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Assessing Performance of the Healthcare Access and Quality Index, Overall and by Select Age Groups, for 204 Countries and Territories, 1990–2019: A Systematic Analysis From the Global Burden of Disease Study 2019 Publisher Pubmed



Haakenstad A1, 5 ; Yearwood JA12 ; Fullman N1 ; Bintz C1 ; Bienhoff K1 ; Weaver MR1, 2 ; Nandakumar V1 ; Joffe JN1 ; Legrand KE1 ; Knight M1 ; Abbafati C13 ; Abbasikangevari M14 ; Abdoli A21 ; Zuniga RAA22, 23 Show All Authors
Authors
  1. Haakenstad A1, 5
  2. Yearwood JA12
  3. Fullman N1
  4. Bintz C1
  5. Bienhoff K1
  6. Weaver MR1, 2
  7. Nandakumar V1
  8. Joffe JN1
  9. Legrand KE1
  10. Knight M1
  11. Abbafati C13
  12. Abbasikangevari M14
  13. Abdoli A21
  14. Zuniga RAA22, 23
  15. Adedeji IA24
  16. Adekanmbi V25
  17. Adetokunboh OO27, 28
  18. Afzal MS29
  19. Afzal S30, 31
  20. Agudelobotero M32
  21. Ahinkorah BO34
  22. Ahmad S36
  23. Ahmadi A37, 39
  24. Ahmadi S40
  25. Ahmed A43, 44
  26. Rashid TA45
  27. Aji B46
  28. Akandesholabi W47
  29. Alam K52
  30. Hamad HA50, 51
  31. Alhassan RK53
  32. Ali L56
  33. Alipour V58, 59
  34. Aljunid SM63, 64
  35. Ameyaw EK65
  36. Amin TT66
  37. Amu H54
  38. Amugsi DA67
  39. Ancuceanu R68
  40. Andrade PP71, 72
  41. Anjum A73
  42. Arabloo J58
  43. Arabzozani M74
  44. Ariffin H76, 77
  45. Arulappan J78
  46. Aryan Z6, 14
  47. Ashraf T79
  48. Atnafu DD82
  49. Atreya A83
  50. Ausloos M84, 85
  51. Avilaburgos L86
  52. Ayano G87, 88
  53. Ayanore MA55, 89
  54. Azari S60
  55. Badiye AD90
  56. Baig AA91
  57. Bairwa M92
  58. Bakkannavar SM93
  59. Baliga S98
  60. Banik PC102
  61. Barnighausen TW7, 103
  62. Barra F104
  63. Barrow A107, 108
  64. Basu S8, 109
  65. Bayati M114
  66. Belete R116
  67. Bell AW9, 117
  68. Bhagat DS118
  69. Bhagavathula AS119
  70. Bhardwaj P121, 122
  71. Bhardwaj N120
  72. Bhaskar S125, 126
  73. Bhattacharyya K127, 128
  74. Bhutta ZA129, 130
  75. Bibi S131
  76. Bijani A132
  77. Bikbov B133
  78. Biondi A134
  79. Bolarinwa OA136
  80. Bonny A137, 138
  81. Brenner H139
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  83. Burkart K1, 2
  84. Busse R141
  85. Butt ZA145, 146
  86. Butt NS143
  87. Dos Santos FLC147
  88. Cahuanahurtado L148
  89. Camera LA149, 150
  90. Cardenas R152
  91. Carneiro VLA153, 155
  92. Catalalopez F156, 157
  93. Chandan JS158
  94. Charan J123
  95. Chavan PP159
  96. Chen S103
  97. Chen S103
  98. Choudhari SG163
  99. Chowdhury EK88, 164
  100. Chowdhury MAK169, 171
  101. Cirillo M173
  102. Corso B174
  103. Dadras O175, 176
  104. Dahlawi SMA177
  105. Dai X1, 2
  106. Dandona L1, 180, 181
  107. Dandona R1, 2, 180, 181
  108. Dangel WJ1
  109. Davilacervantes CA182
  110. Davletov K183
  111. Deuba K184, 185
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  113. Dhimal ML187, 188
  114. Djalalinia S190
  115. Do HP191
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  123. El Tantawi M198
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  170. Hostiuc S69, 249
  171. Hoveidamanesh S250
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  174. Huang J253
  175. Huda MM254
  176. Ifeagwu SC256
  177. Ikuta KS1, 3
  178. Ilesanmi OS48, 257
  179. Irvani SSN258
  180. Islam RM165
  181. Islam SMS259, 260
  182. Ismail NE262
  183. Iso H263
  184. Isola G134
  185. Itumalla R265
  186. Iwagami M266, 268
  187. Jahani MA132
  188. Jahanmehr N41, 42
  189. Jain R272, 273
  190. Jakovljevic M274, 275
  191. Janodia MD94
  192. Jayapal SK276
  193. Jayaram S277
  194. Jha RP278, 279
  195. Jonas JB280, 281
  196. Joo T209
  197. Joseph N100
  198. Jurisson M282
  199. Kabir A62
  200. Kalankesh LR194
  201. Kalhor R216, 217
  202. Kamath AM4
  203. Kamenov K283
  204. Kandel H261, 284
  205. Kantar RS285, 286
  206. Kapoor N90
  207. Karanikolos M269, 270
  208. Katikireddi SV287
  209. Kavetskyy T288, 289
  210. Kawakami N290
  211. Kayode GA291, 292
  212. Keikavoosiarani L293
  213. Keykhaei M14, 17
  214. Khader YS294
  215. Khajuria H295
  216. Khalilov R296, 297
  217. Khammarnia M298
  218. Khan MN299
  219. Khan MAB301, 302
  220. Khan M300
  221. Khezeli M303
  222. Kim MS304, 305
  223. Kim YJ306
  224. Kisa S309
  225. Kisa A307, 308
  226. Klymchuk V310, 311
  227. Koly KN245, 271
  228. Korzh O312
  229. Kosen S313
  230. Koul PA314
  231. Defo BK315, 316
  232. Kumar GA180
  233. Kusuma D110, 317
  234. Kyu HH1, 2
  235. Larsson AO318, 319
  236. Lasrado S320
  237. Lee WC26
  238. Lee YH321
  239. Lee CB251
  240. Li S167
  241. Lucchetti G322
  242. Mahajan PB323
  243. Majeed A111
  244. Makki A324
  245. Malekzadeh R18, 115
  246. Malik AA81, 144
  247. Malta DC325
  248. Mansournia MA19
  249. Mantovani LG328, 329
  250. Martinezvalle A33, 330
  251. Martinsmelo FR331
  252. Masoumi SZ332
  253. Mathur MR179, 333
  254. Maude RJ240, 334
  255. Maulik PK161, 335
  256. Mckee M270
  257. Mendoza W337
  258. Menezes RG178
  259. Mensah GA338, 339
  260. Meretoja A340, 342
  261. Meretoja TJ341, 344
  262. Mestrovic T1, 345
  263. Michalek IM346
  264. Mirrakhimov EM347, 348
  265. Misganaw A2, 349
  266. Misra S124
  267. Moazen B103, 350
  268. Mohammadi M351
  269. Mohammed S142, 352
  270. Moitra M1
  271. Mokdad AH1, 2
  272. Molokhia M353
  273. Monasta L355
  274. Moni MA255
  275. Moradi G356, 357
  276. Moreira RS358, 359
  277. Mosser JF1
  278. Mostafavi E360, 361
  279. Mouodi S132
  280. Nagarajan AJ362, 363
  281. Nagata C364
  282. Naghavi M1, 2
  283. Nangia V365
  284. Swamy SN366
  285. Narayana AI95
  286. Nascimento BR326, 327
  287. Nassereldine H1
  288. Nayak BP295
  289. Nazari J367
  290. Negoi I70, 368
  291. Nepal S369
  292. Kandel SN370
  293. Ngunjiri JW371
  294. Nguyen HLT372
  295. Nguyen CT372
  296. Ningrum DNA373, 374
  297. Noubiap JJ375
  298. Oancea B377
  299. Oghenetega OB49
  300. Oh IH378
  301. Olagunju AT379, 380
  302. Olakunde BO381
  303. Bali AO248
  304. Omer E382
  305. Onwujekwe OE383
  306. Otoiu A85
  307. Padubidri JR93
  308. Palladino R111, 173
  309. Pana A85, 384
  310. Pandajonas S385
  311. Pandiperumal SR386
  312. Pardhan S387
  313. Pasupula DK388
  314. Pathak PK389, 390
  315. Patton GC343, 391
  316. Pawar S392
  317. Pereira J393
  318. Pilania M394
  319. Piroozi B356
  320. Podder V376, 395
  321. Pokhrel KN396
  322. Postma MJ397, 398
  323. Prada SI399, 400
  324. Syed ZQ163
  325. Rabiee N228, 401
  326. Radhakrishnan RA95
  327. Rahman MM402
  328. Rahman M403
  329. Rahman M403
  330. Ur Rahman MH404
  331. Rahmani AM405
  332. Ranabhat CL186, 406
  333. Rao CR96
  334. Rao SJ407
  335. Rasella D408
  336. Rawaf S111, 410
  337. Rawaf DL112, 409
  338. Rawal L411
  339. Renzaho AMN412
  340. Reshmi B97, 413
  341. Resnikoff S162, 414
  342. Rezapour A58
  343. Riahi SM75
  344. Ripon RK73
  345. Sacco S415
  346. Sadeghi M416
  347. Saeed U417, 418
  348. Sahebkar A419, 420
  349. Sahiledengle B421
  350. Sahoo H422
  351. Sahu M1
  352. Salama JS1
  353. Salamati P20
  354. Samy AM423
  355. Sanabria J424, 425
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  357. Sathian B50, 428
  358. Sawhney M429
  359. Schmidt MI195
  360. Seidu AA430, 431
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  362. Seylani A432
  363. Shaikh MA433
  364. Sheikh A11, 434
  365. Shetty A101
  366. Shigematsu M435
  367. Shiri R436
  368. Shivakumar KM437
  369. Shokri A356
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  378. Szocska M210
  379. Tabaresseisdedos R447, 448
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  388. Tripathy JP460
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  390. Uezono DR461, 462
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Source: The Lancet Global Health Published:2022


Abstract

Background: Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods: We distinguished the overall HAQ Index (ages 0–74 years) from scores for select age groups: the young (ages 0–14 years), working (ages 15–64 years), and post-working (ages 65–74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings: Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9–21·3), as well as among the young (22·5, 19·9–24·7), working (17·2, 15·2–19·1), and post-working (15·1, 13·2–17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6–33·0) on average in low-SDI countries to 83·4 (82·4–84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4–89·0), working (33·8–82·8), and post-working (30·4–79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. Interpretation: Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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