Universal Health Coverage Index Research Articles

Measuring progress towards universal health coverage in 22 Middle East and North African countries

PurposeMonitoring progress towards universal health coverage (UHC) has become increasingly important, especially given the centrality of UHC in achieving the sustainable development goals. We sought to estimate the progress towards UHC in the 22 Middle East and North Africa (MENA) countries. MethodsEmploying the Joint World Bank and World Health Organization Framework for Monitoring UHC, we estimated the UHC index for MENA countries using both service coverage and financial protection indicators. We also explored the correlation between the UHC index with government expenditure/investment in health. ResultsThe 2021 UHC index ranged from 48.2 (Somalia) to 90.3 (United Arab Emirates) with a mean, median, and standard deviation of 74.9, 77.4, and 11.1, respectively, with significant differences between low-income and high-income countries. Service coverage lags behind financial protection in most MENA countries. There is a significant positive relationship between UHC and government health spending/investments. ConclusionThe majority of MENA countries are yet to achieve UHC. There is a need to expand healthcare services, especially PHC services, and adopt strategies that address concerns related to financial protection.

District-level monitoring of universal health coverage, India.

To develop a framework and index for measuring universal health coverage (UHC) at the district level in India and to assess progress towards UHC in the districts. We adapted the framework of the World Health Organization and World Bank to develop a district-level UHC index (UHC d ). We used routinely collected health survey and programme data in India to calculate UHC d for 687 districts from geometric means of 24 tracer indicators in five tracer domains: reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; service capacity and access; and financial risk protection. UHC d is on a scale of 0% to 100%, with higher scores indicating better performance. We also assessed the degree of inequality within districts using a subset of 14 tracer indicators. The disadvantaged subgroups were based on four inequality dimensions: wealth quintile, urban-rural location, religion and social group. The median UHC d was 43.9% (range: 26.4 to 69.4). Substantial geographical differences existed, with districts in southern states having higher UHC d than elsewhere in India. Service coverage indicator levels were greater than 60%, except for noncommunicable diseases and for service capacity and access. Health insurance coverage was limited, with about 10% of the population facing catastrophic and impoverishing health expenditure. Substantial wealth-based disparities in UHC were seen within districts. Our study shows that UHC can be measured at the local level and can help national and subnational government develop prioritization frameworks by identifying health-care delivery and geographic hotspots where limited progress towards UHC is being made.

Global, Regional and National Burden of Paediatric Atopic Dermatitis: A Trend and Geographic Inequalities Analysis.

Atopic dermatitis (AD) is a common chronic skin disorder in children. We aimed to investigate trends and regional disparities of burden in paediatric AD at global, regional and national levels, and to explore potential associated factors. Based on data from Global Burden of Disease study 2019, we assessed trends in burden of AD aged <19 years from 1990 to 2019, including prevalent and incident cases, age-standardised prevalence and age-standardised incidence. For potential associated factors, correlations of above trends and indexes of socio-economic status (sociodemographic index, SDI) and health service coverage (universal health coverage index, UHCI) were evaluated. We conducted decomposition analysis to understand the net contribution of population-level factors and their contribution proportions on changes of prevalent and incident cases, including age structure, population change and epidemiological change. Global prevalent and incident cases of paediatric AD increased by about 5.7 and 0.7 million between 1990 and 2019, respectively. Global age-standardised prevalence and incidence decreased by -0.17% (-0.19% to -0.16%) and -0.12% (-0.13% to -0.11%) per year from 1990 to 2019, respectively. Regionally, the highest increase of prevalent and incident cases was in low SDI region (by 96.77% and 84.85%); the highest decrease of age-standardised prevalence and incidence was in high SDI regions (by -0.20% and -0.27% per year). The correlation analyses identified significant negative correlations between trends and SDI and UHCI. Population change was a major driver of case rise; epidemiological change and age structure showed negative impact of case rise. Regional disparities in contribution of three population-level factors were seen, including net contribution direction (positive or negative) and contribution proportion levels. Global paediatric AD case numbers increased, primarily due to population growth. Prevalence and incidence decreased slightly. Geographic inequalities were seen. Developing region-specific strategies targeting potential factors is essential to reduce paediatric AD burden.

Provincial inequality of China's progress towards universal health coverage: An empirical analysis in 2016-21.

Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the regional economy and resource allocation, subnational evidence in China is urgently needed. This study aimed to monitor provincial progress from 2016 to 2021, thereby informing the development of region-specific strategies. Based on the UHC monitoring framework proposed by the World Health Organization, a UHC index was constructed comprising the service coverage dimension (16 indicators) and financial protection dimension (four indicators). In this observational study, routinely collected health data from 25 provinces (autonomous regions and municipalities) in mainland China were obtained from statistical yearbooks, relevant literature, and nationally representative surveys. The indices were calculated using geometric means. Socioeconomic inequalities among provinces were quantified using the slope index of inequality (SII) and relative index of inequality (RII). From 2016 to 2021, China made laudable progress towards achieving UHC, with the index rising from 56.94 in 2016 to 63.03 in 2021. Most provinces demonstrated better performance in service coverage. Western provinces generally presented faster rates of progress, which were attributed to more substantial increases in financial protection. Despite significant disparities, with the UHC index ranging from 77.94 in Shanghai to 54.61 in Fujian in 2021, the overall equity of UHC has improved across the 25 provinces. SII decreased from 17.78 (95% confidence interval (CI) = 11.64, 23.93) to 12.25 (95% CI = 5.86, 18.63) and RII from 1.38 (95% CI = 1.29, 1.46) to 1.22 (95% CI = 1.16, 1.29). However, the non-communicable disease (NCD) domain experienced a drop in both index score and equity, underscoring the need for prioritised attention. In the context of SDGs and the 'Healthy China 2030' initiative, China has made commendable progress towards UHC, and inter-provincial equity has improved. However, substantial differences persisted. The equitable realisation of UHC necessitates prioritising the enhancement of service capacity and financial protection in less developed regions, particularly by addressing shortages in the general practitioner workforce and mitigating catastrophic payments. Developed regions should focus on preventing NCDs through effective interventions targeting key risk factors. This study provides insights for other countries to adopt comprehensive monitoring frameworks, identify subnational disparities, and introduce targeted policy initiatives.

The comparative analysis of health care systems based on rating definition

The comparative analysis of effectiveness and efficiency of health care systems functioning causes a number of difficulties due to different indicators applied in countries as assessment tools, different data collection mechanisms and differences in nature and dimension of determining indicators. To ensure comparability of absolute values of various indicators and possibility to compare activities of single medical organizations and effectiveness of health care system of both various Subjects of the Russian Federation and health care system as a whole, it is possible to apply different rating techniques. The article presents comprehensive comparative analysis of activities of health care systems based on construction of rating using integral indicators of public health: indicators of key functioning of health systems (financial support and infrastructure development), total mortality from non-communicable diseases, probability of dying at the age of 30 to 70 years from any of cardiovascular diseases, cancer, diabetes or chronic respiratory diseases, universal health coverage index, life expectancy (at birth and at the age of 60). The comprehensive comparative analysis of results permitted to to conclude that the greatest financial costs for health care and best level of infrastructural support (beds and medical personnel) in countries with health insurance system. At that, according to ranking results and all selected integral public health indicators, health insurance system took the first place.

Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019

Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs). We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables. A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981-0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973-0·993) than poorer quintiles (quintile 1 0·991, 0·985-0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57). Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands. UK National Institute for Health and Care Research.

Population mobility : spatial spillover effect of government health expenditure in China

ABSTRACT Background Since the 20th century, pursuing Universal Health Coverage (UHC) has emerged as an important developmental objective in numerous countries and across the global health community. With the intricate ramifications of population mobility (PM), the government faces a mounting imperative to judiciously deploy health expenditure to realise UHC effectively. Objective This study aimed to construct a comprehensive UHC index for China, assess the spatial effects of Government Health Expenditure (GHE) on UHC, and explore the moderating effects of PM on this association. Method A Dynamic Spatial Durbin Model (DSDM) was employed to investigate the influence of the GHE on UHC. Therefore, we tested the moderating effect of PM. Results In the short-term, the GHE negatively impacted local UHC. However, it enhanced the UHC in neighbouring regions. Over the long term, GHE improved local UHC but decreased UHC in neighbouring regions. In the short-term, when the PM exceeded 1.42, the GHE increased the local UHC. Over the long term, when the PM exceeded 1.107, the GHE impeded local UHC. If the PM exceeded 0.91 in the long term, the GHE promoted UHC in neighbouring regions. The results of this study offer a partial explanation of GHE decisions and behaviours. Conclusions To enhance UHC, a viable strategy involves augmenting vertical transfer payments from the central government to local governments. Local governments should institute healthcare systems tailored to the urban scale and developmental stages, with due consideration for PM. Optimising the information disclosure mechanism is also a worthwhile endeavour.

Evaluating health systems' efficiency towards universal health coverage: A data envelopment analysis.

To estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, including the UHC index (a summary measure that captures both service coverage and financial protection) as the output variable and per capita health expenditure, doctors, nurses, and hospital bed density as input variables. We used a Tobit simple-censored regression with bootstrap analysis to observe the socioeconomic and environmental factors associated with efficiency estimates. The global UHC index improved from the 2019 estimates, ranged from 48.4 (Somalia) to 94.8 (Canada), with a mean of 76.9 (std. dev.: ±12.0). Approximately 78.5% (150 of 191) of the studied countries were inefficient (ϕ < 1.0) with respect to using health system resources toward achieving UHC. By improving health system efficiency, low-income, lower-middle-income, upper-middle-income, and high-income countries can improve their UHC indices by 4.6%, 5.5%, 6.8%, and 4.1%, respectively, by using their current resource levels. The percentage of health expenditure spent on primary health care (PHC), governance quality, and the passage of UHC legislation significantly influenced efficiency estimates. Our findings suggests health systems inefficiency toward achieving UHC persists across countries, regardless of their income classifications and WHO regions, as well as indicating that using current level of resources, most countries could boost their progress toward UHC by improving their health system efficiency by increasing investments in PHC, improving health system governance, and where applicable, enacting/implementing UHC legislation.

Feasibility of monitoring Global Breast Cancer Initiative Framework key performance indicators in 21 Asian National Cancer Centers Alliance member countries

The Global Breast Cancer Initiative (GBCI) Framework, launched by the World Health Organisation (WHO) in 2023, emphasises assessing, strengthening, and scaling up services for the early detection and management of breast cancer. This study aims to determine the feasibility of monitoring the status of breast cancer control in the 21 Asian National Cancer Centers Alliance (ANCCA) countries based on the three GBCI Framework key performance indicators (KPIs): stage at diagnosis, time to diagnosis, and treatment completion. We reviewed published literature on breast cancer control among 21 ANCCA countries from May to July 2023 to establish data availability and compiled the latest descriptive statistics and sources of the indicators using a standardised data collection form. We performed bivariate Pearson's correlation analysis to measure the strength of correlation between stage at diagnosis, mortality and survival rates, and universal health coverage. Only 12 (57%) ANCCA member countries published national cancer registry reports on breast cancer age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR). Indonesia, Myanmar, and Nepal had provincial data and others relied on WHO's Global Cancer Observatory (GLOBOCAN) estimates. GLOBOCAN data differed from the reported national statistics by 5-10% in Bhutan, Indonesia, Iran, the Republic of Korea, Singapore, and Thailand and >10% in China, India, Malaysia, Mongolia, and Sri Lanka. The proportion of patients diagnosed in stages I and II strongly correlated with the five-year survival rate and with the universal health coverage (UHC) index. Three countries (14%) reported national data with >60% of invasive breast cancer patients diagnosed at stages I and II, and a five-year survival rate of >80%. Over 60% of the ANCCA countries had no published national data on breast cancer staging, the time interval from presentation to diagnosis, and diagnosis to treatment. Five (24%) countries reported data on treatment completion. The definition of delayed diagnosis and treatment completion varied across countries. GBCI's Pillar 1 KPI correlates strongly with five-year survival rate and with the UHC index. Most ANCCA countries lacked national data on cancer staging, timely diagnosis, and treatment completion KPIs. While institutional-level data were available in some countries, they may not represent the nationwide status. Strengthening cancer surveillance is crucial for effective breast cancer control. The GBCI Framework indicators warrant more detailed definitions for standardised data collection. Surrogate indicators which are measurable and manageable in country-specific settings, could be considered for monitoring GBCI indicators. Ensuring UHC and addressing health inequalities are essential to early diagnosis and treatment of breast cancer. Funding for this research article's processing fee (APC) will be provided by the affiliated institution to support the open-access publication of this work. The funding body is not involved in the study design; collection, management, analysis and interpretation of data; or the decision to submit for publication. The funding body will be informed of any planned publications, and documentation provided.

Global, regional, and national trends in incidence of depression among women, 1990-2019: An analysis of the global burden of disease study

Depression is a common mental disorder and more women are affected by depression than men. In this study, we aimed to analyze the trends in the incidence of depression among women from 1990 to 2019 and their associations with sociodemographic and universal health coverage indices based on data from the Global Burden of Disease study 2019. It was observed that while the incidence rate of depression among women decreased by an average of 0.35% per year at the global level, the incidence rate increased at the regional level for the high sociodemographic index region by an average of 0.39% per year from 1990 to 2019. And the global downward trend in incidence rate from 1990 to 2019 was contributed by the downward trend from 2000 to 2009. In Spearman correlation analyzes at the level of country/territory, a negative correlation between the estimated annual percentage change in the incidence rate and the universal health coverage index was found (ρ=-0.15).

Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries

The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC). In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing. Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries-namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC. Bill & Melinda Gates Foundation.

Gender gap in life expectancy in Europe and the United Kingdom in 2019

Abstract Background Life expectancy (LE) is an important metric for overall population health and well-being. The gender gap in LE can be used as a population health metric to capture progress and monitor health inequality in a specific setting. Health inequality is an expression of universal health care coverage and unequal access to health care and the quality of health care - otherwise known as ‘amenable’ mortality. Methods The Global Burden of Disease (GBD) Study- a comprehensive global epidemiologic database has developed and validated two population health metrics across 200+ countries- the Universal Health Coverage (UHC) Index (0-100) and the Healthcare Access and Quality (HAQ) Index (0-100) to monitor progress in these two specific domains for each country. We set out to examine the association of gender gap in LE with UHC and HAQ indices across 27 EU countries and the UK combined for year 2019 employing correlation and linear regression analyses. Results Overall, LE ranged from 73.3 years in Bulgaria to 83.1 years in Italy; UHC index was worst in Bulgaria (62.6), while Luxembourg (91.5) was the best performing nation; HAQ index had the highest score in the Netherlands (91.1), while Bulgaria had the lowest score (64.9). Lithuania had the largest gender gap in LE (9.2 years; M:71.5; F: 80.7), while the Netherlands had the narrowest gender gap (3.4 years; M:80.0; F: 83.4). On multivariable linear regression, gender gaps in LE were significantly associated with both HAQ (beta: -0.17; R2=0.66), and UHC (beta: -0.14; R2=0.52) across 27 EU countries and the UK combined. Conclusions Gender gap in LE can be a proxy measure to monitor progress in health inequality in terms of universal health care coverage, as well as health care access and quality of health care for a specific population setting. The findings suggest that gender gap in LE can be significantly reduced through expansion of universal health care and improving both access and quality of health care in the EU. Key messages • Gender gap in life expectancy can be a good proxy to monitor progress in health inequality for EU countries and the UK combined, which has 5.5 years of gender gap in life expectancy on average in 2019. • A 10% increase in both universal health care coverage and health care access and quality, can reduce gender gap in life expectancy by 1.4 and 1.7 years, respectively, across EU and the UK combined.

Global disease burden of neonatal jaundice from 1990 to 2019

To examine the global, regional, and national disease burden of neonatal jaundice. The 2019 Global Burden of Disease database was searched to collect incident cases/incidence and deaths/mortality of neonatal jaundice, as well as global socio-demographic index (SDI) and universal health coverage index (UHCI). The epidemiological trend of neonatal jaundice from 1990 to 2019 was analyzed. The correlations between incidence/mortality of neonatal jaundice and SDI and UHCI were evaluated. From 601 681 in 1990 to 626 005 in 2019, with a 4.04% increase in global incident cases of neonatal jaundice. The overall age-standardized incidence rate exhibited an increase [estimated annual percent change=0.13 (95%CI: 0.03 to 0.23)] during this period. Additionally, deaths due to neonatal jaundice decreased by 58.83%, from 128 119 in 1990 to 52 742 in 2019. The overall age-standardized mortality rate showed a decrease [estimated annual percent change=-2.78 (95%CI: -3.00 to -2.57)] over the same period. Countries with lower SDI, such as India, Pakistan, and Nigeria, reported a higher proportion of neonatal morbidity and mortality. In 2019, a negative correlation was observed between estimated annual percent change in age-standardized mortality rate and SDI (ρ=-0.320, P<0.05) or UHCI (ρ=-0.252, P<0.05). The global incidence of neonatal jaundice is on the rise, while the mortality rate is declining. The burden of neonatal jaundice is influenced by social development, economic factors, and the level of medical care.

Geographic disparities in trends of thyroid cancer incidence and mortality from 1990 to 2019 and a projection to 2030 across income-classified countries and territories.

The rising incidence of thyroid cancer (TC) has generated growing concern globally; yet there are no studies examining whether this incidence was followed by a rise in related mortality. We aimed to comprehensively quantify current trends and future projections of TC incidence and mortality, and to explore the association between the TC burden and socioeconomic inequality in different income strata. We obtained incidence and mortality data on TC and population from the 2019 Global Burden of Disease (GBD) study and the United Nations' World Population Prospects 2022. We applied an age-period-cohort (APC) model to estimate the overall annual percentage change (net drift) and age, period, and cohort effects from 1990 to 2019, and also constructed a Bayesian APC model to predict the TC burden through 2030. Over a third of global TC cases belonged to the high-income group. From 1990 to 2019, net drifts of TC incidence were >0 in all income groups, while a modest reduction (net drift <0) in mortality was observed in most income groups, except for the lower-middle-income group. Unfavourable age, period, and cohort effects were most notable in Vietnam, China, and Korea. The age-standardised incidence rate (ASIR) is predicted to increase whereas the age-standardized mortality rate (ASMR) is expected to decrease globally between 2020 and 2030, with geographic heterogeneity being detected across income groups. We observed a positive correlation between ASIR and universal health coverage index and health worker density, but a negative one between ASMR and the two indicators, primarily in upper-middle-income and high-income countries. Opposite patterns in incidence and mortality of TC raise concerns about overdiagnosis, particularly in upper-middle-income and high-income countries. Discrepancies in the distribution of health service accessibility, including diagnostic techniques and therapeutic care, should be addressed by narrowing health inequalities in the TC burden across countries.

Abstract 26: Correlation of Childhood Cancer Mortality Trends and CureAll Metrics for 134 LMICs

Abstract Purpose: Disparities in cancer outcomes still remain in low-and-middle income countries (LMICs), where less than 30% of children living with cancer survive. In this context, the Global Initiative for Childhood Cancer has set the goal of achieving at least 60% survival for all countries by 2030. The aim of this study was to describe trends in childhood mortality rates for LMICs over time and evaluate their association with the health system metrics related to the WHO CureAll framework. Methods: In this ecological study, childhood cancer was defined as all-cancers for the age group of 0-14 years old. Data were collected from public data sources including the Global Burden of Disease, WHO cancer profiles and World Bank. Descriptive analyses were performed to investigate mortality rate patterns over time (1990-2019). Exposure variables including density of hospital beds, density of CT scanners, density of MRI scanners, density of density of external beam radiotherapy, out-of-pocket expenditure, and universal health coverage index were evaluated against percent change of mortality of cancer rates (1990-2019). Smooth regression lines were used to visualize inflections points within income level groups. Results: A total of 134 LMICs were included in this study. Overall, low-income countries had the major decrease in childhood mortality rates from 1900 to 2019. The top three countries with the highest decrease in rates were Malawi, Ethiopia, and Zambia deaths (-22.6 to -9.1/100,000 population). The top three countries with the highest increase in rates were Botswana, Burkina Faso, and Dominica (+1.2 to +1.8 deaths/100,000 population). The factors associated the most with changes in the childhood cancer mortality rates over time were improvements in infrastructure, such as increasing hospital beds and the availability of cancer treatments, increasing universal coverage, and decreasing out-of-pocket expenditures for healthcare costs. Conclusion: An improved understanding of cancer mortality trends and their relation with health system variables in LMICs is important to monitor and evaluate progress in survival rates for children living with cancer in these countries. This study intends to provide insights on the use of health system metrics related to the WHO CureAll framework as priority interventions for childhood cancer in LMICs. Citation Format: Hannah Rice, Emily Smith, Cesia Cotache-Condor, Esther Majaliwa, Pamela Espinoza, Madeline Metcalf, Henry Rice. Correlation of Childhood Cancer Mortality Trends and CureAll Metrics for 134 LMICs [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 26.

Global, Regional, and National Trends in Incidence and Mortality of Primary Liver Cancer and Its Underlying Etiologies from 1990 to 2019: Results from the Global Burden of Disease Study 2019

ObjectivePrimary liver cancer is not only one of the most common causes of cancer deaths but also the second most common cause of premature death worldwide. Understanding the trends in incidence and mortality of primary liver cancer and its etiologies is crucial for development of effective prevention and mitigation strategies. This study aimed to quantify the trends in incidence and mortality of primary liver cancer and its etiologies at the global, regional and national levels using data from Global Burden of Disease (GBD) study.MethodAnnual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of primary liver cancer and its etiologies, including hepatitis B, hepatitis C, alcohol use, nonalcoholic steatohepatitis, and other causes, between 1990 and 2019 were collected from GBD study 2019. Percentage changes in incident cases and deaths and estimated annual percentage changes (EAPCs) in ASIRs and ASMRs of primary liver cancer and its etiologies were calculated to quantify their temporal trends. Correlations of EAPC in ASIRs and ASMRs with socio-demographic index (SDI) and universal health coverage index (UHCI) in 2019 were separately evaluated by Pearson correlation analyses.ResultsGlobally, the incident cases and deaths of primary liver cancer increased by 43.11% from 373 393 in 1990 to 534 365 in 2019 and 32.68% from 365 213 in 1990 to 484 584 in 2019, respectively. ASIR and ASMR of primary liver cancer decreased by an average of 2.23% (95% CI 1.83%, 2.63%) and 1.93% (95% CI 1.55%, 2.31%) per year between 1990 and 2019 worldwide, respectively. ASIRs and ASMRs of primary liver cancer varied between regions, with an increasing trend in ASIR (EAPC = 0.91; 95% CI 0.47, 1.35) and a stable trend in ASMR (EAPC = 0.42, 95% CI − 0.01, 0.85) of primary liver cancer in high SDI region between 1990 and 2019. Nearly half (91/204) of the countries suffered an increasing trend in ASIR of primary liver cancer and more than one-third (71/204) of the countries suffered an increasing trend in ASIRs of primary liver cancer from all etiologies between 1990 and 2019 worldwide. Positive correlations of EAPC in ASIR and ASMR of primary liver cancer with SDI and UHCI were observed in nations with SDI ≥ 0.7 or UHCI ≥ 70.ConclusionPrimary liver cancer remains a major public health concern globally, with an increasing trend in the numbers of incident cases and deaths in the past three decades. We observed an increasing trend in ASIR of primary liver cancer in nearly half of the countries and an increasing trend in ASIRs of primary liver cancer by etiology in more than one-third of the countries worldwide. In line with the Sustainable Development Goals, the identification and elimination of risk factors for primary liver cancer will be required to achieve a sustained reduction in liver cancer burden.

Global Burden of Prostate Cancer and Association with Socioeconomic Status, 1990–2019: A Systematic Analysis from the Global Burden of Disease Study

ImportanceBoth the morbidity and mortality of prostate cancer are increasing worldwide. Updated evaluations of prostate cancer burden and its global, regional and national patterns are essential for formulating effective preventive strategies.ObjectiveTo investigate prostate cancer incidence, mortality, and disability-adjusted life years (DALYs) between 1990 and 2019 to facilitate preventive measures and control planning.MethodsAnnual incident cases, deaths, DALYs, age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and age-standardized DALYs rates (ASDRs) of prostate cancer between 1990 and 2019 were derived from the Global Burden of Diseases study 2019. Percentage changes in incident cases, deaths and DALYs and estimated annual percentage changes (EAPCs) in ASIRs, ASMRs and ASDRs were calculated to quantify temporal trends. Correlations between EAPCs and socio-demographic index (SDI) and universal health coverage index (UHCI) were evaluated by Pearson correlation analyses.ResultsGlobally, the number of incident cases, deaths, and DALYs of prostate cancer increased by 116.11%, 108.94%, and 98.25% from 1990 to 2019, respectively. The ASIR increased by an average of 0.26% (95% CI: 0.14%, 0.37%) per year between 1990 and 2019, while the ASMR and ASDR decreased by an average of – 0.75% (95% CI: – 0.84%, – 0.67%) and – 0.71% (95% CI: – 0.78%, – 0.63%) per year in this period, respectively. Epidemic trends in the burdens of prostate cancer were not uniform throughout different groups of SDI or geography. The burdens of prostate cancer varied across SDI regions, with an increasing trend in ASIR, ASMR, and ASDR in low and low-middle SDI regions between 1990 and 2019. A significant positive correlation between the EAPC in ASIR and UHCI was observed in countries with a UHCI < 70 (ρ = 0.37, p < 0.001).InterpretationProstate cancer remains a major global health burden due to the increase in incident cases, deaths, and DALYs in the past three decades. These increases are likely to continue as the population ages, which indicates a potential talent gap in the trained healthcare workforce. The diversity of prostate cancer development models implies the importance of specific local strategies tailored for each country’s risk factor profile. Prevention, early detection and more effective treatment strategies for prostate cancer are essential.

Global, regional, and national incidence and mortality of neonatal sepsis and other neonatal infections, 1990-2019.

Neonatal infections, especially neonatal sepsis, are one of the major causes of incidence and mortality in pediatrics. However, the global burden of neonatal sepsis and other neonatal infections (NSNIs) remains unclear. From the 2019 global disease burden study, we collected annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized deaths rates (ASDRs) of NSNIs in the past 30 years. Analysis indicators included the percentage of relative changes in incident cases and deaths, and the estimated annual percentage changes (EAPCs) of ASIRs and ASDRs. Correlations were assessed between the EAPCs of ASIRs and ASDRs and social evaluation indicators, including sociodemographic index (SDI) and universal health coverage index (UHCI). Globally, the number of incident cases of NSNIs grew by 12.79% per year, and the number of deaths dropped by 12.93% per year. During this period, global ASIR of NSNIs increased by 46% annually on average, while ASDR decreased by 53% annually on average. The ASIR and ASDR of female NSNIs were consistently lower than that of male NSNIs. The EAPC of female ASIR was 0.61, nearly twice that of male ASIR, and female ASIR was growing rapidly. The same declining trends of ASDR were noted in males and females. The ASIR of NSNIs in high-SDI regions grew by an average of 14% annually from 1990 to 2019. Except for high-SDI regions, the ASIRs of other 4 SDI regions maintained a rising trend at a high level, and were improved in the past 10 years. The ASDRs of all 5 SDI regions generally showed a downward trend. The region with the highest ASIR of NSNIs was Andean Latin America, and Western Sub-Saharan Africa had the highest mortality. We found a negative correlation between EAPCs of ASDRs and UHCI in 2019. The global health situation was still not optimal. The incidence of NSNIs remained high, and continues to rise. The mortality of NSNIs has decreased, especially in the countries/territories with high UHCI. Therefore, it is crucial to improve the overall awareness and management of NSNIs, and take interventions for NSNIs worldwide.

Disparities in the global burden of tracheal, bronchus, and lung cancer from 1990 to 2019.

Tracheal, bronchus, and lung (TBL) cancer imposes a high disease burden globally, and its pattern varies greatly across regions and countries. This study aimed to explore the global burden and temporal trends of TBL cancer from 1990 to 2019. Data on incidence, mortality, and disability-adjusted life years (DALYs) metrics (number, crude rate, and age-standardized rates), and the attributable risk fraction of DALY of TBL cancer from 1990 to 2019 in 21 Global Burden of Disease (GBD) regions, four World Bank income regions, 204 countries and territories, and the globe were obtained from the up-to-date GBD 2019 study. We applied estimated annual percentage changes (EAPCs) to the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) to quantify the temporal trends of the TBL cancer burden from 1990-2019. Associations of EAPC of age-standardized rates with universal health coverage (UHC) index at the national level were evaluated with Pearson correlation analysis. Globally, approximately 2,260,000 new TBL cancer cases, 2,042,600 deaths, and 45,858,000 DALYs were reported in 2019. Combination of all modifiable risk factors, behavioral, environmental, and metabolic risk factors accounted for 79.1%, 66.4%, 33.3%, and 7.9% of global lung cancer DALYs, respectively. The overall ASIR (EAPC: -0.1 [95% confidence interval [CI]: -0.2, -0.1]), ASMR (EAPC: -0.3 [95% CI: -0.4, -0.3]), and ASDR (EAPC: -0.7 [95% CI: -0.7, -0.6]) decreased from 1990 to 2019. The highest mortality rate of TBL cancer occurred in the >85-year-old age group for both sexes among high-income countries (HICs) and upper-middle-income countries (UMCs), and in males aged 80-84 years and females aged >85 years in lower middle-income countries (LMCs). HICs experienced the largest declines in ASIR (-12.6%), ASMR (-20.3%), and ASDR (-27.8%) of TBL cancer between 1990 and 2019, while UMCs had the highest increases in ASIR (16.7%) and ASMR (8.0%) over the period. Eleven (52.4%), 14 (66.7%), and 15 (71.4%) regions of the 21 GBD regions experienced descending trends in ASIR, ASMR, and ASDR of TBL cancer between 1990 and 2019, respectively, with the greatest mean decrease per year (EAPC: -1.7 [95% CI: -2.0, -1.5] for ASIR, -1.9 [95% CI: -2.2, -1.7] for ASMR, and -2.2 [95% CI: -2.5, -2.0] for ASDR) being observed in eastern Europe. The ASIR, ASMR, and ASDR of TBL cancer were deemed to be in decreasing trends in 85, 91, and 104 countries and territories, with the largest decrease in Bahrain (EAPC: -3.0 [95% CI: -3.3, -2.7] for ASIR, -3.0 [95% CI: -3.3, -2.6] for ASMR, and -3.4 [95% CI: -3.8, -3.1] for ASDR). ASIR (r=0.524), ASMR (r=0.411), and ASDR (r=0.353) of TBL cancer were positively associated with UHC index at the national level in 2019. The TBL cancer burden shows a downward trend at the global level but varies greatly across regions and countries. A decreasing trend in the TBL cancer burden was observed in the most of the 21 GBD regions and 204 countries from 1990 to 2019. UMCs had the highest burden of TBL cancer and showed the largest increases in ASIR and ASMR.

Global, regional, and national incidence and mortality of congenital birth defects from 1990 to 2019.

The study aims to estimate the trends in incidence and mortality of congenital birth defects at global, regional, and national levels from 1990 to 2019. Annual incident cases, age-standardized incidence rates (ASIRs), deaths, and age-standardized mortality rates (ASMRs) of congenital birth defects during 1990-2019 were collected from Global Burden of Diseases Study 2019. We calculated percentage of relative changes and estimated annual percentage changes (EAPCs) to quantify temporal trends, and explored potential influence factors of EAPCs using Pearson correlation. Globally, total incident cases and deaths of congenital birth defects were 8.52 million and 0.55 million in 2019. Congenital heart anomalies were the major category of congenital birth defects worldwide in 2019. From 1990 to 2019, the ASIR remained stable (EAPC=0.01, 95% CI -0.03 to 0.05), whereas the ASMR decreased (EAPC=-1.79, 95% CI -1.84 to -1.74). The most pronounced increase in ASIR occurred in low-middle socio-demographic index (SDI) regions (EAPC=0.03, 95% CI 0.01 to 0.06). The number of deaths increased by 14.49% in low SDI regions and the ASMR increased in Southern Sub-Saharan Africa (EAPC=0.17, 95% CI 0.02 to 0.33). Negative correlations of EAPCs in ASIRs and ASMRs with SDI and universal health coverage index values in 2019 were detected at national levels. Conclusions: Congenital birth defects are an important child health problem. There is urgent need to strengthen surveillance and detection of congenital birth defects, build and improve maternal and child healthcare capacity, and promote treatment and rehabilitation, especially in resource-limited countries. What is known: • Congenital birth defects were the fourth leading cause of death among children under 5years in 2019, accounting for nearly 10% of deaths. What is new: • In this study using data from the Global Burden of Disease Study, global incident cases, deaths, and age-standardized mortality rate (ASMR) of congenital birth defects decreased, whereas age-standardized incidence rate (ASIR) remained stable from 1990 to 2019. • From 1990 to 2019, the most pronounced increase in ASIR occurred in Oceania, and the ASMR increased by an average of 0.17% per year in Southern Sub-Saharan Africa.