Living longer with disability in China and G20 nations: a quantitative model for the Sustainable Development Goal for health post-2015: a reproducible study

Abstract

BackgroundEvidence from the Global Burden of Disease Study 2010 is consistent with the expectation that, in China, where the number of healthy years lost to disability at birth in 2010 was 7·95 years compared with the median of 10·51 (median absolute deviation=1·15) of G20 nations, post-2015 a society living longer will lose an increasing number of years to non-fatal disease and injury. We generated the conditional hypothesis that this expansion of morbidity also has economic effects: in 2012, with a per-person total health expenditure of 480 purchasing power parity in international dollars, China was the third lowest spender among the G20 nations (median 2222, median absolute deviation 1723). We reviewed published work on convergence of health status and analysed data from the Global Health Data Exchange (GHDx) of the Institute for Health Metrics and Evaluation, the University of Washington, Seattle, WA, USA, and from the WHO Health Expenditure Statistics Database. MethodsReproducibility can improve evidence-based research, engage stakeholders, and promote transparency among health policy makers. For these reasons, this study uses open-access R software and public repositories of the GHDx (454 410 records) and the WHO Health Expenditure Statistics Database (164 220 records); our statistical inference can be downloaded from GitHub, and reproduced and improved by fellow researchers. We tested the multiple linear model that, within the reference population of G20 nations, per-person total health expenditure is related to health-adjusted life expectancy (HALE) and the number of years lived with disability (YLD). FindingsIn our reference population, the log transformation of per-person total health expenditure is positively related to HALE and YLD (R2 0·61; F-statistic 33; p<0·001; variance inflation factor 1·35), with YLD showing the strongest incremental effect: per-person total health expenditure increases exponentially by 1·47 times (95% CI 1·21–1·79) per additional year of disability versus 1·11 times (95% CI 1·05–1·17) per additional year of health-adjusted life expectancy. InterpretationWe generated the conditional hypothesis that post-2015 in China, if YLD and HALE converge towards the median of G20 nations, per-person total health expenditure will grow from 480 to 2195 purchasing power parity in international dollars (95% CI 1827–2636). Our results lent support to the conclusion that YLD and HALE are relevant quantities for an evidence-based assessment of the sustainability of the health development agenda in China and G20 nations post-2015. FundingUniversity of Bergamo, Bergamo, Italy.