High Human Development Index Research Articles

Thyroid Cancer: Global Burden and Trends.

The incidence of thyroid cancer continues to increase, representing the 5th most common cancer type in the USA today (Sherman, Lancet 361(9356):501-11, 2003). The current study sought to analyze the global burden of thyroid cancer utilizing the publicly accessible GLOBOCAN database. An estimated 586,202 cases of thyroid cancer were reported in 2020, making thyroid cancer the 10th most common cancer worldwide. The majority of thyroid cancer cases occurred in countries with a high or very high Human Development Index (HDI), accounting for 91% of new cases. With respect to the World Health Organization (WHO) regions, the Western Pacific had the highest incidence of thyroid cancer accounting for 47.6% of cases despite representing only 25.4% of the world's population. Thyroid cancer incidence and mortality are expected to increase by 29.9% and 67%, respectively, by the year 2040. The African region is projected to experience the highest increase in both incidence (84.3%) and mortality (100.3%) over this time period. The results of our study demonstrate that the incidence and mortality of thyroid cancer vary by the geographic location and socio-economic status. Although the incidence was noted to be the highest in very high HDI countries and the Western Pacific region, mortality was noted to be disproportionately higher in the low HDI countries and African region. This may be due to discrepancies in access to care and/or environmental exposures such as ionizing radiation and iodine deficiency. Further measures are required to improve the outcomes from thyroid cancer regardless of the geographic location or socio-economic status.

1511P The demographics of cancer care in a developing country: ten years’ experience from an academic university hospital in India

Developing countries make up four-fifths of the world’s population and more than 90% of the worldwide disease burden. The demographics of cancer in developing countries are different from those with a high or very high human development index (HDI).

Social segregation and lethal police violence in the city of São Paulo, Brazil (2014-2015).

We aimed to investigate how lethal police violence (LPV) in the City of São Paulo (CSP), Brazil, is associated with socioeconomic development when we consider the victims' place of residence and the locations of the fatal injuries. The spatial distribution of lethal police violence rate (LPVR) and its association with the human development index (HDI) was investigated using the Moran's I (Global and Bivariate Local). Between 2014 and 2015 we found 403 police victims in the Health database and 794 victims in the Security Department. We found a non-random spatial distribution of the LPV considering the victim's place of residence (I=+0.12; p<0.001) and the locations where the fatal injuries were inflicted (I=+0.07; p<0.001). We found a negative association between LPVR and the HDI of the place of residence (I=-0.10; p<0.001) and a positive association between LPVR and the HDI of the locations of the fatal injuries (I=+0.02; p<0.001). The results point to different dynamics of LPV in CSP. High mortality clusters are found in areas with lower HDI, when considering the victim's address, and in areas with higher HDI, when considering the address of the violent events. LPV impacts young blacks, poorly educated residents of outskirts informing us about patterns of social segregation.

Modeling global transfusion medicine education.

Modeling global transfusion medicine education.

Evaluation of Dietary Patterns and All-Cause Mortality

The 2020 Dietary Guidelines Advisory Committee conducted a systematic review of existing research on diet and health to inform the current Dietary Guidelines for Americans. The committee answered this public health question: what is the association between dietary patterns consumed and all-cause mortality (ACM)? To ascertain the association between dietary patterns consumed and ACM. Guided by an analytical framework and predefined inclusion and exclusion criteria developed by the committee, the US Department of Agriculture's Nutrition Evidence Systematic Review (NESR) team searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase and dual-screened the results to identify articles that were published between January 1, 2000, and October 4, 2019. These studies evaluated dietary patterns and ACM in participants aged 2 years and older. The NESR team extracted data from and assessed risk of bias in included studies. Committee members synthesized the evidence, developed conclusion statements, and graded the strength of the evidence supporting the conclusion statements. A total of 1 randomized clinical trial and 152 observational studies were included in the review. Studies enrolled adults and older adults (aged 17-84 years at baseline) from 28 countries with high or very high Human Development Index; 53 studies originated from the US. Most studies were well designed, used rigorous methods, and had low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the body of evidence. Results across studies were highly consistent. Evidence suggested that dietary patterns in adults and older adults that involved higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) were associated with a decreased risk of ACM. These healthy patterns were also relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Some of these dietary patterns also included intake of alcoholic beverages in moderation. Results based on additional analyses with confounding factors generally confirmed the robustness of main findings. In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes.

A global country-level analysis of the relationship between obesity and COVID-19 cases and mortality.

AimTo assess the association of country‐level obesity prevalence with COVID‐19 case and mortality rates, to evaluate the impact of obesity prevalence on worldwide variation.MethodsData on COVID‐19 prevalence and mortality, country‐specific governmental actions, socioeconomic, demographic, and healthcare capacity factors were extracted from publicly available sources. Multivariable negative binomial regression was used to assess the independent association of obesity with COVID‐19 case and mortality rates.ResultsAcross 168 countries for which data were available, higher obesity prevalence was associated with increased COVID‐19 mortality and prevalence rates. For every 1% increase in obesity prevalence, the mortality rate was increased by 8.3% (incidence rate ratio [IRR] 1.083, 95% confidence interval [CI] 1.048‐1.119; P < 0.001) and the case rate was higher by 6.6% (IRR 1.066, 95% CI 1.035‐1.099; P < 0.001). Additionally, higher median population age, greater female ratio, higher Human Development Index (HDI), lower population density, and lower hospital bed availability were all significantly associated with higher COVID‐19 mortality rate. In addition, stricter governmental actions, higher HDI and lower mean annual temperature were significantly associated with higher COVID‐19 case rate.ConclusionThese findings demonstrate that obesity prevalence is a significant and potentially modifiable risk factor of increased COVID‐19 national caseload and mortality. Future research to study whether weight loss improves COVID‐19 outcomes is urgently required.

Influence of the Human Development Index on the Maternal-Perinatal Morbidity and Mortality of Pregnant Women with SARS-CoV-2 Infection: Importance for Personalized Medical Care.

Coronavirus disease-19 (COVID-19) is perhaps the most worrisome pandemic in the 21st century, having entailed devastating consequences for the whole society during the last year. Different studies have displayed an existing association between pregnancy and COVID-19 severity due to the various physiological changes that occur during gestation. Recent data identified maternal country of origin as an important determinant of COVID-19 presentation in pregnant women. However, the explanation of this fact remains to be fully elucidated. Therefore, the purpose of this work is to analyze the possible relationship between Human Development Index (HDI) of maternal country of origin with the morbimortality of pregnant women and their newborns. Here, we conducted a multicentric, ambispective, observational case-control study (1:1 ratio) and compare with the HDI of each country (group 1—very high HDI, group 2—high HDI, group 3—medium HDI, and group 4—low HDI). In total, 1347 pregnant women with confirmed SARV-CoV-2 infection (cases) were enrolled, and each was paired with one control to give a total number of 2694 participants from 81 tertiary care centers. Among the women with SARS-CoV-2 infection, more cases were produced of perinatal mortality, overall maternal morbidity, COVID-19 maternal morbidity, C-sections, hypertensive maternal morbidity, and perinatal morbidity. Our results described an inverse association between HDI and maternofetal morbidity and mortality. Moreover, the countries with an HDI lower than 1 showed higher rates of patients with maternal COVID-19-related morbidity (6.0% vs. 2.4%, p < 0.001), a need for oxygen therapy (4.7% vs. 1.8%, p < 0.001), and maternal ICU admission (2.6% vs. 1.0%, p = 0.007). Compared to other risk factors such as overweight, obesity, preexisting and obstetric comorbidities, HDI emerged as an independent risk factor explaining much of the increased maternal–perinatal morbidity and mortality detected in our group of cases. Further research is needed to establish to confirm the real impact of this factor and its components on pregnancy outcomes.

Improvement in the Mortality-to-Incidence Ratios for Gastric Cancer in Developed Countries With High Health Expenditures.

The mortality-to-incidence ratio (MIR) is widely used to evaluate the efficacy of cancer management outcomes for individual countries. However, the association among health care expenditure, human development index (HDI), and changes in MIR over time (δMIR) remains unknown. We aimed to elucidate the significance between these indicators and gastric cancer outcomes in different countries. Among the regions, Asia had the highest number of new gastric cancer cases, gastric cancer-related deaths, age-standardized ratio of incidence, and mortality. Chile had the highest age-standardized ratio (ASR) for gastric cancer incidence and the highest ASR for mortality. Moreover, MIR was highest in Africa (0.91) and lowest in North America (0.43). Of note, MIR was negatively associated with HDI, current health expenditure (CHE) per capita, and CHE/GDP % and δMIR was positively associated with CHE/GDP % in countries with very high HDI. However, δMIR showed no significant associations with these indicators in the countries analyzed. In conclusion, increased HDI, CHE per capita, and CHE/GDP are associated with improved gastric cancer outcomes. In addition, the δMIR could be an indicator that can be used to evaluate the improvement in cancer management outcomes over time.

Telework, Hybrid Work and the United Nation’s Sustainable Development Goals: Towards Policy Coherence

With increased participation in telework expected to continue, in the aftermath of COVID, it will be important to consider what long-term impact this practice could have on sustainability outcomes. This paper describes a scoping review and identifies connections between telework and sustainability outcomes from previous academic studies. These connections were categorised, and are discussed, based on their contributions to different United Nations Sustainable Development Goals. Most research was found to focus on countries classified as having a very high human development index status. The SWOT matrix technique was used to illustrate the strengths and weaknesses identified in the existing literature, and the threats and opportunities for future work. This aims to ensure policy coherence so that strategies to promote one outcome, such as economic productivity improvements, do not undermine another, such as improved health. Practical implications and research opportunities were identified across a range of SDG impact areas, including good health and well-being, gender equality, reduced inequality, climate mitigation, sustainable cities, and resilient communities. Overall, our impression is that increased rates of telework present an important opportunity to improve sustainability outcomes. However, it will be important that integrated and holistic policy is developed that mitigates key risks.

Does water fluoridation influence ethnic inequalities in caries in Brazilian children and adolescents?

This study aimed to investigate the influence of community water fluoridation on ethnic inequalities in untreated dental caries among children and adolescents in Brazil while taking the human development context into account. Data from a nationwide Brazilian epidemiological population oral health survey were used (SB Brazil 2010). Outcomes were caries prevalence measured by the proportion of individuals with one or more untreated decayed teeth and caries severity defined by the mean number of untreated decayed teeth (DT). Three different contexts were considered: 1-cities with no water fluoridation; 2-cities with water fluoridation and low Human Development Index (HDI); and 3-cities with water fluoridation and high HDI. The exposure was ethnic/racial group (White, Pardo, Black) and covariates were age, sex and household income. Multilevel logistic and negative binomial regressions were performed with 6696 children (aged 5years) and 11585 adolescents (aged 12 and 15-19years). For both children and adolescents, ethnic differences in caries prevalence and mean DT were found in the nonfluoridated cities with low HDI and also in cities with high HDI, most of which were fluoridated. For example in nonfluoridated cities with low HDI, 5-year-old Pardo children were more likely to have untreated decay (OR=1.22; 95% CI: 1.02, 1.46) and had more decayed teeth (RR=1.18; 95% CI: 1.04, 1.34) than their White counterparts after adjusting for sex and household income. No statistically significant differences were observed in fluoridated cities with low HDI. Water fluoridation appears to be associated with reduced ethnic inequalities in dental caries prevalence and mean DT among children and adolescents in more disadvantaged settings.

Management of glioblastoma: a perspective from Lithuania.

Lithuania is one the three Baltic states surrounded by Latvia, Belarus, Poland and Russia. Since 1940 Lithuania was occupied by the Soviet Union but declared its independence in 1991, and since 2004 is a member of the European Union (EU) (1). The population of Lithuania is 2,789,533, however this is a significant decline from 3,704,134 in 1991 (2). Lithuania belongs to a group of countries with a very high human development index (3). It is a high-income country with mean GDP per capita of $34,596 that is estimated to continue to grow (4). The major sociodemographic challenges of present-day Lithuania include fast-declining population, regional disparities and aging population that may subsequentially incur increasing strains on healthcare system resources (5).

Inverse correlates of COVID-19 mortality across European countries during the first versus subsequent waves

The objectives of the study were to calculate the standardised mortality rates (SMRs) for COVID-19 in European Union/European Economic Area countries plus the UK and Switzerland and to evaluate the...

Proposal and Test of an Assessment Method for Municipal Solid Waste Management Systems

This paper proposed a methodology for the quality assessment of a municipal solid waste management system to help the decision-making process and improve the services and the system itself. This method considers four dimensions (strategy, collection and transportation, sorting and treatment, final disposal), with 202 analysis items based on information to be obtained mainly in loco and to be transformed in one single quality index, from 0 to 1. First, this method was applied in 20 cities of Brazil and the municipality that showed the lowest index, 0.07, also presented the lowest Gross Domestic Product (GDP) per capita, second-lowest population, and the third lower Human Development Index (HDI). The city with the highest indicator (0.53) presented the larger population, the highest GDP per capita, and the highest HDI. Later, one municipality used the methodology for five years, which helped the administrators make decisions that made the index improve from an initial value of 0.24 to 0.55 after five years. The proposed evaluation model proved to be efficient in diagnosing and to help the decision-makers, aiming for the improvement of a solid waste management index after the improvement of the related services for the population.

Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis.

Cancer is the third leading cause of mortality in the world, and cancer patients are more exposed to financial hardship than other diseases. This paper aimed to review studies of catastrophic healthcare expenditure (CHE) in cancer patients, measure their level of exposure to CHE, and identify factors associated with incidence of CHE. This study is a systematic review and meta-analysis. Several databases were searched until February 2020, including MEDLINE, Web of Science, Scopus, ProQuest, ScienceDirect and EMBASE. The results of selected studies were extracted and analyzed using a random effects model. In addition, determinants of CHE were identified. Among the 19 studies included, an average of 43.3% (95% CI 36.7-50.1) of cancer patients incurred CHE. CHE varied substantially depending on the Human Development Index (HDI) of the country in which a study was conducted. In countries with the highest HDI, 23.4% of cancer patients incurred CHE compared with 67.9% in countries with the lowest HDI. Key factors associated with incidence of CHE at the household level included household income, gender of the household head, and at the patient level included the type of health insurance, education level of the patient, type of cancer and treatment, quality of life, age and sex. The proportion of cancer patients that incur CHE is very high, especially in countries with lower HDI. The results from this review can help inform policy makers to develop fairer and more sustainable health financing mechanisms, addressing the factors associated with CHE in cancer patients.

The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran

BackgroundDental healthcare is the costliest and single most source of the financial barrier to seeking and use of needed healthcare. Hence, this study aims to analyses impact of out-of-pocket (OOP) payments for dental services on prevalence catastrophic healthcare expenditure (CHE) among Iranian households during 2018.MethodsWe performed a cross-sectional analysis to determine the prevalence rate of CHE due to use of dental healthcare services among 38,858 Iranian households using the 2018 Household Income and Expenditure Survey (HIES) survey data of Iran. The WHO approach was used to determine the CHE due to use of dental care services at the 40% of household capacity to pay (CTP). Multiple logistic regression models were used to obtain the odds of facing with CHE among households that paid for any dental healthcare services over the last month while adjusting for covariates included in the model. These findings were reported for urban, rural areas and also for low, middle and high human development index HDI across provinces.ResultsThe study indicated that the prevalence of CHE among households that used and did not used dental services over the last month was 16.5% (95% CI: 14.9 to 18.3) and 4.3% (95% CI: 4.1 to 4.6), respectively. The adjusted odds ratio (AOR) for the covariates revealed that the prevalence of CHE for the overall households that used dental healthcare service was 6.2 times (95% CI: 5.4 to 7.1) than those that did not use dental healthcare services. The urban households that used dental healthcare had 7.8 times (95%CI: 6.4–9.4) while the rural ones had 4.7 times (95% CI: 3.7–5.7) higher odds of facing CHE than the corresponding households that did not use dental healthcare services.ConclusionsThe study indicates that out-of-pocket costs for dental care services impose a substantial financial burden on household’s budgets at the national and subnational levels. Alternative health care financing strategies and policies targeted to the reduction in CHE in general and CHE due to dental services in particular are urgently required in low and middle income countries such as Iran.

Health Education and Vaccination for the Construction of Inclusive Societies.

Globalization has led to what has happened in a certain part of the world having a significant and rapid impact on other places, causing significant changes in health problems. In the last quarter of the 18th century, the history of vaccination began, becoming an effective tool to prevent and control communicable diseases. This paper proposes an observational research with a cross-sectional design to study the importance of health education and vaccination in building inclusive societies. With a sample of 1000 participants from 76 countries, vaccine awareness and regulation were analyzed, considering the following variables: gender, age, sector, Human Development Index (HDI), and continent. The instrument used was a questionnaire (VACUNASEDUCA) developed for this research and timely validated. As a result, it is highlighted that the profiles of women, people under 30 years of age, education sector, high Human Development Index, and European continent are those that most value the importance of raising awareness in society and the regulation of actions for vaccination compliance. The consequences of “vaccine reluctance” are of concern in every country on the planet. Therefore, it is concluded that effective and evidence-based communication is key to allaying fears and promoting acceptance of vaccination around the world, building inclusive societies in which all citizens enjoy the health benefits.

Epidemiological study of toxoplasmosis outbreaks in Brazil.

In Brazil, notification of toxoplasmosis outbreaks and epidemiological investigation is a mandatory activity of health surveillance. We investigated the risk factors for toxoplasmosis during outbreaks, notifications of outbreaks by the health secretary and reports in the literature. Other factors related to the municipalities were determined through the Institute of Geography and Statistics portal. We found that fruits and vegetables were the most described transmission routes in outbreaks, and oocysts were the most common parasitic form; in recent years; there has been an increase in outbreak notifications. We also found that municipalities with high municipal human development index have a higher number of toxoplasmosis infections during outbreaks. There is a need to raise awareness among the population and producers regarding good water management and quality practices and to facilitate the acquisition of complex data to improve preventive strategies.

Dissemination of COVID-19 in inland cities of Northeastern Brazil.

SARS-CoV-2 causes the new coronavirus disease (COVID-19) and it is weakening all health systems. Therefore, the most vulnerable populations are exposed to harmful consequences, such as illness and death. Thus, this study aims to estimate the temporal effect of COVID-19 dissemination on social indicators of the Northeastern region of Brazil. An ecological time-series study was developed with the following: diagnosed cases of COVID-19 in the largest inland cities of Northeast Brazil, Human Development Index (HDI), poverty incidence, and Gini coefficient. Cities with high HDI, poverty rate, and Gini presented a larger number of patients. It was observed by evaluating case trends that COVID-19 spreads unevenly in inland cities of the Northeastern region of Brazil. In this sense, we emphasize that regional health managers should support small cities with vulnerable population and social assistance.

Colorectal cancer incidence and mortality: the current status, temporal trends and their attributable risk factors in 60 countries in 2000-2019.

Background:Globally, colorectal cancer (CRC) imposes a substantial burden on healthcare systems and confers considerable medical expenditures. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of CRC.Methods:We used data from the GLOBOCAN database to estimate CRC incidence and mortality worldwide in 2020 and their association with the human development index (HDI). Trends of age-standardized rates of incidence and mortality in 60 countries (2000–2019) were evaluated by Joinpoint regression analysis using data of Global Burden of Disease 2019. The association between exposure to country-level lifestyle, metabolic and socioeconomic factors obtained from the World Health Organization Global Health Observatory and World Bank DataBank data and CRC incidence and mortality was determined by multivariable linear regression.Results:CRC incidence and mortality varied greatly in the 60 selected countries, and much higher incidence and mortality were observed in countries with higher HDIs, and vice versa. From 2000 to 2019, significant increases of incidence and mortality were observed for 33 countries (average annual percent changes [AAPCs], 0.24–3.82) and 18 countries (AAPCs, 0.41–2.22), respectively. A stronger increase in incidence was observed among males (AAPCs, 0.36–4.54) and individuals <50 years (AAPCs, 0.56–3.86). Notably, 15 countries showed significant decreases in both incidence (AAPCs, −0.24 to −2.19) and mortality (AAPCs, −0.84 to −2.74). A significant increase of incidence among individuals <50 years was observed in 30 countries (AAPCs, 0.28–3.62). Countries with higher incidence were more likely to have a higher prevalence of alcohol drinking, higher level of cholesterol level, higher level of unemployment, and a poorer healthcare system.Conclusions:Some high-HDI countries showed decreasing trends in CRC incidence and mortality, whereas developing countries that previously had low disease burden showed significantly increased incidence and mortality trends, especially in males and populations ≥50 years, which require targeted preventive health programs.

Global, Regional, and National Lifetime Probabilities of Developing Cancer in 2020

Background: The lifetime risk of cancer is a measure of the cumulative impact of cancer across a defined age span, and has obvious intuitive appeal. There are however few examples of its systematic use in comparative assessments of cancer-specific risk across populations. We therefore sought to estimate and interpret the lifetime and age-conditional probabilities of developing cancer at the country, world region and global level in 2020. Methods: We obtained estimates of sex- and age-specific cancer incidence rates from GLOBOCAN for 185 countries for the year 2020, alongside all-cause mortality and population data from the United Nations. Countries were categorized into quartiles of the Human Development Index (HDI) as developed by the United Nations Development Programme. The lifetime risk of cancer was estimated using the adjusted for multiple primaries (AMP) method, taking into account competing risks of death from causes other than cancer as well as average life expectancy. Findings: In 2020, the estimated global lifetime risk of cancer from birth to death was 25.1% (26.3% in men and 24.0% in women) . There were marked differences in risks between countries within world regions and by level of human development. In very high HDI, high HDI, medium HDI and low HDI countries, the lifetime risk of cancer was 38.5%, 25.4%, 11.4%, and 10.3%, respectively, with cancer risks highest in Ireland (49.7%) and lowest in Central African Republic (6.6%). There was similar heterogeneity according to cancer type by sex. Worldwide, prostate cancer and breast cancer were associated with the greatest lifetime risks among men and women, of 4.6% and 5.9% respectively. The lifetime risk of cancer decreased by age, with a remaining risk of 12.6% from the age 70 years. Interpretation: In 2020, the global lifetime risk of cancer from birth to death translates approximately 1 in 4 persons developing cancer, with men and women having similar levels of lifetime risk. The identified age-specific variations in cancer risk at the population level can provide important information to support the targeted cancer prevention and health systems planning. Funding: National Key R&D Program of China, National Natural Science Foundation of China, and Beijing Nova Program Declaration of Interest: All authors declare no competing interests.