Expectation Gap Research Articles

Government Audit Quality: Audit Expectation – Performance Gap

This paper seeks to explore the audit expectation and performance gap in the Indonesian government audit. This research utilized a qualitative approach involving three methods of data collection namely interviews, focus group discussions, and document analysis with a total of 32 government auditors of the Indonesian Supreme Audit Institution (BPK-RI). The data from all methods were analyzed through a qualitative thematic analysis framework. This research found that there are three types of occur in the context of Indonesian government audit quality namely deficient performance, deficient standards, and reasonableness gap.

Historical Redlining and Contemporary Racial Disparities in Neighborhood Life Expectancy

Abstract While evidence suggests a durable relationship between redlining and population health, we currently lack an empirical account of how this historical act of racialized violence produced contemporary inequities. In this paper, we use a mediation framework to evaluate how redlining grades influenced later life expectancy and the degree to which contemporary racial disparities in life expectancy between Black working-class neighborhoods and White professional-class neighborhoods can be explained by past Home Owners’ Loan Corporation (HOLC) mapping. Life expectancy gaps between differently graded tracts are driven by economic isolation and disparate property valuation which developed within these areas in subsequent decades. Still, only a small percent of a total disparity between contemporary Black and White neighborhoods is explained by HOLC grades. We discuss the role of HOLC maps in analyses of structural racism and health, positioning them as only one feature of a larger public–private project conflating race with financial risk. Policy implications include not only targeting resources to formerly redlined neighborhoods but also the larger project of dismantling racist theories of value that are deeply embedded in the political economy of place.

Transforming Perceptions: The Development of Pre-pack Regulations in England and Wales.

The article systematically assesses the extent to which the Administration (Restrictions on Disposal etc. to Connected Persons) Regulations 2021 achieve the goal of the government to quell the negative perceptions of pre-pack administration. The pre-pack has generated much criticism from disenfranchised groups who regard the practice with much suspicion. These criticisms have triggered questions as to whether and how to structure the regulation of pre-packs. The article introduces original frames through which to distinguish the competing regulatory visions of the pre-pack, as well as to systematically evaluate the regulatory frameworks that have been introduced. The evaluation reveals a gap between the regulatory visions of the critics and the regulator. This gap has impacted the reception and effectiveness of successive regulatory frameworks. Combining its frames with the expectation gap theory, the article offers a critical assessment of the 2021 reforms, which address most but not all the criticisms of the pre-pack.

Simulation via Instant Messaging - Birmingham Advance helps to narrow the gap of knowledge and expectations between clinicians and women with polycystic ovary syndrome: A SIMBA-PCOS mixed-method study

Simulation via Instant Messaging - Birmingham Advance helps to narrow the gap of knowledge and expectations between clinicians and women with polycystic ovary syndrome: A SIMBA-PCOS mixed-method study

Complaint Management Performed at X Public Hospital in Indonesia

Health consumers or patients become aware of their health literacy by obtaining, processing, understanding, and communicating health-related information when they come to health decisions. However, background knowledge obtained would set patients' expectations and satisfaction, and the expression of patients' expectation gap that creates dissatisfaction or concern with a service provided is called complaint. This present study aimed to obtain a comprehensive understanding about the role and activities of public relations on patient complaint management at X public hospital in Indonesia. This research applied a qualitative method using the purposive sampling technique. The research finding showed that the informants at the hospital lacked communication and public relations knowledge, and no training was given to the staff involved in communication matters. This absence of an academic foundation to guide the work directly affects the professionalism of the public relations manager, especially during managing complaints and making policies. As a result, the public relations department of the hospital did not have a direct channel for the patients to register their complaints, and the only indirect patient complaint facility aimed at the public relations was not managed by the public relations department. In short, this study shows that the public relations manager did not have a management role on the complaint management at the hospital, which consequently brings a snowball effect to the overall management of complaints due to the practices of encroachment, and the hospital must provide more training and professional coaching to bring back the role and functions of public relations.

Lessons from project-scale reducing emissions from deforestation and forest degradation: A case study in northern Lao People’s Democratic Republic

The reducing emissions from deforestation and forest degradation (REDD+) framework has been implemented over the past decade, and has led to a restructuring of forest governance systems in host countries. In the case of Lao People’s Democratic Republic, which is promoting REDD+, activities have been implemented at project, sub-national, and national scales. Project-scale REDD+ is assumed to be compatible with small-scale forestry, and usually targets local people to enhance participatory forest management through technology transfer. Such projects were also supported by foreign governments under bilateral cooperation or by private funding. In the case of sub-national- or national-scale REDD+, the Lao People’s Democratic Republic government aims to develop a system of forest monitoring, as well as related structures required by international REDD+ entities. These activities are supported by substantial funding from multilateral organizations. Lessons learned from project-scale REDD+ in northern Lao People’s Democratic Republic showed a gap in expectations among different donors and recipients regarding how to implement REDD+, in particular how to reduce dependency on forest resources in rural areas, and how to estimate and account for greenhouse gas emissions reductions with consistent methodologies at different scales. Such differences are related to the attitudes of local people toward participation, and those of the private entities that fund projects and ground-based activities. In future REDD+ schemes, the structural network or structural social capital among project-, sub- national-, and national-scale activities should be reconsidered to enhance the continued participation of stakeholders and make use of their accumulated experience and knowledge of small-scale forestry management.

Future parenting aspirations and minority stress in U.S. sexual minority adults.

Parenthood is an aspiration shared by a majority of U.S. adults. However, previous research has found that sexual minority adults (e.g., lesbian, gay, bisexual [LGB]) are less likely than heterosexual counterparts to be parents or desire to become parents in the future. To date, few studies have examined how minority stress (i.e., everyday discrimination [ED], felt stigma [FS], and internalized homophobia [IH]) influences parenting desire, parenting likelihood, and expectation a gap between the two. Even fewer studies have examined the parenting aspirations of sexual minority individuals following nationwide legalization of same-sex marriage in the United States. We analyzed data from 487 childfree lesbian, gay, bisexual, and queer participants from two cohorts ("equality cohort": ages 18-25; "visibility" cohort: ages 34-41) from the Generations study, a national probability sample of sexual minority adults in the United States. As expected, we found that the visibility cohort adults had significantly lower parenting desire and parenting likelihood, and a greater parenting expectation gap than the equality cohort adults. Additionally, while everyday discrimination (ED) did not predict parenting aspirations, IH and FS predicted higher parenting desire and lower parenting likelihood, respectively. We found a cohort by FS interaction such that FS predicted even lower parenting likelihood in the visibility cohort adults. Our findings contribute to a growing body of research on sexual minority parenthood and may inform community practice and clinical support for sexual minority adults who pursue parenthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study

Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20-100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005-19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6-17·0) for Scottish women to 59·6% (58·5-60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017-18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2-59·3) for men and 64·1 years (64·0-64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013-14 in Lithuania (43·7 years [42·7-44·6]) for men and in 2010-11 in Latvia (54·2 years [53·4-54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010-11 to 2015-16 and in the USA from 2009-10 to 2014-15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015-16) to 12·9 years (Israel Clalit Health Services; 2015-16) for 20-year-old men and from 3·1 years (Finland; 2011-12) to 11·2 years (Israel Clalit Health Services; 2010-11 and 2015-16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009-10 and 2014-15 for 20-year-old men (a decrease of 2·7 years). Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. US Centers for Disease Control and Prevention and Diabetes Australia.

Association of socioeconomic deprivation with life expectancy and all-cause mortality in Spain, 2011–2013

Life tables summarise a population’s mortality experience during a time period. Sex- and age-specific life tables are needed to compute various cancer survival measures. However, mortality rates vary according to socioeconomic status. We present sex- and age-specific life tables based on socioeconomic status at the census tract level in Spain during 2011–2013 that will allow estimating cancer relative survival estimates and life expectancy measures by socioeconomic status. Population and mortality data were obtained from the Spanish Statistical Office. Socioeconomic level was measured using the Spanish Deprivation Index by census tract. We produced sex- and age-specific life expectancies at birth by quintiles of deprivation, and life tables by census tract and province. Life expectancy at birth was higher among women than among men. Women and men in the most deprived census tracts in Spain lived 3.2 and 3.8 years less than their counterparts in the least deprived areas. A higher life expectancy in the northern regions of Spain was discovered. Life expectancy was higher in provincial capitals than in rural areas. We found a significant life expectancy gap and geographical variation by sex and socioeconomic status in Spain. The gap was more pronounced among men than among women. Understanding the association between life expectancy and socioeconomic status could help in developing appropriate public health programs. Furthermore, the life tables we produced are needed to estimate cancer specific survival measures by socioeconomic status. Therefore, they are important for cancer control in Spain.

Gaps in expectations and current practices of pharmacy services among doctors and patients – an exploratory study in a Sri Lankan tertiary care hospital providing free healthcare

The pharmacist is an important link between doctor and patient. To optimise patient care, it is essential that expectations of doctors and patients regarding pharmacy services are met. Hence the objective of this study was to assess the satisfaction levels of doctors and patients on pharmacy services currently provided, and their expectations from pharmacy services. This cross sectional study was conducted in selected clinics of a university based teaching hospital. Questionnaires developed in-house by referring previously published resources, content validated by a group of experts, and face validated through a pilot study were used. Doctors and patients of chronic disease clinics were selected for the study. All doctors involved in prescribing for more than six months, and patients or their regular care givers attending clinics for more than one year were included. Mentally incapacitated patients were excluded. An interviewee administered questionnaire was distributed to doctors and an interviewer administered questionnaire was used for patients. Exploratory factor analysis (EFA) (principal component analysis with Varimax rotation) was conducted to divide variables of the questionnaires into reliable components. Response rate of doctors was 82.3%. Among them 59.6% (50/84) doctors said that they have a good relationship with pharmacists, and 89.3% (75/84) expected communication with pharmacists more often. EFA for doctors’ perceptions resulted in four components. A statistically significant difference was observed between doctors’ expectation (95.9% - 81/84) and current practice (22.6% - 19/84) on communicating medication issues (p<0.001). A total of 380 patients participated. EFA for patients’ perceptions resulted in ten components. The majority considered pharmacists as an integral part of the healthcare system (98.7% - 375/380) and experts in medication (84.7% - 322/380). They further perceived that dispensed medications are safe (82.9% - 315/380) and of good quality (76.3% - 290/380). Further 95.5% (363/380) were satisfied with dispensing label information. A statistically significant difference was found between the expectations (93% - 353/380) and satisfaction levels (86.5% - 329/380) of patients on pharmacy services (p=0.003). According to findings, both doctors and patients held a positive perception on pharmacy services and pharmacists, but the statistically significant gap reported between expectations and current level of pharmacy service, highlighting both the potential and scope for service improvement.

Impacts of family environment on adolescents' academic achievement: The role of peer interaction quality and educational expectation gap.

The current study uses a two-wave longitudinal survey to explores the influence mechanism of the family environment on adolescents’ academic achievement. The family environment is measured by parents and children’s reports, including family atmosphere, parent–child interaction, and family rules, to reveal the mediating effect of adolescents’ positive or negative peers between the family environment and academic achievement, and whether the gap between self- and parental educational expectation plays a moderating effect. This study uses the data of the China Education Panel Study (CEPS); the survey samples include 9,449 eighth-grade students (Mage = 13.55 years, SD = 0.70), establishing a multilevel moderated mediating effect model. The results showed (1) the family environment and peer interaction quality can positively predict adolescents’ academic achievement. (2) Using the KHB test, peer interaction quality plays a partial mediating role in the process of family environment positively affecting academic achievement, and the mediating ratio is 27.5%. (3) The educational expectation gap moderates the effect of the family environment on academic achievement and also on peer interaction quality. Therefore, from the perspective of environment and important others, to correctly grasp the academic achievement of junior high school students in the process of socialization, it is necessary to recognize that the family environment, peer interaction quality, and educational expectation gap play an important role.

Changing the research paradigm for digital transformation in healthcare delivery.

The growing focus on healthcare transformation (i.e., new healthcare delivery models) raises interesting issues related to research design, methodology, and funding. More than 20 years have passed since the Institute of Medicine first called for the transition to digital health with a focus on system-wide change. Yet progress in healthcare delivery system change has been painfully slow. A knowledge gap exists; research has been inadequate and critical information is lacking. Despite calls by the National Academies of Science, Engineering, and Medicine for convergent, team-based transdisciplinary research with societal impact, the preponderance of healthcare research and funding continues to support more traditional siloed discipline research approaches. The lack of impact on healthcare delivery suggests that it is time to step back and consider differences between traditional science research methods and the realities of research in the domain of transformational change. The proposed new concepts in research design, methodologies, and funding are a needed step to advance the science. The Introduction looks at the growing gap in expectations for transdisciplinary convergent research and prevalent practices in research design, methodologies, and funding. The second section summarizes current expectations and drivers related to digital health transformation and the complex system problem of healthcare fragmentation. The third section then discusses strengths and weaknesses of current research and practice with the goal of identifying gaps. The fourth section introduces the emerging science of healthcare delivery and associated research methodologies with a focus on closing the gaps between research and translation at the frontlines. The final section concludes by proposing new transformational science research methodologies and offers evidence that suggests how and why they better align with the aims of digital transformation in healthcare delivery and could significantly accelerate progress in achieving them. It includes a discussion of challenges related to grant funding for non-traditional research design and methods. The findings have implications broadly beyond healthcare to any research that seeks to achieve high societal impact.

The Reality of the Audit Expectations Gap in Saudi Banks: The Mediating Effect on the Relationship between Loan Decisions Performance and Individual Factors

This research work investigated the impact of individual factors such as the knowledge and experience of Saudi bank employees on the Audit Expectation Gap (AEG) and inquires if the gap can mediate the relationship between individual criteria and loan decision performance.

Whether the audit expectation-performance gap is expanding amid changes in audit landscape? New evidence from an emerging economy

PurposeThe purpose of this study is to provide fresh insights into whether there is an expectation gap between external auditors' and other stakeholders' perceptions of external auditors' responsibilities in an emerging economy, in light of recent changes to the global audit landscape.Design/methodology/approachA quantitative approach in the positivistic paradigm was adopted, and a structured questionnaire was used to gather data.FindingsThe findings suggested that there was a statistically significant discrepancy between external auditors' and social groups' perceptions of the responsibilities of external auditors. More than half of the gap was due to deficiency in standards, 19% due to unreasonable expectations by society, while 25% of the gap was found to be due to deficient performance.Research limitations/implicationsThe study focused on the duties of external auditors and not on the duties of other types of auditors while examining the audit expectation-performance gap (AEG), and this was due to the drastic differences in the scope of their duties.Practical implicationsThe findings of this study are likely to have direct policy implications for regulators, authorities, educators and auditing professionals, who should take immediate actions and measures to reduce the AEG in light of the current global audit landscape advancements and changes.Originality/valueThe present study used a substantially updated model to measure the AEG to suit the contemporary changes in the auditing landscape, and could be considered as a pioneering study that measures the AEG in an emerging economy amid recent changes.

Does audit firm tenure enhance firm value? Closing the expectation gap through corporate social responsibility

PurposeThis study aims to examine the moderating effect of audit firm tenure on the association between corporate social responsibility (CSR) and firm value. Prior studies provide mixed results on this association, which may be due to differing theoretical expectations related to CSR and firm value. It is also possible that external stakeholders are unable to differentiate between positive and negative CSR investments, as CSR reports are generally not assured by independent third parties. Thus, the authors propose that audit firm tenure may be used by external stakeholders to evaluate CSR performance.Design/methodology/approachThe authors use an ordinary least squares regression to examine the moderating effect of audit firm tenure on the relation between CSR and firm value after controlling for other determinants of firm value and various internal and external governance mechanisms documented in the literature. The sample consists of 15,707 firm-year observations from US firms during the sample period of 2000 to 2012. The authors measure CSR quality using rating scores from MSCI ESG STATS (formerly the KLD database), audit firm tenure as the number of years the incumbent auditor has served the client and firm value using Tobin’s Q.FindingsThe results indicate that CSR is positively associated with firm value when audit firm tenure is long but not when tenure is short. The results are robust to alternative measures of firm value, CSR performance scores, and individual CSR dimensions. The evidence supports the argument against mandatory audit firm rotation in the USA.Research limitations/implicationsFuture studies could examine a similar issue in alternative settings and/or look at cross-sectional variations among firms on the association between CSR and firm value by other auditor traits such as auditor industry specialization and big-name reputation. Additionally, as auditor alone is unable to ensure the quality of management disclosures and their accountability, future studies could examine the moderating effect of internal and other external governance mechanisms on the association between CSR and firm value, exploring when the signaling effect of auditor tenure on CSR reporting quality and its effect on firm value is most salient.Practical implicationsThe findings are important to regulators and investors. The authors provide evidence that longer audit tenure serves as a signaling device for external investors with regard to the quality of a firm’s CSR performance. Hence, the study facilitates regulators’ cost-benefit analysis related to mandating audit firm rotation. The evidence suggests that mandating a term limit on auditor tenure may have the unintended consequence of eliminating a signaling effect of auditor tenure on the quality of CSR disclosures under information asymmetry. This supports the Public Company Oversight Board’s decision to forgo the requirement of mandatory audit firm rotation in the USA.Originality/valuePrior literature presents mixed findings on the association between CSR performance and firm value based on a variety of underlying theories (economic, stakeholder and contingency theory). Literature on mandatory auditor rotation has concentrated on the auditor tenure effect on perceived and actual audit quality as reflected in earnings quality. Relying on agency theory, this study posits that auditor tenure serves as a signal for the quality of CSR activities in the absence of CSR assurance reporting as CSR quality can be difficult to evaluate. The authors provide evidence that audit tenure moderates the association between CSR activities and firm value and longer audit tenure makes it more likely that the CSR activities are associated with increased firm value.

We are all aging, and here's why.

Here, through this review, we aim to serve this purpose by first discussing the statistics and aging demographics, including the life expectancy of the world and India, along with the gender life expectancy gap observed throughout the world, followed by explaining the hallmarks and integral causes of aging, along with the role played by senescent cells in controlling inflammation and the effect of senescence associated secretory phenotype on longevity. A few of the molecular pathways which are crucial in modulating the process of aging, such as the nutrient‐sensing mTOR pathway, insulin signaling, Nrf2, FOXO, PI3‐Akt, Sirtuins, and AMPK, and their effects are also covered in paramount detail. A diverse number of ingenious research methodologies are used in the modern era of longevity exploration. We have attempted to cover these methods under the umbrella of three broad categories: in vitro, in vivo, and in silico techniques. The drugs developed to attenuate the aging process, such as rapamycin, metformin, resveratrol, etc. and their interactions with the above‐mentioned molecular pathways along with their toxicity have also been reviewed in detail.

Considerations for bridging the Audit Expectation Gap: A Desk Review

The difference between what the general public and users of financial information believe auditors are responsible for and what auditors actually believe their obligations are is known as the expectation gap. This study aims to identify the nature of the audit expectation gap and suggest ways to close it. This will include a focus on how technology can be deployed to address similar concerns. The study proposed a set of criteria that might be utilized to close the expectation gap between user needs and expectations and audit expectations, including society knowledge, audit report length, audit independence, auditor efforts, and auditor abilities. The study came to the further conclusion that technology is crucial for closing both the performance and reasonableness gaps.

Audit Evidence Gathering and Audit Quality Theory: Implications for Auditors' Opinion during COVID-19 Era

Audit Evidence gathering has a direct effect on the quality of audit reports through the expression of audit opinions by audit firms. De–Angel (1981) believes that the bigger the audit firm, the more the capacity to deploy advanced technology, infrastructure, and qualified human resources in carrying out audit services and the higher the audit quality. This paper explored the effects of audit evidence gathering during the COVID-19 pandemic on audit opinion and audit quality due to changes in work patterns by audit firms in carrying out audit assignments remotely. This paper used a purposive sampling technique with the use of a questionnaire by administering 276 practicing accountants in Lagos who are experienced in audit evidence gathering and know how the COVID-19 pandemic has affected the quality of audits and expression of opinion. The study found out from the inferential statistics Adjusted R Square showed enough evidence against the Null Hypothesis and concluded that audit evidence-gathering techniques have a significant positive effect on qualifying audit opinions, Non-qualifying audit opinions, Disclaimers audit opinions, and Stakeholders' expectation gap. The study also found the scarcity of literature in this area due to the recency of the issue, and further research is recommended to be extensively done in the future.

Implementing the Readiness of Key Audit Matters at Division X KAP ABC

Users of financial statements may have higher expectations due to audit reports, which are thought to be of no informational value. Including essential information in the audit report will decide how it can be used because the "expectations gap"—the difference between what users expect and what the auditing profession believes—has risen dramatically over time. This study aims to analyze the readiness to implement Audit Standard SA 701 Key Audit Matters (KAM) at Division X KAP ABC (an Indonesian audit firm) and the auditors' understanding of KAM, including potential doubts regarding the classification of KAMs with other reporting standards such as SA 706 Emphasis of Matter and SA 570 Going Concern. The method of collecting data was through a questionnaire and semi-structured interviews with external auditors in charge at Division X KAP ABC. The questionnaire statements are taken from previous research of Hegazy and Kamareldawla based on paragraphs SA 701, SA 706, and SA 570, which consist of 26 statements. The analysis results conclude that the auditors understand the explanation of SA 701. However, there is potential for doubt in classifying a matter as the Emphasis of a Matter and Going Concern. Concerning the implementation readiness of KAM SA 701 in 2022, Division X KAP ABC has communicated and interacted more with its clients and conducted training and sharing sessions.

Immune restoration affects 10-year survival in people living with HIV/AIDS.

In recent years, a reduction in the life expectancy gap between people living with HIV (PLWH) and the general population has been observed, irrespective of CD4 lymphocyte count, due to widespread access to antiretroviral treatment. The increase in the life expectancy of PLWH has increased awareness of both the ageing process and gender discrepancies in immune restoration and survival. Longitudinal data were collected for 2240 patients followed up at the Hospital for Infectious Diseases in Warsaw, Poland (n=1482), and the Department of Acquired Immunodeficiency, Pomeranian Medical University, Szczecin, Poland (n=758). Immune restoration was measured from the time of starting combination antiretroviral therapy until achieving 500 CD4 lymphocytes/μL, 800 CD4 lymphocytes/μL, and CD4/CD8 lymphocyte ratios of > 0.8 and > 1.0. Full recovery was achieved when the patient was restored to both 800 CD4 lymphocytes/μL and a CD4/CD8 lymphocyte ratio > 1.0. For all endpoints, immune restoration had a protective effect by reducing mortality. Patients who achieved immune restoration had a greater chance of reduced mortality than those who did not achieve immune restoration: for CD4 count > 500 cells/μL, HR=5.4 (interquartile range: 3.09-9.41), p < 0.001; for CD4 > 800 cells/μL, HR=5.37 (2.52-11.43), p < 0.001; for CD4/CD8 ratio > 0.8, HR=3.16 (1.81-5.51), p < 0.001; for CD4/CD8 ratio > 1.0, HR=2.67 (1.49-5.24), p=0.001, and for full immune recovery, HR=3.62 (1.63-8.04), p=0.002. Immune restoration remains a powerful factor in improving the survival of PLWH, regardless of the speed of recovery.