Abstract
BackgroundSeveral risk factors for cardiovascular disease (CVD) have been identified in recent decades. However, the association between the health system and the burden of CVD has not yet been sufficiently researched. The objective of this study was to analyse the association between health system development and the burden of CVD, in particular CVD-related disability-adjusted life–years (DALYs).MethodsUnivariate and multivariate generalized linear mixed models were applied to country-level data collected by the World Bank and World Health Organization. Response variables were the age-standardized CVD mortality and age-standardized CVD DALY rates.ResultsThe amount of available health system resources, indicated by total health expenditures per capita, physician density, nurse density, dentistry density, pharmaceutical density and the density of hospital beds, was associated with reduced CVD DALY rates and CVD mortality. However, in the multivariate models, the density of nurses and midwives was positively associated with CVD. High out-of-pocket costs were associated with increased CVD mortality in both univariate and multivariate analyses.ConclusionA highly developed health system with a low level of out-of-pocket costs seems to be the most appropriate to reduce the burden of CVD. Furthermore, an efficient balance between human health resources and health technologies is essential.
Highlights
The health of a population is greatly affected by the health system in operation
The overall objective of this study was to analyse the association between health system development and the burden of cardiovascular disease (CVD), in particular CVD-related disability-adjusted life–years (DALYs)
Data description Several statistics characterizing the burden of CVD and the health system in the 193 World Health Organization (WHO) member states have been collected by the World Bank and the WHO (Table 1)
Summary
The health of a population is greatly affected by the health system in operation. The World Health Organization (WHO) defines the health system as all activities that take place to improve, conserve or revitalize health [1]. May the overall amount of available human health resources differ, and the degree of qualification and the distribution among general practitioners, specialists, nurses, etc. Health financing is of great relevance [3] It might be based on private or statutory health insurance, can be tax based and, can consist of a certain degree of out-of-pocket costs. Considering highly justified interventions, the amount of health expenditure has been judged to be too low in some poor countries [4]. This is accompanied by a considerable degree of out-of-pocket spending, reaching the maximum limit of what private households are able to pay. The objective of this study was to analyse the association between health system development and the burden of CVD, in particular CVD-related disability-adjusted life–years (DALYs)
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