Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015
Date
2017-07-15Author
Barber, Ryan M
Fullman, Nancy
Sorensen, Reed JD
Bollyky, Thomas
McKee, Martin
Nolte, Ellen
Abajobir, Amanuel Alemu
Abate, Kalkidan Hassen
Abbafati, Cristiana
Abbas, Kaja M
Abd-Allah, Foad
Abdulle, Abdishakur M
Abdurahman, Ahmed Abdulahi
Abera, Semaw Ferede
Abraham, Biju
Abreha, Girmatsion Fisseha
Adane, Kelemework
Adelekan, Ademola Lukman
Adetifa, Ifedayo Morayo O
Afshin, Ashkan
Agarwal, Arnav
Agarwal, Sanjay Kumar
Agarwal, Sunilkumar
Agrawal, Anurag
Kiadaliri, Aliasghar Ahmad
Ahmadi, Alireza
Ahmed, Kedir Yimam
Ahmed, Muktar Beshir
Akinyemi, Rufus Olusola
Akinyemiju, Tomi F
Akseer, Nadia
Al-Aly, Ziyad
Alam, Khurshid
Alam, Noore
Alam, Sayed Saidul
Alemu, Zewdie Aderaw
Alene, Kefyalew Addis
Alexander, Lily
Ali, Raghib
Ali, Syed Danish
Alizadeh-Navaei, Reza
Alkerwi, Ala'a
Alla, François
Allebeck, Peter
Allen, Christine
Al-Raddadi, Rajaa
Alsharif, Ubai
Altirkawi, Khalid A
Alvarez Martin, Elena
Alvis-Guzman, Nelson
Amare, Azmeraw T
Amini, Erfan
Ammar, Walid
Amo-Adjei, Joshu
Amoako, Yaw Ampem
Anderson, Benjamin O
Androudi, Sofia
Ansari, Hossein
Ansha, Mustafa Geleto
T Antonio, Carl Abelardo
Ärnlöv, Johan
Artaman, Al
Asayesh, Hamid
Assadi, Reza
Astatkie, Ayalew
Atey, Tesfay Mehari
Atique, Suleman
Atnafu, Niguse Tadele
Atre, Sachin R
Avila-Burgos, Leticia
Arthur Avokpaho, Euripide Frinel G
Ayala Quintanilla, Beatriz Paulina
Awasthi, Ashish
Ayele, Nebiyu Negussu
Azzopardi, Peter
Ba Saleem, Huda Omer
Bärnighausen, Till
Bacha, Umar
Badawi, Alaa
Banerjee, Amitava
Barac, Aleksandra
Barboza, Miguel A
Barker-Collo, Suzanne L
Barrero, Lope H
Basu, Sanjay
Baune, Bernhard T
Baye, Kaleab
Bayou, Yibeltal Tebekaw
Bazargan-Hejazi, Shahrzad
Bedi, Neeraj
Beghi, Ettore
Béjot, Yannick
Bello, Aminu K
Bennett, Derrick A
Bensenor, Isabela M
Berhane, Adugnaw
Bernabé, Eduardo
Bernal, Oscar Alberto
Beyene, Addisu Shunu
Beyene, Tariku Jibat
Bhutta, Zulfiqar A
Biadgilign, Sibhatu
Bikbov, Boris
Birlik, Sait Mentes
Birungi, Charles
Biryukov, Stan
Bisanzio, Donal
Bizuayehu, Habtamu Mellie
Bose, Dipan
Brainin, Michael
Brauer, Michael
Brazinova, Alexandra
Breitborde, Nicholas JK
Brenner, Hermann
Butt, Zahid A
Cárdenas, Rosario
Cahuana-Hurtado, Lucero
Campos-Nonato, Ismael Ricardo
Car, Josip
Carrero, Juan Jesus
Casey, Daniel
Caso, Valeria
Castañeda-Orjuela, Carlos A
Castillo Rivas, Jacqueline
Catalá-López, Ferrán
Cecilio, Pedro
Cercy, Kelly
Charlson, Fiona J
Chen, Alan Z
Chew, Adrienne
Chibalabala, Mirriam
Chibueze, Chioma Ezinne
Chisumpa, Vesper Hichilombwe
Chitheer, Abdulaal A
Chowdhury, Rajiv
Christensen, Hanne
Christopher, Devasahayam Jesudas
Ciobanu, Liliana G
Cirillo, Massimo
Coggeshall, Megan S
Cooper, Leslie Trumbull
Cortinovis, Monica
Crump, John A
Dalal, Koustuv
Danawi, Hadi
Dandona, Lalit
Dandona, Rakhi
Dargan, Paul I
Neves, Jose Das
Davey, Gail
Metadata
Show full item recordAbstract
Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.
Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.