Country Human Development Index Research Articles

Burden of six major types of digestive system cancers globally and in China.

Digestive system cancers constitute a significant number of cancer cases, but their burden is not uniform. As Global Cancer Observatory (GLOBOCAN) 2022 has recently updated its estimates of cancer burden, we aimed to investigate the burden of six major digestive system cancers both worldwide and in China, along with geographical and temporal variations in cancer-specific incidence and mortality. We extracted data on primary cancers of the esophagus, stomach, colorectum, liver, pancreas, and gallbladder from the GLOBOCAN database for 2022. Age-standardized incidence and mortality rates were calculated and stratified by sex, country, region, and human development index (HDI). We used the 2022 revision of the World Population Prospects (United Nations) to obtain demographic data for various age groups in China from 1988 to 2012 and used the joinpoint model and the average annual percentage change (AAPC) to analyze cancer incidence trends in China. In 2022, the estimated global incidence of digestive system cancers reached 4,905,882, with an estimated 3,324,774 cancer-related deaths. Colorectal cancer was most prevalent in terms of incidence and mortality. There was a significant correlation between the burden of gastrointestinal cancers and country HDI. From 1988 to 2012, the incidence of esophageal, gastric, and liver cancers declined in China, whereas colorectal and pancreatic cancer incidences continued to increase. By 2050, colorectal and liver cancers are projected to remain the leading cancer types in China in terms of incidence and mortality, respectively. Digestive system cancers remain a significant public health challenge globally and in China. Although progress has been made in the prevention and control of some cancers, the burden of digestive system cancers persists. The implementation of tertiary prevention strategies must be intensified to reduce the incidence and mortality of digestive system cancers, mitigating their impact on public health.

Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination.

Cervical cancer is the first cancer deemed amenable to elimination through prevention, and thus lessons from the epidemiology and prevention of this cancer type can provide information on strategies to manage other cancers. Infection with the human papillomavirus (HPV) causes virtually all cervical cancers, and an important proportion of oropharyngeal, anal and genital cancers. Whereas 20th century prevention efforts were dominated by cytology-based screening, the present and future of HPV-associated cancer prevention relies mostly on HPV vaccination and molecular screening tests. In this Review, we provide an overview of the epidemiology of HPV-associated cancers, their disease burden, how past and contemporary preventive interventions have shaped their incidence and mortality, and the potential for elimination. We particularly focus on the cofactors that could have the greatest effect on prevention efforts, such as parity and human immunodeficiency virus infection, as well as on social determinants of health. Given that the incidence of and mortality from HPV-associated cancers remain strongly associated with the socioeconomic status of individuals and the human development index of countries, elimination efforts are unlikely to succeed unless prevention efforts focus on health equity, with a commitment to both primary and secondary prevention.

Anaesthesia for Emergent Caesarean Section: A Population-based Study on Icelandic and Migrant Women during 2007-2018

General anaesthesia for emergent caesarean section, though uncommon, is vital in expediting deliveries. Studies indicate higher complication risks among pregnant migrant women. This research investigates if migrant women in Iceland are more likely to undergo general anaesthesia for emergent caesarean section compared to their Icelandic counterparts. This population-based cohort study analysed 4,415 emergency caesarean sections in Iceland between 2007 and 2018, sourced from the National Birth Registry. Participants were categorized by citizenship, with migrants further stratified by their country's Human Development Index (HDI). NCSP-IS and ICD-10 codes indexed diseases, interventions, and complications. The impact of variables was assessed through multiple logistic regression analysis. Migrant women received general anaesthesia in 16.1% of cases, slightly surpassing Icelandic women's 14.6%. Adjusting for risk factors showed no increased risk for migrant women. However, they had a higher likelihood of urgent caesarean sections (OR 1.45, 95% CI 1.08-1.94, p=0.015), a known risk factor for general anaesthesia, despite fewer comorbidities. Adjusting for confounders revealed reduced odds with a history of previous caesarean section (aOR 0.73, 95% CI 0.59-0.89, p=0.003) and placement of epidural anaesthesia in the delivery room (aOR 0.49, 95% CI 0.40-0.60, p< 0.001). Migrant women in Iceland do not face increased risks of general anaesthesia for emergent caesarean sections. However, their elevated risk of urgent caesarean sections suggests potential challenges, including language barriers or inadequate antenatal care. Early information dissemination and targeted interventions may mitigate these risks in this vulnerable community.

Abstract WP265: Connecting the Dots: Human Development Index and Stroke Burden in ASEAN

Introduction: Stroke's far-reaching impact encompasses societal, economic, and healthcare dimensions. A country's Human Development Index (HDI), comprising its performance in health, education, and living standards, offers insights into the nation's capacity in stroke management. The Association of Southeast Asian Nations' (ASEAN) adaptive growth strategy, accommodating the diverse developmental stages of its members, presents a unique context for exploring the relationship between HDI and stroke burden in the region. Methods: Data regarding the burden of stroke, expressed in the form of stroke-related mortality and Disability-Adjusted Life Years (DALY) rates, within the current 10 members of ASEAN were sourced from the 2019 Global Burden of Disease (GBD) study. Data on the 2019 HDI for these countries were obtained using the tool on the United Nations Development Programme (UNDP) website. Statistical analysis included normality testing and correlation assessments using Pearson and Spearman methods across 3 age groups (all-ages, 20+, 55+) with 3 sex sub-groups (both-sexes, female, male) in each age category. Results: In terms of mortality, higher HDI correlated significantly with lower mortality rates in all three age groups for both-sexes and female sub-groups. The male sub-groups also showed similar findings in the 20+ and 55+ age groups, but no significant correlation was found in the all-ages group (Table 1). For DALY, a significant correlation was observed between higher HDI and reduced DALY rates in the 20+ and 55+ age groups across all sex sub-group, but no significant correlation emerged in the all-ages group for any of its sex sub-groups (Table 2). Conclusion: These findings collectively suggest that higher levels of human development, as indicated by HDI, are associated with lower stroke-related mortality and DALY rates in ASEAN countries, emphasizing the importance of effective strategies to alleviate the burden of stroke in the region.

Assessing the Epidemiological Effects of COVID-19 Vaccination in Countries around the World: A Cross-Sectional Study

Relevance. To maximize the success of COVID-19 vaccination, it is necessary to consider the sensitivity of population health not only to these specific exposures, but also to the inherent socioeconomic factors that can modulate the effectiveness of health interventions. Aims. To assess the relationships between infection, mortality and the fatality ratio from COVID-19 in the countries of the world with the proportion of vaccinated in the population, as well as the relationship of the epidemic situation on COVID-19 with the parameters of the well-being of the population based on a cross-sectional study. Materials and methods. Statistical analysis used the data of the portal Our World in Data as of 15/12/2021, as well as UNO data on human development. Results. The frequencies of infection and death were higher the higher the human development index of countries. The inverse correlation of vaccination rates with infection and mortality rates was typical only for countries with very high human development. In the same group of countries, the infection fatality rate was the lowest. Conclusion. The nature of the correlations between the level of vaccination and the parameters of the epidemic situation is not the same for countries with different levels of human development. Apparently, a number of socio-economic factors, including the integral level development of the country and the level of urbanization, can influence the effectiveness of vaccination.

Access to Water‐Related Services Strongly Modulates Human Development

AbstractWater enables health, education, and economic well‐being opportunities for humanity. Access to basic water and sanitation services, freshwater variability, and water storage are some of the dimensions that may impact on human development worldwide. Yet few studies quantitatively explore the relationship between water and human development. This study uses a statistical approach to quantify the Water‐Human Development relation in a global sample, both in terms of correlation and causality between variables. Correlation is established using a multiple linear regression approach, while causality is explored by implementing the multi‐spatial convergent cross mapping technique. Our study finds strong interdependence between water‐related variables and human development globally. Access to water services positively influences the Human Development Index (HDI), seasonal variability of freshwater resources restricts it, and large water storage is not significant. The analysis is robust between 2000 and 2017, and implies that a 1% increment in a country's HDI is associated with a 1.3%–3.2% increment in water and sanitation access. Causal analyses show strong coupling, suggesting positive feedback between access to water services and HDI that could be exploited. Reaching Sustainable Development Goal 6 requires closing the water and sanitation access gaps while addressing freshwater variability challenges. This will result in global human development benefits.

KASHMIR'S BEGGING INDUSTRY AS A MONEYMAKING VENTURE

It was observed that beggars made up a sizable portion of the population in most urban and rural areas, regardless of the motivations for their chosen profession. They continue to grow as a fascinating phenomenon in all fields of study. This study added to the limited body of research on the topic by looking at the history and health effects of panhandling. Because of the qualitative character of the study, we used a combination of in-depth interviews, key informant interviews, and observations made by observers who were not involved in the study. Coverage included the Kashmir valley city of Srinagar. The findings revealed that some of the panhandlers have been operating for almost twenty years. They didn't see beggars as a burden on society but rather as people trying to make a living. Some people resort to begging on the streets since they have few other options for making a living because of their financial situation. Invasion into begging as a means of subsistence was prompted by chronic economic failure. Environmental annoyance and health hazards, as well as a negative portrayal of the country's human development index to foreigners, are all ways in which street begging can have an impact on public health and development. As their population keeps growing, they must keep cutting back on their labour force. As a result, the social welfare system will collapse, leaving people and ecosystems susceptible to the effects of un sustainability.

Association between smoking and colorectal cancer in Eastern Mediterranean Regional Office (EMRO): A systematic review and meta-analysis.

Smoking poses a significant risk for colorectal cancer (CRC), considered the third leading reason for cancer-related deaths worldwide. However, there has been limited research on the relationship between smoking and CRC in the Eastern Mediterranean Regional Office (EMRO). Therefore, a meta-analysis was conducted to combine available data and gain a comprehensive understanding of the relationship between smoking and CRC in EMRO. Two independent researchers searched PubMed, Scopus, and Web of Science until December 2022. The included studies were checked for risk of bias administering the Newcastle-Ottawa scale. Heterogeneity was evaluated using I2 statistics and the Cochrane test. Publication bias was determined through funnel plot analysis and Egger's regression test. Additionally, a meta-regression analysis explored the impact of a country's Human Development Index (HDI) on the relationship between smoking and CRC. The final analysis included 26 studies, revealing a significant association between smoking and CRC (OR = 1.40; 95% CI: 1.11 - 1.78; P = 0.004). Moreover, smoking had a more pronounced adverse effect on CRC in countries with higher HDIs compared to those with lower HDIs (OR = 1.30; 95% CI: 0.99 - 1.71; P = 0.054). Our findings underscore the importance of implementing smoking cessation programs and policies in EMRO countries, as they demonstrate a positive relationship between smoking and the risk of CRC. Furthermore, the results suggest that a country's level of human development may influence the association between smoking and CRC. Further research is needed to investigate this potential connection and develop targeted public health interventions.

The relationship between human development and prevalence of deficit schizophrenia: Results from a systematic review and meta-analysis

This study examined the relationship between the prevalence of deficit schizophrenia (DS) and a country's Human Development Index (HDI). A systematic review and meta-analysis of the literature published in the last decade were conducted to acquire data on the worldwide prevalence of deficit syndrome in schizophrenia cohorts and examine the correlation between DS prevalence and the HDI of the countries in the review. Twenty-six studies meeting our eligibility criteria provided prevalence data on DS in 14 countries with both low-to-middle and high-incomes, ranging from 14.34%-to 61.57%. The pooled prevalence of DS was 32.19% (95% CI = 26.17 to 38.52). Statistical analysis yielded a correlation coefficient (r) of -0.518 (95% CI = -0.754 to -0.164; p = 0.007), indicating a moderate inverse correlation between DS prevalence and HDI. This relationship remained significant in partial correlation analysis after controlling for potential sources of bias in the DS estimates (r = -0.489, p = 0.013). Our results show that schizophrenia cohorts from low-to-middle-income countries are more prone to primary and enduring negative symptoms, and contribute to the emerging evidence questioning the axiom that schizophrenia in the developing world has a better course than in high-income countries.

Global prevalence of Trichinella in pigs: A systematic review and meta-analysis.

Investigating the global epidemiological patterns of Trichinella in pigs is required for accurate recognition and to establishing proper control programmes and preventive measures, as well as to decrease human exposure. To obtain a better understanding of the global prevalence of Trichinella in domestic pigs and factors that might influence the prevalence, a systematic review and meta-analysis was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Multiple databases were used to identify literature published between January 2000 and December 2021, representing studies from 1985 to 2021, on Trichinella prevalence in domestic pigs. Prevalence was calculated on a global and country level, by country Human Development Index (HDI), climate, pig management system, and diagnostic test. The global pooled prevalence based on 60 manuscripts representing 32 countries and 65 pig populations was 2.02% (95% confidence interval [CI]: 0.88-3.62) and the estimated pooled prevalence in different continents ranged from 0.00% to 11.8%. Trichinella was highest in low HDI countries (21.6%; 95% CI: 4.3-47.2), tropical wet climates (20.9%; 95% CI: 10.3-34.1), and non-intensive pig farming systems (6.1%; 95% CI: 1.0-15.5). While there were regional differences in Trichinella prevalence in domestic pigs, these were likely driven by country HDI and pig farming systems versus climatic factors. Increased biosecurity in outdoor pig production systems, focused meat inspections and promoting awareness could potentially decrease risk of infection.

Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis.

Autistic individuals experience higher co-occurring medical conditions than the general population, and yet the estimates of autistic individuals with epilepsy are not updated. Co-occurrence of epilepsy in autistic individuals often aggravated cognitive impairment and increased the risk of poor long-term prognosis. Thus, an updated systematic review and meta-analysis was conducted to study the relevant articles published from inception to 2020, evaluate the prevalence of epilepsy in autistic individuals, and further explore the putative factors influencing the prevalence. A total of 66 studies from 53 articles were included in this study. The results showed that epilepsy is more common in autistic individuals than in the general population. The prevalence of epilepsy in autistic individuals in the clinical sample-based studies was higher than that in the population-based based cross-sectional or cohort studies. The prevalence of epilepsy in autistic adults was higher than that in autistic children. A significantly increased prevalence of epilepsy was detected in the autistic adolescent group (11-17 years old), and a higher trend of prevalence of epilepsy was observed in the autistic pre-school group (⩽ 6 -years-old) than that of the autistic school-aged group (7-10 years-old). The prevalence of epilepsy increased with age, female rate, and low intellectual function rate of autistic individuals. However, the human development index of countries was negatively associated with the pooled prevalence, which could be attributed to the different levels of awareness, diagnostic technologies, and autism-service support worldwide. About 1/10 autistic individuals also had epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability and less common in the country with high human development index. Thus, these findings provided critical and innovative views on the prevalence of epilepsy in autistic individuals and contributed to the targeted clinical management and preventive measures.

Global Inland Capture and Culture Finfisheries Follow Different Trends When Evaluated by the Human Development Index

To assess whether and how socioeconomic factors might be influencing global freshwater finfisheries, inland fishery data reported to the FAO between 1950 and 2015 were grouped by capture and culture, country human development index, plotted, and compared. We found that while capture inland finfishes have greatly increased on a global scale, this trend is being driven almost entirely by poorly developed (Tier-3) countries which also identify only 17% of their catch. In contrast, capture finfisheries have recently plateaued in moderately-developed (Tier-2) countries which are also identifying 16% of their catch but are dominated by a single country, China. In contrast, reported capture finfisheries are declining in well-developed (Tier-1) countries which identify nearly all (78%) of their fishes. Simultaneously, aquacultural activity has been increasing rapidly in both Tier-2 and Tier-3 countries, but only slowly in Tier-1 countries; remarkably, nearly all cultured species are being identified by all tier groups. These distinctly different trends suggest that socioeconomic factors influence how countries report and conduct capture finfisheries. Reported rapid increases in capture fisheries are worrisome in poorly developed countries because they cannot be explained and thus these fisheries cannot be managed meaningfully even though they depend on them for food. Our descriptive, proof-of-concept study suggests that socioeconomic factors should be considered in future, more sophisticated efforts to understand global freshwater fisheries which might include catch reconstruction.

Caregiving as suicide-prevention: an ecological 20-country study of the association between men's family carework, unemployment, and suicide.

Suicide rates are generally higher in men than in women. Men's higher suicide mortality is often attributed to public-life adversities, such as unemployment. Building on the theory that men's suicide vulnerability is also related to their private-life behaviors, particularly men's low engagement in family carework, this ecological study explored the association between men's family carework, unemployment, and suicide. Family-carework data for twenty Organization for Economic Co-operation and Development (OECD) countries were obtained from the OECD Family Database. Sex-specific age-standardized suicide rates came from the Global Burden of Disease dataset. The association between men's engagement in family carework and suicide rates by sex was estimated, with OECD's unemployment-benefits index and United-Nations' Human Development-Index (HDI) evaluated as controls. The moderation of men's carework on the unemployment-suicide relationship was also assessed. Overall and sex-specific suicide rates were lower in countries where men reported more family carework. In these countries, higher unemployment rates were not associated with higher male suicide rates. In countries where men reported less family carework, higher unemployment was associated with higher male suicide rates, independent of country's HDI. Unemployment benefits were not associated with suicide rates. Men's family carework moderated the association between unemployment and suicide rates. This study's findings that higher levels of men's family carework were associated with lower suicide mortality, especially among men and under high-unemployment conditions, point to the suicide-protective potential of men's family carework. They are consistent with evidence that where gender equality is greater, men's and women's well-being, health, and longevity are greater.

The Costs of Burn Victim Hospital Care around the World: A Systematic Review.

Background:Burn injuries are very common and fire-related burns account for over 300,000 deaths per year globally. The costs of the treatment of these patients change around the world. The aim of the present study was to conduct a systematic literature review to identify the costs related to hospital stays of burn victims in countries with different Human Development Index (HDIs).Methods:PubMed, CINAHL and BVIS databases were searched using the following terms: “burn,” treatment” and “costs”. The review included articles that presented cost studies or economic assessments of burn victims in which the costs were reported, and published between 2012 and 2019. The quality of the evidence was assessed using the Consensus on Health Economic Criteria. This review presents register in Prospero (CRD42019137580).Results:The review included 19 economic studies conducted in 13 countries, most with a very high HDIs. Most studies estimated direct acute burn care costs through bottom-up costing and institutional data. Total hospital care costs ranged from US$ 10.58 to US$ 125,597.86 per patient, the cost of 1% of total body surface area burned ranged from US$ 2.65 to US$ 11,245.04, and the cost of hospital care per day, from US$ 24.23 to US$ 4,125.50.Conclusion:The costs are high and show wide discrepancies among countries. Medical costs and other losses caused by fatal and non-fatal burn injuries differ considerably among demographic groups, care protocols, and country HDIs.

Association between intra-operative cardiac arrest and country Human Development Index status: a systematic review with meta-regression analysis and meta-analysis of observational studies.

Intra-operative cardiac arrests differ from most in-hospital cardiac arrests because they reflect not only the patient's condition but also the quality of surgery and anaesthesia care provided. We assessed the relationship between intra-operative cardiac arrest rates and country Human Development Index (HDI), and the changes occurring in these rates over time. We searched PubMed, EMBASE, Scopus, LILACS, Web of Science, CINAHL and SciELO from inception to 29 January 2020. For the global population, rates of intra-operative cardiac arrest and baseline ASA physical status were extracted. Intra-operative cardiac arrest rates were analysed by time, country HDI status and ASA physical status using meta-regression analysis. Proportional meta-analysis was performed to compare intra-operative cardiac arrest rates and ASA physical status in low- vs. high-HDI countries and in two time periods. Eighty-two studies from 25 countries with more than 29million anaesthetic procedures were included. Intra-operative cardiac arrest rates were inversely correlated with country HDI (p=0.0001); they decreased over time only in high-HDI countries (p=0.040) and increased with increasing ASA physical status (p<0.0001). Baseline ASA physical status did not change in high-HDI countries (p=0.106), while it decreased over time in low-HDI countries (p=0.040). In high-HDI countries, intra-operative cardiac arrest rates (per 10,000 anaesthetic procedures) decreased from 9.59 (95%CI 6.59-13.16) pre-1990 to 5.17 (95%CI 4.42-5.97) in 1990-2020 (p=0.013). During the same time periods, no improvement was observed in the intra-operative cardiac arrest rates in low-HDI countries (p=0.498). Odds ratios of intra-operative cardiac arrest rates in ASA 3-5 patients were 8.48 (95%CI 1.67-42.99) times higher in low-HDI countries than in high-HDI countries (p=0.0098). Intra-operative cardiac arrest rates are related to country-HDI and decreased over time only in high-HDI countries. The widening gap in these rates between low- and high-HDI countries needs to be addressed globally.

Responses to the Covid-19: A Political Economic Analysis

The Covid-19 pandemic posed serious threats to the national and international communities. Worldwide responses to combat its effects seemed weak and controversial. It led individual countries to exercise responses that varied depending upon their tradition, institutions, and leadership. What worked? And what did not? And why is still not comprehended. In this background, this study examines correlation between market economy frameworks such as liberal market economies (LMEs), coordinated market economies (CMEs), state-led market economies (SMEs)and Covid-19 caused deaths. More so, the death cases have been analyzed and interpreted based on published data from worldometer.com as well as national and institutional sources of 23 countries representing three distinct market economy frameworks. The data is juxtaposed with the acts of right-wing populism that determined decision making and institutional mobilization against Covid-19. The approach is dichotomized with a country's human development index and income inequality index (Gini Index). This study found that a country’s market economy framework has had a correlation with the Covid-19 caused deaths The impact, however, was associated with the acts of right-wing populism within different market economies. The 5 selected countries with LMEs have highest; another 5 selected countries with CMEs have higher and 13 selected countries with SMEs have lowest number of deaths. The findings also proves that rate of human development does not appear to be a valid framework for explaining differing death rates between the countries.

The Inequitable Global Burden of Lip and Oral Cancers: Widening Disparities Across Countries

In light of continued innovation in cancer immunotherapy regimens and surgical management, no studies currently exist assessing the effect of these advances on global disparities in lip and oral cavity cancer disease burden. The purpose of this study is to characterize longitudinal trends in disease burden caused by lip and oral cavity cancers globally. This retrospective, longitudinal cohort study extracted data on lip and oral cavity cancer disease burden from The Global Health Data Exchange for 1990-2017. The primary predictor variable was country human development index (HDI). The primary outcome variable was disease burden, measured by age-standardized disability-adjusted life years (DALYs) per 100,000 population, listed for each individual country. Additional variables assessed include country-level data on alcohol consumption and tobacco smoking. Concentration indices were also calculated. Mann-Whitney U and Kruskal-Wallis one-way analysis of variance tests with Bonferroni correction were utilized with a significance threshold of 0.008. A total of 185 countries met inclusion criteria. Global age-standardized DALYs increased from 44.5±35.7 to 51.1±41.1 from 1990 to 2017. High HDI and medium HDI countries showed a+37.6% and+22.4% median increase in DALYs, respectively, which is significantly greater than very-high HDI (+3.8%) and low HDI countries (-0.5%) (P<.001). The concentration index for lip and oral cavity cancer became increasingly negative from -0.064 to -0.077 from 1990 to 2015. In 2017, disease burden was concentrated in South Asia and Eastern Europe. High and medium HDI countries experienced a disproportionate growth in lip and oral cavity cancer disease burden. These findings may have resulted from increased life expectancy among these countries. Global and public health policy initiatives should focus on understanding the mechanisms driving these disparities with the goal of reducing disease burden globally.

Perioperative mortality in older patients: a systematic review with a meta-regression analysis and meta-analysis of observational studies

Study objectiveOlder patients have a higher probability of developing major complications during the perioperative period than other adult patients. Perioperative mortality depends on not only on a patient condition but also on the quality of perioperative care provided. We tested the hypothesis that the perioperative mortality rate among older patients has decreased over time and is related to a country's Human Development Index (HDI) status. DesignA systematic review with a meta-regression and meta-analysis of observational studies that reported perioperative mortality rates in patients aged ≥60 years was performed. We searched the PubMed, EMBASE, LILACS and SciELO databases from inception to December 30, 2019. SettingMortality rates up to the seventh postoperative day were evaluated. MeasurementsWe evaluated the quality of the included studies. Perioperative mortality rates were analysed by time, country HDI status and baseline American Society of Anesthesiologists (ASA) physical status using meta-regression. Perioperative mortality and ASA status were analysed in low- and high-HDI countries during two time periods using proportion meta-analysis. Main resultsWe included 25 studies, which reported 4,412,100 anaesthesia procedures and 3568 perioperative deaths from 12 countries. Perioperative mortality rates in high-HDI countries decreased over time (P = 0.042). When comparing pre-1990 to 1990–2019, in high-HDI countries, the perioperative mortality rates per 10,000 anaesthesia procedures decreased 7.8-fold from 100.85 (95% CI 43.36 to 181.72) in pre-1990 to 12.98 (95% CI 6.47 to 21.70) in 1990–2019 (P < 0.0001). There were no studies from low-HDI countries pre-1990. In the period from 1990 to 2019, perioperative mortality rates did not differ between low- and high-HDI countries (P = 0.395) but the limited number of patients in low-HDI countries impaired the result. Perioperative mortality rates increased with increasing ASA status (P < 0.0001). There were more ASA III-V patients in high-HDI countries than in low-HDI countries (P < 0.0001), and the perioperative mortality rate increased 24-fold in ASA III-V patients compared with ASA I-II patients (P < 0.0001). ConclusionThe perioperative mortality rates in older patients have declined over the past 60 years in high-DHI countries, highlighting that perioperative safety in this population is increasing in these countries. Since data prior to 1990 were lacking in low-HDI countries, the evolution of their mortality rates could not be analysed. The perioperative mortality rate was similar in low- and high-HDI countries in the post-1990 period, but the low number of patients in the low-HDI countries does not allow a definitive conclusion.

Global disparities in breast cancer outcomes: new perspectives, widening inequities, unanswered questions

Breast cancer is the most common neoplastic disease and leading cause of cancer mortality in women.1 Global estimates have recorded regional variations in the burden of breast cancer, but none have been disaggregated by menopausal status.1 In The Lancet Global Health, Emily Heer and colleagues2 contribute to the body of evidence on global disparities in outcomes, with particular reference to breast cancer incidence and survival by menopausal status and by a country's human development index (HDI).

The Impact of COVID-19 on Nigeria’s Human Development Trajectory

Human development has become a significant term since it was introduced in development discourse in the 1990s. It has remained a veritable term in discussing the living standards of any country. But human development is under threat by the novel corona virus. COVID-19 was detected in Wuhan, China at the end of 2019, but quickly spread across the world in the first quarter of 2020 causing unprecedented disruptions of varying proportions not seen since the 20th century. Using the constituents of human development, i.e. life expectancy, education and per capital, recognised by the United Nations Development Program, this paper brings to fore the disproportionate impacts of the pandemic on human development in Nigeria. This is largely because the human development index of countries in the sub-Saharan Africa is low, consequently, these countries are not able to withstand massive impact of a pandemic. It is hoped that the governments of developing countries such as Nigeria would seize the opportunity the pandemic presents and change strategies by bridging the gap of inequalities, improving the capabilities of its peoples, diminish poverty and increase the enablers that will improve the human development of its people.