Medium Human Development Index Countries Research Articles

Exploring the nexuses between carbon dioxide emissions, material footprints and human development: An empirical study of 151 countries

In order to achieve the Sustainable Development Goals, it is necessary to actively promote a coordinated and balanced relationship between carbon dioxide emissions (CO2e), material footprints (MF) and human development, based on the economic and social development stages of different countries and their material resource endowments. However, the existing research results lack cross-country comparisons and overly focus on the single conclusion of quantifying decoupling while ignoring the impact of coupling coordination nexus. Thus, this study comprehensively evaluated the nexus between CO2e, MF, and human development index (HDI) in 151 countries from 1990 to 2019 based on the modified coupling coordination degree model and the improved decoupling index model. The results show that, both the global MF per capita and HDI have maintained an increasing trend, and the MF per capita has been increasing significantly faster than the HDI. The trend of CO2e per capita is slowly dropping, with very high HDI countries being the main contributors. Besides, global regional differences in CO2e per capita and MF per capita are still expanding. Worldwide differences in per unit of CO2e and per unit of MF for HDI variation are narrowing. Furtherly, there is a more general but short-lived trend of absolute decoupling for very high HDI and low HDI countries, while medium HDI countries show a significant trend of coupling. By combining the endowment characteristics of some typical countries, it can be observed that the net fossil energy importing countries with higher HDI have high degree of coupling coordination, but gradually evolve towards the state of relative decoupling. There is still a significant trend of recoupling between the MF and HDI in the net fossil energy exporting countries with higher HDI, but CO2e is gradually evolving towards decoupling. The coupling coordination state is deepening in some low HDI countries. Due to the huge differences in national endowment characteristics and development stages, targeted energy conservation and emission reduction strategies are important for achieving coordinated development between CO2e, MF and HDI.

The Economic Dynamics After a Flood: Evidence from Satellite Data

This study investigates the effect of flash floods on local economic activity in Central America and the Caribbean. I measure these rarely analyzed floods by constructing a high-resolution, physically based index of flash flood occurrence from satellite data and connect these to changes in local night light emissions. After accounting for tropical cyclone activity, flash floods have a delayed, short-term negative effect on economic activity. In countries with a low to medium human development index (HDI), the average negative effect can be up to 5.6%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$5.6\\%$$\\end{document} in the following months. Countries with higher HDI appear more resilient and are only marginally affected. Also, flash floods exhibit a minor positive spatial spillover in low to medium HDI countries, besides their more substantial local negative effect. Due to their high frequency, flash floods have a detrimental effect on local economic growth in developing countries that will likely be exacerbated by climate change. (JEL )

Global epidemiological comparison of Streptococcus pyogenes emm-types associated with pharyngitis and pharyngeal carriage

ObjectivesTo test the prevailing dogma that Streptococcus pyogenes emm-types that cause pharyngitis are the same as those associated with the carriage, using a global dataset. MethodsDrawing on our systematic review of the global distribution of S. pyogenes emm-types and emm-clusters from 1990 to 2023, we compared the distribution and diversity of strains associated with pharyngitis and pharyngeal carriage, in the context of local United Nations Development Programme Human Development Index (HDI) values. ResultsWe included 20 222 isolates from 71 studies done in 34 countries, with the vast majority of carriage strain data from studies in ‘Low HDI’ settings (550/1293; 43%). There was higher emm-type diversity for carriage than pharyngitis strains (Simpson Reciprocal Index of diversity 28.9 vs. 11.4). Compared with pharyngitis strains, carriage emm-types were disproportionately from emm-clusters E and D, usually described as ‘generalist’ or ‘skin’ strains. DiscussionA limited number of studies have compared S. pyogenes strains from cases of pharyngitis compared with carriage. Our understanding of strains associated with carriage is the poorest for high-income settings. In low and medium HDI countries, we found greater strain associated with pharyngeal carriage than pharyngitis. Improving our understanding of S. pyogenes carriage epidemiology in the pre-vaccine era will help to decipher the direct and potential indirect effects of vaccines.

Barriers and prospects for skin grafting in burn treatment across African countries

IntroductionThe current standard management of full-thickness or deep dermal burns is early tangential excision and skin grafting. A conservative approach to deep burns without the option of skin grafting results in delayed wound healing, possibly leading to wound infection and is associated with hypertrophic scarring and increased morbidity and mortality. The aim of this study was to improve the understanding of the management and availability to perform skin grafting for burns on the African continent. It also sought to identify challenges and perceived improvements. MethodsA web-based, structured, closed-formatted, multinational survey was designed to gather information on the current state and availability of skin grafting of burn wounds on the African continent. The questionnaire consisted of 27 questions, available in English and French. It was reviewed within the GAP-Burn collaboration network and sent to 271 health care professionals who had participated in a previous study and had initially been recruited by means of the snowball system. ResultsThe questionnaire was completed 84 times (response rate: 31.0%), of which 3 were excluded. Responses originated from 22 African countries. The majority 71 (87.7%) resulted from countries with a low Human Development Index (HDI), 7 (8.6%) from medium HDI countries. Split thickness skin grafting (STSG) is performed in 51 (63.0%) centers. The majority considers STSG to reduce length of stay (72.8%) and improve scarring (54.3%), yet some indicated that STSG is associated with increased risk of donor site infection (8.6%) and severe bleeding (7.4%). Factors preventing increased grafting included lack of equipment and training. ConclusionSkin grafting is not performed in a significant number of hospitals treating burns. The majority of the staff believe that more skin grafting would lead to a better outcome. Advocacy and improved infrastructure, human resources coupled with introduction to well-structured health coverage for all in African countries could help to better access and affordability in burn care.

A Scoping Review of the Oral Health Status, Oral Health Behaviours and Interventions to Improve the Oral Health of Children and Young People in Care and Care Leavers.

Children and young people (CYP) in care experience poorer physical health and overall wellbeing in comparison to their peers. Despite this, relatively little is known about what their oral health needs and behaviours are. The aim of this scoping review was to provide a global perspective on the oral health status and behaviours of CYP in care and care leavers. It also aimed to synthesise interventions that have been trialled in this population to improve oral health. Five databases were searched, Ovid Embase, Ovid MEDLINE, CINAHL (EBSCOhost), SocINDEX (EBSCOhost) and Dentistry and Oral Sciences Source (EBSCOhost), alongside grey literature sources up to January 2023. Eligibility criteria were studies that (i) reported on children and adolescents aged 25 years or younger who are currently in formal/informal foster or residential care and care leavers, (ii) pertained to oral health profile, behaviours or oral health promotion interventions (iii) and were published in the English language. Thematic analysis was used to develop the domains for oral health behaviours and interventions. Seventy-one papers were included. Most papers were published from very high or medium Human Development Index countries. CYP in care were found to experience high levels of decay, dental trauma, periodontal disease and poorer oral health-related quality of life. Oral health behaviours included limited oral health self-care behaviours and a lack of oral health-based knowledge. The trialled interventions involved oral health education, supervised brushing and treatment or preventative dental care. This scoping review reveals that CYP in care experience poorer oral health in comparison to their peers. They are also less likely to carry out oral health self-care behaviours. This review highlights a scarcity of interventions to improve the oral health of this population and a paucity of evidence surrounding the oral health needs of care leavers.

Access to Dental Care for Children and Young People in Care and Care Leavers: A Global Scoping Review.

This scoping review aimed to explore three research questions: 1. What is the dental care access for children and young people (CYP) in care and care leavers? 2. What factors influence CYP in care and care leavers' access to dental care? 3. What pathways have been developed to improve access to oral health care for CYP in care and care leavers? Five databases (Ovid MEDLINE, Ovid Embase, CINAHL, SocINDEX and Dentistry and Oral Sciences Source) and grey literature sources were systematically searched. Articles relating to CYP in care or care leavers aged 0-25 years old, published up to January 2023 were included. Abstracts, posters and publications not in the English language were excluded. The data relating to dental care access were analysed using thematic analysis. The search identified 942 articles, of which 247 were excluded as duplicates. A review of the titles and abstracts yielded 149 studies. Thirty-eight were eligible for inclusion in the review: thirty-three peer-reviewed articles, one PhD thesis and four grey literature sources. All papers were published from very high or medium Human Development Index countries. The studies indicate that despite having higher treatment needs, CYP in care and care leavers experience greater difficulty in accessing dental services than those not care-experienced. Organisational, psycho-social and logistical factors influence their access to dental care. Their experience of dental care may be impacted by adverse childhood events. Pathways to dental care have been developed, but little is known of their impact on access. There are very few studies that include care leavers. The voices of care-experienced CYP are missing from dental access research. care-experienced CYP are disadvantaged in their access to dental care, and there are significant barriers to their treatment needs being met.

Does the Validity of the Environmental Kuznets Curve Postulation Empirically Depend on the Level of Human Development in Africa?

Purpose: The interconnectedness between human development and environmental degradation is a complex issue that warrants investigation in Africa. Although there are a few studies on the economic growth and environmental degradation nexus for African countries, there is a huge scarcity of empirical research that explores the Environmental Kuznets Curve (EKC) postulation in the context of human development and environmental degradation in Africa. The study therefore empirically explored the relationship between Human Development and Environmental Degradation within the framework of the EKC using 50 African countries subdivided into High Human Development Index Countries (HHDICs), Medium Human Development Index Countries (MHDICs) and Low Human Development Index Countries (LHDICs) from 2000 to 2019. Data for the study were obtained from the World Bank’s development indicators and the Human Development Reports of the United Nations Development Programme (UNDP-HDR).
 Methodology: The study made use of the Panel Corrected Standard Error (PCSE) model and the Feasible Generalised Least Squares Regression model (FGLS) which are econometrically suitable to handle N > T and T > N panels respectively, and are both robust to cross sectional dependence, contemporaneous correlation, group wise heteroscedasticity and slope heterogeneity. Other econometric techniques such as Descriptive Statistics, Correlation Analysis, Variance Inflation Factor test (Multicollinearity), second generation unit root tests (CADF and CIPS), Durbin Watson, Breusch Godfrey tests (Serial Correlation) and the White Test (Heteroscedasticity) were also employed in the study.
 Findings: The empirical results produced evidence that the data is integrated of order one I(1) and exhibits cross sectional dependence, slope heterogeneity and cointegration. The data was also found to be serially correlated and heteroscedastic. However, multicollinearity was absent. The panel estimates of the PCSE and the FGLS estimators showed that Human Development is a key driver of Environmental Degradation in Africa, with the greatest proportion of the impact on HHDICs, followed by MHDICs and then finally LHDICs. The results also revealed the validity of the EKC postulation only in the HHDICs, evidenced by the presence of an inverted U-shaped relationship between Environmental Degradation and Human Development. In The LHDICs and MHDICs on the other hand, U-shaped relationships between Environmental Degradation and Human Development were found, signalling the invalidity of the EKC. There was significant evidence for the support of the feedback hypothesis between Human Development and Environmental Degradation in HHDICs, MHDICs, LHDICs and all the 50 African countries at large. Based on the findings, Policymakers were given recommendations that took into consideration the uniqueness of the economic situations in HHDICs, MHDICs, LHDICs and Africa as a whole.
 Recommendations: The study shows that the degree of environmental degradation is proportional to the level of human development in Africa and indicates that the validity of the EKC postulation in the context of human development) is exclusive to only the HHDICs in Africa. This provides an incentive for policy makers in the MHDICs and LHDICs of Africa to make human development a priority through industrialisation and other profitable economic activities. This is likely to help them afford innovations and technological developments that protect the environment through the greater use of cleaner energy than the naturally abundant fossil fuel as well as the institutionalisation of policies that protect the environment as human development appreciates.

The geographic diversity of authorship in leading general surgery journals; A study of 24,332 authors

BackgroundResearch guides evidence-based general surgery practice, advocacy, policy and resource allocation, but is seemingly lacking representation from those countries with greatest disease burden and mortality. Accordingly, we conducted a geographic study of publications in the most impactful general surgery journals worldwide. MethodsThe six general surgery journals with the highest 2020 impact factors were selected. Only journals specific to general surgery were included. For all original articles over the past five years, the affiliated country and city were extracted for the first, second and last author. Number of publications were adjusted per capita, and compared to Human Development Index (HDI) using logistic regression. Results8274 original articles were published in the top six ranked general surgery journals over 2016–2020, with 24,332 affiliated authors. Authors were most commonly associated with the US (27.88%), Japan (9.09%) and China (8.46%), or per capita, The Netherlands, Sweden and Singapore. There is a linear association between publishing in a top six journal and HDI of country of affiliation. Just four publications were from medium or low HDI countries over the period. ConclusionAuthorship in leading general surgery journals is predominantly from wealthy, Western countries. Authorship is associated with affiliation with a high HDI country, with few authors from medium or low HDI countries. There is a lack of representation in literature from Africa, Russia, and parts of Southeast Asia, and thus a lack of locally relevant evidence to guide surgical practice in these areas of high disease burden and low life expectancy.

Clinical manifestations of respiratory syncytial virus infection and the risk of wheezing and recurrent wheezing illness: a systematic review and meta-analysis.

Respiratory syncytial virus (RSV) infection in infants is a global health priority. We aimed to investigate the common manifestations of RSV infection by age group and human development index (HDI) level and to assess its association with the development of wheezing and recurrent wheezing illness. We searched the literature published between January 1, 2010 and June 2, 2022 in seven databases. Outcomes included common manifestations and long-term respiratory outcomes of RSV infection in children. Random- and fixed-effect models were used to estimate the effect size and their 95% confidence intervals. Subgroup analysis was conducted by age and HDI levels. This review was registered in PROSPERO (CRD42022379401). The meta-analysis included 47 studies. The top five manifestations were cough (92%), nasal congestion (58%), rhinorrhea (53%), shortness of breath (50%), and dyspnea (47%). The clinical symptoms were most severe in infants. In our analysis, compared to very high and high HDI countries, fewer studies in medium HDI countries reported related manifestations, and no study in low HDI countries reported that. The RSV-infected infants were more likely to develop wheezing than the non-infected infants [odds ratio (OR), 3.12; 95% CI, 2.59-3.76] and had a higher risk of developing wheezing illnesses after recovery (OR, 2.60; 95% CI, 2.51-2.70). Cough and shortness of breath are common manifestations of RSV infection. More attention should be given to infants and areas with low HDI levels. The current findings confirm an association between RSV infection and wheezing or recurrent wheezing illness.

Global incidence and mortality of renal cell carcinoma in 2020

Objective: To analyze the global epidemiology of renal cell carcinoma (RCC) in 2020. Methods: The incidence and mortality data of RCC in the cooperative database GLOBOCAN 2020 of International Agency for Research on Cancer of WHO and the human development index (HDI) published by the United Nations Development Programme in 2020 were collated. The crude incidence rate (CIR), age-standardized incidence rate (ASIR), crude mortality rate (CMR), age-standardized mortality rate (ASMR) and mortality/incidence ratio (M/I) of RCC were calculated. Kruskale-Wallis test was used to analyze the differences in ASIR or ASMR among HDI countries. Results: In 2020, the global ASIR of RCC was 4.6/100 000, of which 6.1/100 000 for males and 3.2/100 000 for females and ASIR was higher in very high and high HDI countries than that in medium and low HDI countries. With the rapid increase of age after the age of 20, the growth rate of ASIR in males was faster than that in females, and slowed down at the age of 70 to 75. The truncation incidence rate of 35-64 years old was 7.5/100 000 and the cumulative incidence risk of 0-74 years old was 0.52%. The global ASMR of RCC was 1.8/100 000, 2.5/100 000 for males and 1.2/100 000 for females. The ASMR of males in very high and high HDI countries (2.4/100 000-3.7/100 000) was about twice that of males (1.1/100 000-1.4/100 000) in medium and low HDI countries, while the ASMR of female (0.6/100 000-1.5/100 000) did not show significant difference. ASMR continued to increase rapidly with age after the age of 40, and the growth rate of males was faster than that of females. The truncation mortality rate of 35-64 years old was 2.1/100 000, and the cumulative mortality risk of 0-74 years old was 0.20%. M/I decreases with the increase of HDI, with M/I as 0.58 in China, which was higher than the global average of 0.39 and the United States' 0.17. Conclusion: The ASIR and ASMR of RCC presented significant regional and gender disparities globally, and the heaviest burden was in very high HDI countries.

ENDOGENOUS GROWTH FACTORS IN FOUR CATEGORIES OF COUNTRIES BASED ON HDI

The economic slowdown is an issue that the global economy still faces since the 2007-2009 Great Recession. The decline in physical and natural capital will further exacerbate this slowdown. This study analyzes the factors driving growth based on endogenous growth theory using a case study of four country categories based on the Human Development Index (HDI) level to solve the economic slowdown problem and realize sustained economic growth as Goal 8 of Sustainable Development Goals (SDGs). The variables used in this study are HDI, Global Innovation Index (GII), labor force, and Gross Fixed Capital Formation (GFCF). This study analyzed 98 countries in 2011-2018 using Fixed Effect and Random Effect Model. The estimation results show that HDI, labor force, GII, and GFCF significantly affect economic growth in the very high, high, and medium HDI country categories. This study found that GII did not affect economic growth in the low HDI countries category.

Teleophthalmology research: Where do we stand?

To identify global research trends in teleophthalmology, as well as productivity and its association with Human development index (HDI). A cross-sectional study. The main outcome measures were publication count, citation count, and publications count per million populations. Bibliographic data were derived from the Web of Science website. HDI data were derived from Human Development Report [2020]. One-way ANOVA test was used to examine the association between HDI and the outcome measures. We studied the correlation between continuous variables using Spearman's. Bibliometric analysis software's VOSviewer and Citspace were used to analyse results and creating visualizing maps. The results retrieved 355 publications, one-third of them have been published in the year of the COVID-19 pandemic; (2020). The USA has contributed to one-half of all publications, and just five countries have contributed to about 90% of all records. Very high HDI countries had significantly more publications count per million populations, than high (p-value = 0.0047), medium (p-value = 0.0081) or low HDI countries (p-value = 0.002). The main themes are screening programmes, reliability, photography, COVID-19, access, artificial intelligence, and cost-effectiveness. The leading countries in terms of both publications and citation count are the USA and India. In terms of publications count per million populations, the leading countries are Singapore and Australia. Most of the contribution in teleophthalmology research was confined to a small number of countries. More effort is needed to expand the global contribution. The hotspots in this field are artificial intelligence applications and COVID-19 impact.

The current and future incidence and mortality of gastric cancer in 185 countries, 2020–40: A population-based modelling study

SummaryBackgroundTo examine global patterns of gastric cancer in 2020 and the projected burden in 2040.MethodsData on primary gastric cancer were extracted from the GLOBOCAN database for the year 2020. Age-standardized incidence and mortality rates were calculated by sex, country, world region and level of human development index (HDI) for 185 countries. The predicted burden of incidence and mortality in 2040 was calculated based on demographic projections.FindingsIn total, ∼1.1 million new cases and 770,000 deaths of gastric cancer were estimated in 2020. Incidence rates were on average 2-fold higher in males than females (15.8 and 7.0 per 100,000, respectively) with variation across countries. Highest incidence rates were observed in Eastern Asia for both males and females (32.5 and 13.2, respectively); males residing in Japan (48.1), Mongolia (47.2) and Korea (39.7) had the highest rates in the world. Incidence was lowest in Africa with incidence rates < 5 per 100,000. Highest mortality rates were observed in Eastern Asia for both males (21.1) and females (8.8). A lower share of deaths was observed in very high HDI countries compared to medium and low HDI countries. The annual burden of gastric cancer is predicted to increase to ∼1.8 million new cases and ∼1.3 million deaths by 2040.InterpretationThese estimates of the global burden of gastric cancer pinpoint countries and regions of high incidence and mortality in need of cancer control initiatives. Primary prevention through eradication of H. pylori and behavioural changes such as reducing salt intake, smoking, obesity, and alcohol, remains key in stomach cancer control.FundingNo direct funding was received. All authors had access to the included study data and all authors agreed with the final decision to submit for publication.

Acculturation and 4-year caries increment among children of foreign-born mothers in Sweden: a register-based cohort study

BackgroundTo study the association of maternal age upon arrival and length of residence in Sweden with the 4-year caries increment in their children between ages 3 and 7 years in relation to the human development index (HDI) of the maternal country of origin.MethodThis registry-based cohort study included all children born in 2000–2003 who resided in Stockholm County, Sweden, at age 3 years and who were followed up at age 7 (n = 63,931). Negative binomial regressions were used to analyze different models adjusted for sociodemographic factors.ResultsChildren of foreign-born mothers, regardless of the HDI of the maternal country of origin, had a higher risk of caries increment between ages 3 and 7 years than children of Swedish-born mothers. Furthermore, children of mothers who had arrived from a low or medium HDI country had a lower caries increment if their mothers arrived before age 7 compared with after age 7. Nearly half (44%) of the children whose mothers arrived in Sweden at age ≥ 20 years from a low HDI country had a caries increment compared to 22% of the children whose mothers had arrived in Sweden before 7 years of age. Furthermore, children whose mothers were born in a low HDI country and had resided in Sweden ≤ 19 years had approximately 1.5 times higher risk of caries increment compared to children of mothers who had resided in Sweden for more than 20 years.ConclusionsCaries increment in the children of foreign-born mothers was associated with the age of their mother when she arrived in Sweden and was lower when the mother had arrived before age 7 years. This indicates an intergenerational effect that carries over to the children and is greater the longer the mother has participated in Swedish dental healthcare.

The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020

Thyroid cancer incidence rates have increased in many countries and settings; however, mortality rates have remained stable at lower rates. This epidemiological pattern has been largely attributed to an overdiagnosis effect. Timely evidence for the global epidemiological status is necessary to identify the magnitude of this problem and the areas mostly affected by it. We therefore aimed to provide an up-to-date assessment on the global distribution of thyroid cancer incidence and mortality rates in 2020. We extracted age-standardised incidence and mortality rates per 100 000 person-years of thyroid cancer as defined by the International Classification of Diseases for Oncology 10th Revision (code C73), for 185 countries or territories by sex and 18 age groups (ie, 0-4, 5-9, …, 80-84, and ≥85 years) from the GLOBOCAN database. Both incidence and mortality estimates were presented by country and aggregated across the 20 UN-defined world regions and according to the UN's four-tier Human Development Index (ie, low, medium, high, and very high) in 2020. Globally, in 2020, the age-standardised incidence rates of thyroid cancer were 10·1 per 100 000 women and 3·1 per 100 000 men, and age-standardised mortality rates were 0·5 per 100 000 women and 0·3 per 100 000 men. In both sexes, incidence rates were five times higher in high and very high Human Development Index countries than in low and medium Human Development Index countries, whereas mortality rates were relatively similar across different settings. Incidence rates in women differed by more than 15 times across world regions, with the highest incidence rates being in the Federated States of Micronesia and French Polynesia (18·5 per 100 000 women), North America (18·4 per 100 000), and east Asia (17·8 per 100 000, with South Korea reaching 45 per 100 000). Mortality rates were less than one per 100 000 in most countries and in both sexes. South Korea had the highest incidence-to-mortality rate ratio in both sexes, followed by Cyprus and Canada. The current thyroid cancer epidemiological landscape is strongly suggestive of a large effect of overdiagnosis in many countries and settings worldwide, confirming the relevance of thyroid cancer overdiagnosis as a global public health problem. None.

Modeling global transfusion medicine education.

Modeling global transfusion medicine education.

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.

Cost per DALY averted in low, middle- and high-income countries: evidence from the global burden of disease study to estimate the cost-effectiveness thresholds

BackgroundDetermining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries. This study aimed to estimate the cost per disability-adjusted life-year (DALY) averted for countries with different levels of Human Development Index (HDI) and Gross Domestic Product (GDP).MethodsThe data about DALYs, per capita health expenditure (HE), HDI, and GDP per capita were extracted for 176 countries during the years 2000 to 2016. Then we examined the trends on these variables. Panel regression analysis was performed to explore the correlation between DALY and HE per capita. The results of the regression models were used to calculate the cost per DALY averted for each country.ResultsAge-standardized rate (ASR) DALY (DALY per 100,000 population) had a nonlinear inverse correlation with HE per capita and a linear inverse correlation with HDI. One percent increase in HE per capita was associated with an average of 0.28, 0.24, 0.18, and 0.27% decrease on the ASR DALY in low HDI, medium HDI, high HDI, and very high HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI, medium HDI, high HDI, and very high HDI countries. On average, the cost per DALY averted was 0.34 times the GDP per capita in low HDI countries. While in medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and 1.46 times the GDP per capita, respectively.ConclusionsThis study suggests that the cost-effectiveness thresholds might be less than a GDP per capita in low and medium HDI countries and between one and two GDP per capita in high and very high HDI 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.

Quantifying the Environmental Impacts of Cookstove Transitions: A Societal Exergy Analysis Based Model of Energy Consumption and Forest Stocks in Honduras

Unsustainable consumption of biofuels contributes to deforestation and climate change, while household air pollution from burning solid biofuels in homes results in millions of premature deaths globally every year. Honduras, like many low and medium Human Development Index countries, depends on primary solid biofuels for more than 30% of its primary energy supply (as of 2013). We conducted a societal exergy analysis and developed a forest stock model for Honduras for 1971–2013 and used the results to model an energy transition from traditional wood stoves to either improved efficiency wood cookstoves or modern fuel cookstoves (using Electricity or Liquefied petroleum gas) over the period 2013–2050. The exergy analysis and forest model enabled quantification of the environmental tradeoffs between the improved efficiency and fuel switching scenarios. We find that the continued reliance on wood within both the existing and improved wood cookstove scenarios would exhaust forest stocks by 2050, though improved efficiency could reduce national greenhouse gas emissions. Modern fuel cookstoves would reduce household air pollution, emissions, and deforestation. However, the best alternative to successfully reduce household air pollution, GHG emissions, and deforestation is a rapid switch to electric stoves with significant investment in renewable-based electricity.