673. - PMC - PubMed
    1. Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–1222. - PMC - PubMed

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