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201. Policy analysis of the Iranian Health Transformation Plan in primary healthcare.

Author: Doshmangir, Leila, Moshiri, Esmaeil, Mostafavi, Hakimeh, Sakha, Minoo Alipouri, and Assan, Abraham
Subjects: *POLICY analysis, *HEALTH care reform, *PRIMARY care, *FISCAL capacity, *CAMPAIGN promises
Abstract: Background: Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran.Methods: Qualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson's policy triangle model incorporating the stages heuristic model was used to guide data analysis.Results: The HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development - a gap that occurred because politicians were in a great haste to fulfil a campaign promise.Conclusions: Health reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives. [ABSTRACT FROM AUTHOR]
Published: 2019
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202. A roadmap for strengthening evidence-informed health policy-making in Iran: protocol for a research programme.

Author: Sajadi, Haniye Sadat, Majdzadeh, Reza, Yazdizadeh, Bahareh, Mohtasham, Farideh, Mohseni, Mahsa, Doshmangir, Leila, and Lavis, John
Subjects: MEDICAL care accountability, STAKEHOLDER analysis, FACTOR analysis, DEVELOPING countries, QUALITATIVE research, MEASURING instruments
Abstract: Background: Many initiatives have been taken in the Islamic Republic of Iran to promote evidence-informed health policy-making (EIHP). However, these initiatives are not systematic. Since the implementation of EIHP is not consistent and the interventions in this regard are complex, a comprehensive plan could be a useful tool for employing initiatives to achieve and promote EIHP. Hence, this study aims to develop a roadmap for strengthening EIHP over a 3-year period in Iran.Methods: Nine projects will be conducted to define the roadmap for strengthening EIHP. These projects include two reviews and a stakeholder analysis to identify the factors that facilitate or hinder achieving EIHP. The next study will be a qualitative study to prioritise the challenges and outline the main causes. The following steps will be a review of reviews to extract global experiences on interventions used for strengthening EIHP and two qualitative studies to examine the adoption of these interventions and develop an operational plan for strengthening EIHP in Iran. The research will be completed through conducting two qualitative-quantitative studies to design a tool for measuring EIHP and assessing EIHP in Iran at baseline.Discussion: This national EIHP roadmap will surely be able to identify the gaps and bumps that might exist in the implementation plan for establishing EIHP and eliminate them as needed in the future. This roadmap can be a step in moving towards transparency and accountability in the health system and as thus towards good governance and improvement of the health system's performance. Although the plan can be a good model for developing countries and may promote the use of evidence in health policy-making, we should assume that there are some critical contextual factors that could potentially hinder the complete and successful implementation of EIHP. Thus, to enhance EIHP in these countries with a policy-making context that does not fully support the use of evidence, it is crucial to think about not only those interventions that directly address the EIHP barriers, but also some long-term strategies to make required changes in the context, both beyond and within the health system. [ABSTRACT FROM AUTHOR]
Published: 2019
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203. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Author: Burstein, Roy, Henry, Nathaniel J, Collison, Michael L, Marczak, Laurie B, Sligar, Amber, Watson, Stefanie, Marquez, Neal, Abbasalizad-Farhangi, Mahdieh, Abbasi, Masoumeh, Abd-Allah, Foad, Abdoli, Amir, Abdollahi, Mohammad, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abrigo, Michael RM, Acharya, Dilaram, Adebayo, Oladimeji M, Adekanmbi, Victor, Adham, Davoud, Afshari, Mahdi, Aghaali, Mohammad, Ahmadi, Keivan, Ahmadi, Mehdi, Ahmadpour, Ehsan, Ahmed, Rushdia, Akal, Chalachew Genet, Akinyemi, Joshua O, Alahdab, Fares, Alam, Noore, Alamene, Genet Melak, Alene, Kefyalew Addis, Alijanzadeh, Mehran, Alinia, Cyrus, Alipour, Vahid, Aljunid, Syed Mohamed, Almalki, Mohammed J, Al-Mekhlafi, Hesham M, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amegah, Adeladza Kofi, Amini, Saeed, Amit, Arianna Maever Loreche, Anbari, Zohreh, Androudi, Sofia, Anjomshoa, Mina, Ansari, Fereshteh, Antonio, Carl Abelardo T, Arabloo, Jalal, Arefi, Zohreh, Aremu, Olatunde, Armoon, Bahram, Arora, Amit, Artaman, Al, Asadi, Anvar, Asadi-Aliabadi, Mehran, Ashraf-Ganjouei, Amir, Assadi, Reza, Ataeinia, Bahar, Atre, Sachin R, Quintanilla, Beatriz Paulina Ayala, Ayanore, Martin Amogre, Azari, Samad, Babaee, Ebrahim, Babazadeh, Arefeh, Badawi, Alaa, Bagheri, Soghra, Bagherzadeh, Mojtaba, Baheiraei, Nafiseh, Balouchi, Abbas, Barac, Aleksandra, Bassat, Quique, Baune, Bernhard T, Bayati, Mohsen, Bedi, Neeraj, Beghi, Ettore, Behzadifar, Masoud, Behzadifar, Meysam, Belay, Yared Belete, Bell, Brent, Bell, Michelle L, Berbada, Dessalegn Ajema, Bernstein, Robert S, Bhattacharjee, Natalia V, Bhattarai, Suraj, Bhutta, Zulfiqar A, Bijani, Ali, Bohlouli, Somayeh, Breitborde, Nicholas JK, Britton, Gabrielle, Browne, Annie J, Nagaraja, Sharath Burugina, Busse, Reinhard, Butt, Zahid A, Car, Josip, Cárdenas, Rosario, Castañeda-Orjuela, Carlos A, Cerin, Ester, Chanie, Wagaye Fentahun, Chatterjee, Pranab, Chu, Dinh-Toi, Cooper, Cyrus, Costa, Vera M, Dalal, Koustuv, Dandona, Lalit, Dandona, Rakhi, Daoud, Farah, Daryani, Ahmad, Das Gupta, Rajat, Davis, Ian, Davis Weaver, Nicole, Davitoiu, Dragos Virgil, De Neve, Jan-Walter, Demeke, Feleke Mekonnen, Demoz, Gebre Teklemariam, Deribe, Kebede, Desai, Rupak, Deshpande, Aniruddha, Desyibelew, Hanna Demelash, Dey, Sagnik, Dharmaratne, Samath Dhamminda, Dhimal, Meghnath, Diaz, Daniel, Doshmangir, Leila, Duraes, Andre R, Dwyer-Lindgren, Laura, Earl, Lucas, Ebrahimi, Roya, Ebrahimpour, Soheil, Effiong, Andem, Eftekhari, Aziz, Ehsani-Chimeh, Elham, El Sayed, Iman, El Sayed Zaki, Maysaa, El Tantawi, Maha, El-Khatib, Ziad, Emamian, Mohammad Hassan, Enany, Shymaa, Eskandarieh, Sharareh, Eyawo, Oghenowede, Ezalarab, Maha, Faramarzi, Mahbobeh, Fareed, Mohammad, Faridnia, Roghiyeh, Faro, Andre, Fazaeli, Ali Akbar, Fazlzadeh, Mehdi, Fentahun, Netsanet, Fereshtehnejad, Seyed-Mohammad, Fernandes, João C, Filip, Irina, Fischer, Florian, Foigt, Nataliya A, Foroutan, Masoud, Francis, Joel Msafiri, Fukumoto, Takeshi, Fullman, Nancy, Gallus, Silvano, Gebre, Destallem Gebremedhin, Gebrehiwot, Tsegaye Tewelde, Gebremeskel, Gebreamlak Gebremedhn, Gessner, Bradford D, Geta, Birhanu, Gething, Peter W, Ghadimi, Reza, Ghadiri, Keyghobad, Ghajarzadeh, Mahsa, Ghashghaee, Ahmad, Gill, Paramjit Singh, Gill, Tiffany K, Golding, Nick, Gomes, Nelson GM, Gona, Philimon N, Gopalani, Sameer Vali, Gorini, Giuseppe, Goulart, Bárbara Niegia Garcia, Graetz, Nicholas, Greaves, Felix, Green, Manfred S, Guo, Yuming, Haj-Mirzaian, Arvin, Haj-Mirzaian, Arya, Hall, Brian James, Hamidi, Samer, Haririan, Hamidreza, Haro, Josep Maria, Hasankhani, Milad, Hasanpoor, Edris, Hasanzadeh, Amir, Hassankhani, Hadi, Hassen, Hamid Yimam, Hegazy, Mohamed I, Hendrie, Delia, Heydarpour, Fatemeh, Hird, Thomas R, Hoang, Chi Linh, Hollerich, Gillian, Rad, Enayatollah Homaie, Hoseini-Ghahfarokhi, Mojtaba, Hossain, Naznin, Hosseini, Mostafa, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Househ, Mowafa, Hsairi, Mohamed, Ilesanmi, Olayinka Stephen, Imani-Nasab, Mohammad Hasan, Iqbal, Usman, Irvani, Seyed Sina Naghibi, Islam, Nazrul, Islam, Sheikh Mohammed Shariful, Jürisson, Mikk, Balalami, Nader Jafari, Jalali, Amir, Javidnia, Javad, Jayatilleke, Achala Upendra, Jenabi, Ensiyeh, Ji, John S, Jobanputra, Yash B, Johnson, Kimberly, Jonas, Jost B, Shushtari, Zahra Jorjoran, Jozwiak, Jacek Jerzy, Kabir, Ali, Kahsay, Amaha, Kalani, Hamed, Kalhor, Rohollah, Karami, Manoochehr, Karki, Surendra, Kasaeian, Amir, Kassebaum, Nicholas J, Keiyoro, Peter Njenga, Kemp, Grant Rodgers, Khabiri, Roghayeh, Khader, Yousef Saleh, Khafaie, Morteza Abdullatif, Khan, Ejaz Ahmad, Khan, Junaid, Khan, Muhammad Shahzeb, Khang, Young-Ho, Khatab, Khaled, Khater, Amir, Khater, Mona M, Khatony, Alireza, Khazaei, Mohammad, Khazaei, Salman, Khazaei-Pool, Maryam, Khubchandani, Jagdish, Kianipour, Neda, Kim, Yun Jin, Kimokoti, Ruth W, Kinyoki, Damaris K, Kisa, Adnan, Kisa, Sezer, Kolola, Tufa, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Kraemer, Moritz UG, Krishan, Kewal, Krohn, Kris J, Kugbey, Nuworza, Kumar, G Anil, Kumar, Manasi, Kumar, Pushpendra, Kuupiel, Desmond, Lacey, Ben, Lad, Sheetal D, Lami, Faris Hasan, Larsson, Anders O, Lee, Paul H, Leili, Mostafa, Levine, Aubrey J, Li, Shanshan, Lim, Lee-Ling, Listl, Stefan, Longbottom, Joshua, Lopez, Jaifred Christian F, Lorkowski, Stefan, Magdeldin, Sameh, Abd El Razek, Hassan Magdy, Abd El Razek, Muhammed Magdy, Majeed, Azeem, Maleki, Afshin, Malekzadeh, Reza, Malta, Deborah Carvalho, Mamun, Abdullah A, Manafi, Navid, Manda, Ana-Laura, Mansourian, Morteza, Martins-Melo, Francisco Rogerlândio, Masaka, Anthony, Massenburg, Benjamin Ballard, Maulik, Pallab K, Mayala, Benjamin K, Mazidi, Mohsen, McKee, Martin, Mehrotra, Ravi, Mehta, Kala M, Meles, Gebrekiros Gebremichael, Mendoza, Walter, Menezes, Ritesh G, Meretoja, Atte, Meretoja, Tuomo J, Mestrovic, Tomislav, Miller, Ted R, Miller-Petrie, Molly K, Mills, Edward J, Milne, George J, Mini, GK, Mir, Seyed Mostafa, Mirjalali, Hamed, Mirrakhimov, Erkin M, Mohamadi, Efat, Mohammad, Dara K, Darwesh, Aso Mohammad, Mezerji, Naser Mohammad Gholi, Mohammed, Ammas Siraj, Mohammed, Shafiu, Mokdad, Ali H, Molokhia, Mariam, Monasta, Lorenzo, Moodley, Yoshan, Moosazadeh, Mahmood, Moradi, Ghobad, Moradi, Masoud, Moradi, Yousef, Moradi-Lakeh, Maziar, Moradinazar, Mehdi, Moraga, Paula, Morawska, Lidia, Mosapour, Abbas, Mousavi, Seyyed Meysam, Mueller, Ulrich Otto, Muluneh, Atalay Goshu, Mustafa, Ghulam, Nabavizadeh, Behnam, Naderi, Mehdi, Nagarajan, Ahamarshan Jayaraman, Nahvijou, Azin, Najafi, Farid, Nangia, Vinay, Ndwandwe, Duduzile Edith, Neamati, Nahid, Negoi, Ionut, Negoi, Ruxandra Irina, Ngunjiri, Josephine W, Thi Nguyen, Huong Lan, Nguyen, Long Hoang, Nguyen, Son Hoang, Nielsen, Katie R, Ningrum, Dina Nur Anggraini, Nirayo, Yirga Legesse, Nixon, Molly R, Nnaji, Chukwudi A, Nojomi, Marzieh, Noroozi, Mehdi, Nosratnejad, Shirin, Noubiap, Jean Jacques, Motlagh, Soraya Nouraei, Ofori-Asenso, Richard, Ogbo, Felix Akpojene, Oladimeji, Kelechi E, Olagunju, Andrew T, Olfatifar, Meysam, Olum, Solomon, Olusanya, Bolajoko Olubukunola, Oluwasanu, Mojisola Morenike, Onwujekwe, Obinna E, Oren, Eyal, Ortega-Altamirano, Doris DV, Ortiz, Alberto, Osarenotor, Osayomwanbo, Osei, Frank B, Osgood-Zimmerman, Aaron E, Otstavnov, Stanislav S, Owolabi, Mayowa Ojo, P A, Mahesh, Pagheh, Abdol Sattar, Pakhale, Smita, Panda-Jonas, Songhomitra, Pandey, Animika, Park, Eun-Kee, Parsian, Hadi, Pashaei, Tahereh, Patel, Sangram Kishor, Pepito, Veincent Christian Filipino, Pereira, Alexandre, Perkins, Samantha, Pickering, Brandon V, Pilgrim, Thomas, Pirestani, Majid, Piroozi, Bakhtiar, Pirsaheb, Meghdad, Plana-Ripoll, Oleguer, Pourjafar, Hadi, Puri, Parul, Qorbani, Mostafa, Quintana, Hedley, Rabiee, Mohammad, Rabiee, Navid, Radfar, Amir, Rafiei, Alireza, Rahim, Fakher, Rahimi, Zohreh, Rahimi-Movaghar, Vafa, Rahimzadeh, Shadi, Rajati, Fatemeh, Raju, Sree Bhushan, Ramezankhani, Azra, Ranabhat, Chhabi Lal, Rasella, Davide, Rashedi, Vahid, Rawal, Lal, Reiner, Robert C, Renzaho, Andre MN, Rezaei, Satar, Rezapour, Aziz, Riahi, Seyed Mohammad, Ribeiro, Ana Isabel, Roever, Leonardo, Roro, Elias Merdassa, Roser, Max, Roshandel, Gholamreza, Roshani, Daem, Rostami, Ali, Rubagotti, Enrico, Rubino, Salvatore, Sabour, Siamak, Sadat, Nafis, Sadeghi, Ehsan, Saeedi, Reza, Safari, Yahya, Safari-Faramani, Roya, Safdarian, Mahdi, Sahebkar, Amirhossein, Salahshoor, Mohammad Reza, Salam, Nasir, Salamati, Payman, Salehi, Farkhonde, Zahabi, Saleh Salehi, Salimi, Yahya, Salimzadeh, Hamideh, Salomon, Joshua A, Sambala, Evanson Zondani, Samy, Abdallah M, Santric Milicevic, Milena M, Jose, Bruno Piassi Sao, Saraswathy, Sivan Yegnanarayana Iyer, Sarmiento-Suárez, Rodrigo, Sartorius, Benn, Sathian, Brijesh, Saxena, Sonia, Sbarra, Alyssa N, Schaeffer, Lauren E, Schwebel, David C, Sepanlou, Sadaf G, Seyedmousavi, Seyedmojtaba, Shaahmadi, Faramarz, Shaikh, Masood Ali, Shams-Beyranvand, Mehran, Shamshirian, Amir, Shamsizadeh, Morteza, Sharafi, Kiomars, Sharif, Mehdi, Sharif-Alhoseini, Mahdi, Sharifi, Hamid, Sharma, Jayendra, Sharma, Rajesh, Sheikh, Aziz, Shields, Chloe, Shigematsu, Mika, Shiri, Rahman, Shiue, Ivy, Shuval, Kerem, Siddiqi, Tariq J, Silva, João Pedro, Singh, Jasvinder A, Sinha, Dhirendra Narain, Sisay, Malede Mequanent, Sisay, Solomon, Sliwa, Karen, Smith, David L, Somayaji, Ranjani, Soofi, Moslem, Soriano, Joan B, Sreeramareddy, Chandrashekhar T, Sudaryanto, Agus, Sufiyan, Mu'awiyyah Babale, Sykes, Bryan L, Sylaja, PN, Tabarés-Seisdedos, Rafael, Tabb, Karen M, Tabuchi, Takahiro, Taveira, Nuno, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Tessema, Zemenu Tadesse, Thankappan, Kavumpurathu Raman, Thirunavukkarasu, Sathish, To, Quyen G, Tovani-Palone, Marcos Roberto, Tran, Bach Xuan, Tran, Khanh Bao, Ullah, Irfan, Usman, Muhammad Shariq, Uthman, Olalekan A, Vahedian-Azimi, Amir, Valdez, Pascual R, Van Boven, Job FM, Vasankari, Tommi Juhani, Vasseghian, Yasser, Veisani, Yousef, Venketasubramanian, Narayanaswamy, Violante, Francesco S, Vladimirov, Sergey Konstantinovitch, Vlassov, Vasily, Vos, Theo, Vu, Giang Thu, Vujcic, Isidora S, Waheed, Yasir, Wakefield, Jon, Wang, Haidong, Wang, Yafeng, Wang, Yuan-Pang, Ward, Joseph L, Weintraub, Robert G, Weldegwergs, Kidu Gidey, Weldesamuel, Girmay Teklay, Westerman, Ronny, Wiysonge, Charles Shey, Wondafrash, Dawit Zewdu, Woyczynski, Lauren, Wu, Ai-Min, Xu, Gelin, Yadegar, Abbas, Yamada, Tomohide, Yazdi-Feyzabadi, Vahid, Yilgwan, Christopher Sabo, Yip, Paul, Yonemoto, Naohiro, Lebni, Javad Yoosefi, Younis, Mustafa Z, Yousefifard, Mahmoud, Yousof, Hebat-Allah Salah A, Yu, Chuanhua, Yusefzadeh, Hasan, Zabeh, Erfan, Moghadam, Telma Zahirian, Bin Zaman, Sojib, Zamani, Mohammad, Zandian, Hamed, Zangeneh, Alireza, Zerfu, Taddese Alemu, Zhang, Yunquan, Ziapour, Arash, Zodpey, Sanjay, Murray, Christopher JL, and Hay, Simon I
Subjects: Geography, United Nations, 1. No poverty, Infant, Newborn, Infant, Global Health, 3. Good health, Socioeconomic Factors, Child Mortality, Infant Mortality, Humans, Organizational Objectives, Public Health, 10. No inequality, Child
Abstract: Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

204. Lessons learned from conducting a national health survey (Iran’s multiple indicators demographic and health survey 2010)

Author: Doshmangir, Leila, Rashidian, Arash, Elham Shakibazadeh, Rashidian, Elham, and Elahi, Elham
Subjects: lcsh:Public aspects of medicine, lcsh:RA1-1270
Abstract: No Abstract.

205. Assessment of medical equipment maintenance management: proposed checklist using Iranian experience.

Author: Arab-Zozani, Morteza, Imani, Ali, Doshmangir, Leila, Dalal, Koustuv, and Bahreini, Rona
Subjects: *MEDICAL equipment, *BIOMEDICAL engineering, *EQUIPMENT maintenance & repair, *HEALTH facilities, *INDUSTRIAL equipment maintenance & repair, *RELIABILITY in engineering
Abstract: Background: Effective maintenance management of medical equipment is one of the major issues for quality of care, for providing cost-effective health services and for saving scarce resources. This study aimed to develop a comprehensive checklist for assessing the medical equipment maintenance management (MEMM) in the Iranian hospitals.Methods: This is a multi-methods study. First, data related to factors which affect the assessment of MEMM were collected through a systematic review in PubMed, ProQuest, Scopus, Embase, and web of science without any time limitation until October 2015, updated in June 2017. Then, we investigated these factors affecting using document review and interviews with experts in the Iranian hospitals. In the end, the results of the first and second stages were combined using content analysis and the final checklist was developed in a two-round Delphi.Results: Using a combination of factors extracted from the systematic and qualitative studies, the primary checklist was developed in the form of assessment checklists in seven dimensions. The final checklist includes 7 dimensions and 19 sub-categories: "resources = 3," "quality control = 3," "information bank = 4," "education = 1," "service = 3," "inspection and preventive maintenance = 2" and "design and implementation = 3."Conclusions: Developing an assessment checklist for MEMM provide a comprehensive framework for the proper implementation of accurate assessment of medical equipment maintenance. This checklist can be used to improve the profitability of health facilities and the reliability of medical equipment. In addition, it is implicated in the decision-making in support of selection, purchase, repair and maintenance of medical equipment, especially for capital equipment managers and medical engineers in hospitals and also for the assessment of this process. [ABSTRACT FROM AUTHOR]
Published: 2021
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206. Analysis of controversial driving licensing policies in Iran: Experts' viewpoints.

Author: Sadeghi-Bazargani, Homayoun, Razzaghi, Alireza, Saadati, Mohammad, Golestani, Mina, and Doshmangir, Leila
Subjects: *PRESTIGE, *ORGANIZATIONAL transparency, *TRAFFIC safety, *TRAFFIC police, *TRAFFIC fatalities, *LICENSE system, *ROAD safety measures
Abstract: • The escalating issue of road traffic injuries and fatalities has become a pressing national concern in Iran. The situation urgently calls for a thorough assessment of current policies and the implementation of evidence-based approaches in order to mitigate this deleterious process. • Over the past few decades, several policies regarding driving licensing have been implemented in the interest of safe driving, yet without taking into account the optimal scientific evidence. • It is of utmost importance to provide high prestige evidence in support of the predominant contentious measures and topics concerning the issuance of driving licenses. • A prudent approach towards evidence-informed policy making would involve engaging diverse stakeholders to offer viable alternatives for these contentious issues in the driving licensing system. Licensing policies for driving play a vital role in promoting road safety and decreasing road traffic injuries. Although there have been notable improvements in driving licensing policies in recent years, some policies in Iran are still contentious and controversial. This research aims to examine these controversial driving licensing policies in Iran by using the perspectives of Iranian experts and reviewing relevant documents. A variety of research methods were used to conduct the study, including focus group discussions (FGDs) and a review of relevant documents. Participants were selected through purposive sampling, using a diverse and comprehensive approach. To collect documents for review, national websites such as the Iranian Parliament, Traffic Police and the Ministry of Roads and Urban Development were thoroughly searched, while some documents were collected in person. The data was analysed using a thematic approach. Over the past decades, certain policy issues have continued to pose significant challenges and controversies. These policies within the Iranian driving system have been divided into three main categories including leadership and responsiveness, driver qualifications and vehicle characteristics, and health assessment procedures and standards. The development and implementation of evidence-based policies necessitates the thorough examination and analysis of contentious and complicated policies related to driving licensing, and ultimately contributes to an improved driving experience in Iran. It is advisable to undertake coherent and systematic initiatives, enhance transparency and accountability within the licensing policy framework, and involve policy stakeholders and diverse interest groups, while taking into account the structural, cultural and societal influences on any policy intervention in driving licensing. [ABSTRACT FROM AUTHOR]
Published: 2024
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207. EVALUATING THE PRINCIPLES IN WHICH THE DECISIONS ABOUT PIVOTAL MATTERS IN IRANIAN HEALTH SYSTEM ARE MADE.

Author: Doshmangir, Leila and Rashidian, Arash
Abstract: Background and aims: This study aimed to evaluate the basis in which the decisions about pivotal matters in Iranian health system are made and how these decisions are in accordance with the best available evidence. Methods: To conduct this qualitative study, in the first step, four main issues with a high degree of importance, novelty and significant impact on health system were selected as follows: outsourcing clinical and Para-clinical services and health sectors to the private sector, global payment system to the hospitals and listing or delisting of pharmaceuticals from insurance coverage. In the next step, along with reviewing reports, documents and papers, semi-structured interviews were conducted with policymakers, experts and officials involved in the formulation and implementation of the selected issues. In the following step, a comprehensive search was carried out to find the research studies on the mentioned topics (fundamental evidence of policy-making). In the final stage, the results of the interviews and documentary analysis were compared with the best acquired evidence from the research studies. As a result, analytical model about decision making and interpretation method of evidence informed policy making in the health system were extracted. Results: In Iranian health system, evidence production is limited and the produced evidence is moderately applied in decision-making. Most decisions are made subconsciously, intuitively, fast, with low cognitive load and based on experiences. In recent years, due to the increasing number of researchers, awareness about modern methods of research and using evidence in decision-making is increasing gradually in the health system. Conclusion: Developing the importance and role of using evidence in making better decisions and policies for health managers and policy-makers and localizing global evidence are proper ways to enhance the use of evidence-informed decision-making approach in Iranian health system. [ABSTRACT FROM AUTHOR]
Published: 2017
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208. EXPLORING FACTORS INFLUENCING OVER-MEDICALIZATION: A SCOPING REVIEW.

Author: Doshmangir, Parinaz, Doshmangir, Leila, and Shaghaghi, Reza
Abstract: Background and aims: Medicalization is the process of extending medical gaze on human conditions which is not intrinsically bad phenomenon. Engaging in the medicalization out of defined thresholds or the bad form of medicalization is called over-medicalization. Detriment, dispensable death and waste of numerous resources are the causes of over-medicalization. The aim of this scoping review was to explore influential factors on over medicalization in the world. Methods: We did search in PubMed, Scopus, Cochrane, Ovid, Proquest as reliable databases. Articles that were investigated determinants of over medicalization in different themes were selected. All data entered in data extractions table and Meta synthesis method was used for qualitative research. Factors were grouped according to the musicalized subjects and categorized into three levels (personal, professional and social). Results: Out of 5118 articles identified for the study, over 70 factors were extracted from 30 articles addressing factors affecting over medicalization in various subjects. Among the extracted factors, the social and professional factors were respectively more than personal factors. Conclusion: Over-medicalization originates from a wide range of factors. Identifying potential influential factors in provision of unnecessary care is pivotal to eliminate the menace of this phenomenon. Extra social, political and cultural resources will be needed if the reported factors are to be tackled. [ABSTRACT FROM AUTHOR]
Published: 2017
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209. A systematic synthesis of expert opinion on effective policies to tackle bacterial resistance worldwide.

Author: Mostafaei, Ali, Akbari, Hamid, Lundborg, Cecilia Stålsby, Kabiri, Neda, Vahed, Nafiseh, Hajebrahimi, Sakineh, and Doshmangir, Leila
Subjects: *DRUG resistance in bacteria, *CINAHL database, *DATABASE searching, *ANTIBACTERIAL agents, *DRUG prescribing, *PUBLIC hospitals
Abstract: Actions that are taken to preserve effective antibacterial agents and eliminate transmission of resistant organisms are crucial to prevent a catastrophic postantibiotic era. In this systematic review, we searched and appraised relevant texts and expert opinions to determine effective strategies to tackle bacterial resistance worldwide. We considered expert opinions, consensus, current discourses, comments, assumptions or assertions and discussion papers published in English. We searched following databases for expert opinion‐based literature: MEDLINE, CINAHL, ISI Web of Knowledge, SCOPUS, Cochrane Central Register of Controlled Trials and World Health Organization (WHO). We extracted the textual data from texts using a standardised data extraction tool. Textual pooling was not possible, so the conclusions were presented in a narrative form. Eighteen texts were included in this review. The findings show that, the most repeated policies and strategies include implementing and strengthening bacterial resistance surveillance, developing national guidelines, improving public awareness; enhancing home and everyday life hygiene; improving prescribing patterns, improving laboratories capacity, promoting innovation and research in new drugs and technology and strengthening coordination. This review systematically gathered strategies that were recommended by textual publications. To our knowledge, this was the first systematic review of text and opinion in the field of bacterial resistance. These results can be used by policymakers, hospital managers, and governments, alongside the results of quantitative and qualitative systematic reviews. [ABSTRACT FROM AUTHOR]
Published: 2023
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210. Time to fast-track interventions to road traffic crises in Iran.

Author: Sadeghi-Bazargani, Homayoun, Razzaghi, Alireza, Bazargan-Hejazi, Shahrzad, and Doshmangir, Leila
Subjects: *CRISES, *ROADS
Published: 2024
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211. Policy options for strengthening evidence-informed health policy-making in Iran: overall SASHA project findings.

Author: Majdzadeh, Reza, Sajadi, Haniye Sadat, Yazdizadeh, Bahareh, Doshmangir, Leila, Ehsani-Chimeh, Elham, Mahdavi, Mahdi, Mehrdad, Neda, Lavis, John, Nikooee, Sima, Mohtasham, Farideh, Mohseni, Mahsa, Akbari, Paria, Asgardoon, Mohammad Hossein, Rezaei, Niloofar, Neyazi, Narges, Ghaffarifar, Saeideh, Haghdoost, Ali Akbar, Khodayari-Zarnaq, Rahim, Mosadeghrad, Ali Mohammad, and Pourabbasi, Ata
Subjects: *ROAD maps, *POLICY sciences, *VOTING registers, *PUBLIC opinion polls
Abstract: Background: The institutionalization of evidence-informed health policy-making (EIHP) is complex and complicated. It is complex because it has many players and is complicated because its institutionalization will require many changes that will be challenging to make. Like many other issues, strengthening EIHP needs a road map, which should consider challenges and address them through effective, harmonized and contextualized strategies. This study aims to develop a road map for enhancing EIHP in Iran based on steps of planning.Methods: This study consisted of three phases: (1) identifying barriers to EIHP, (2) recognizing interventions and (3) measuring the use of evidence in Iran's health policy-making. A set of activities was established for conducting these, including foresight, systematic review and policy dialogue, to identify the current and potential barriers for the first phase. For the second phase, an evidence synthesis was performed through a scoping review, by searching the websites of benchmark institutions which had good examples of EIHP practices in order to extract and identify interventions, and through eight policy dialogues and two broad opinion polls to contextualize the list of interventions. Simultaneously, two qualitative-quantitative studies were conducted to design and use a tool for assessing EIHP in the third phase.Results: We identified 97 barriers to EIHP and categorized them into three groups, including 35 barriers on the "generation of evidence" (push side), 41 on the "use of evidence" (pull side) and 21 on the "interaction between these two" (exchange side). The list of 41 interventions identified through evidence synthesis and eight policy dialogues was reduced to 32 interventions after two expert opinion polling rounds. These interventions were classified into four main strategies for strengthening (1) the education and training system (6 interventions), (2) the incentives programmes (7 interventions), (3) the structure of policy support organizations (4 interventions) and (4) the enabling processes to support EIHP (15 interventions).Conclusion: The policy options developed in the study provide a comprehensive framework to chart a path for strengthening the country's EIHP considering both global practices and the context of Iran. It is recommended that operational plans be prepared for road map interventions, and the necessary resources provided for their implementation. The implementation of the road map will require attention to the principles of good governance, with a focus on transparency and accountability. Video abstract. [ABSTRACT FROM AUTHOR]
Published: 2022
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212. Preventing and controlling water pipe smoking: a systematic review of management interventions.

Author: Babaie, Javad, Ahmadi, Ayat, Abdollahi, Gholamreza, and Doshmangir, Leila
Subjects: *TOBACCO pipes, *PIPE smoking, *PHYSIOLOGICAL effects of tobacco, *SUBSTANCE use of teenagers, *SMOKING prevention, TOBACCO & health
Abstract: Background: Water pipe smoking (WPS) is re-gaining widespread use and popularity among various groups of people, especially adolescents. Despite different adverse health effects of WPS, many of the WPS interventions have failed to control this type of tobacco smoking. This study was conducted to identify experienced management interventions in preventing and controlling WPS worldwide.Methods: A systematic literature review was conducted. Electronic databases were searched for recordes which were published from beginning 1990 to August 2018. Studies aiming at evaluating, at least, one intervention in preventing and controlling WPS were included in this review, followed by performing the quality assessment and data extraction of eligible studies by two independent investigators. Finally, interventions that were identified from the content analysis process were discussed and classified into relevant categories.Results: After deleting duplications, 2228 out of 4343 retrieved records remained and 38 studies were selected as the main corpus of the present study. Then, the identified 27 interventions were grouped into four main categories including preventive (5, 18.51%) and control (8, 29.62%) interventions, as well as the enactment and implementation of legislations and policies for controlling WPS at national (7, 25.92%) and international (7, 25.92%) levels.Conclusion: The current enforced legislations for preventing and controlling WPS are not supported by rigorous evidence. Informed school-based interventions, especially among adolescents can lead to promising results in preventing and controlling WPS and decreasing the effects of this important social and health crisis in the global arena. [ABSTRACT FROM AUTHOR]
Published: 2021
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213. Combining health insurance funds in a fragmented context: what kind of challenges should be considered?

Author: Bazyar, Mohammad, Rashidian, Arash, Alipouri Sakha, Minoo, Vaez Mahdavi, Mohammad Reza, and Doshmangir, Leila
Subjects: *HEALTH insurance, *HEALTH care reform, *INSURANCE funding, *HEALTH funding, *HEALTH insurance laws
Abstract: Background: Iran's Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran.Methods: A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework.Results: This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to "the justification of the consolidation process" in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system.Conclusions: Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations. [ABSTRACT FROM AUTHOR]
Published: 2020
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214. Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Author: Angela E Micah, Kayleigh Bhangdia, Ian E Cogswell, Dylan Lasher, Brendan Lidral-Porter, Emilie R Maddison, Trang Nhu Ngoc Nguyen, Nishali Patel, Paola Pedroza, Juan Solorio, Hayley Stutzman, Golsum Tsakalos, Yifeng Wang, Wesley Warriner, Yingxi Zhao, Bianca S Zlavog, Cristiana Abbafati, Jaffar Abbas, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Michael Abdelmasseh, Deldar Morad Abdulah, Aidin Abedi, Kedir Hussein Abegaz, E S Abhilash, Richard Gyan Aboagye, Hassan Abolhassani, Michael R M Abrigo, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Mohammed Hussien Adem, Muhammad Sohail Afzal, Ali Ahmadi, Haroon Ahmed, Tarik Ahmed Rashid, Budi Aji, Hossein Akbarialiabad, Yibeltal Akelew, Hanadi Al Hamad, Khurshid Alam, Fahad Mashhour Alanezi, Turki M Alanzi, Mohammed Khaled Al-Hanawi, Robert Kaba Alhassan, Syed Mohamed Aljunid, Sami Almustanyir, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Azmeraw T Amare, Edward Kwabena Ameyaw, Mostafa Amini-Rarani, Hubert Amu, Robert Ancuceanu, Tudorel Andrei, Sumadi Lukman Anwar, Francis Appiah, Muhammad Aqeel, Jalal Arabloo, Morteza Arab-Zozani, Aleksandr Y Aravkin, Olatunde Aremu, Raphael Taiwo Aruleba, Seyyed Shamsadin Athari, Leticia Avila-Burgos, Martin Amogre Ayanore, Samad Azari, Atif Amin Baig, Abere Tilahun Bantie, Amadou Barrow, Pritish Baskaran, Sanjay Basu, Abdul-Monim Mohammad Batiha, Bernhard T Baune, Zombor Berezvai, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Micheal Kofi Boachie, Virginia Bodolica, João Silva Botelho Botelho, Dejana Braithwaite, Nicholas J K Breitborde, Reinhard Busse, Lucero Cahuana-Hurtado, Ferrán Catalá-López, Collins Chansa, Jaykaran Charan, Vijay Kumar Chattu, Simiao Chen, Isaac Sunday Chukwu, Omid Dadras, Lalit Dandona, Rakhi Dandona, Abdollah Dargahi, Sisay Abebe Debela, Edgar Denova-Gutiérrez, Belay Desye, Samath Dhamminda Dharmaratne, Nancy Diao, Linh Phuong Doan, Milad Dodangeh, Wendel Mombaque dos Santos, Leila Doshmangir, John Dube, Ebrahim Eini, Maysaa El Sayed Zaki, Maha El Tantawi, Daniel Berhanie Enyew, Sharareh Eskandarieh, Mohamad Ezati Asar, Adeniyi Francis Fagbamigbe, Emerito Jose A Faraon, Ali Fatehizadeh, Hamed Fattahi, Ginenus Fekadu, Florian Fischer, Nataliya A Foigt, Kayode Raphael Fowobaje, Alberto Freitas, Takeshi Fukumoto, Nancy Fullman, Peter Andras Gaal, Amiran Gamkrelidze, M A Garcia-Gordillo, Mesfin Gebrehiwot, Urge Gerema, Mansour Ghafourifard, Seyyed-Hadi Ghamari, Reza Ghanbari, Ahmad Ghashghaee, Ali Gholamrezanezhad, Mahaveer Golechha, Davide Golinelli, Yitayal Ayalew Goshu, Girma Garedew Goyomsa, Avirup Guha, Damitha Asanga Gunawardane, Bhawna Gupta, Samer Hamidi, Harapan Harapan, Reza Hashempour, Khezar Hayat, Golnaz Heidari, Ileana Heredia-Pi, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Yuta Hiraike, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Mohammad Enamul Hoque, Mehdi Hosseinzadeh, Sorin Hostiuc, Salman Hussain, Olayinka Stephen Ilesanmi, Mustapha Immurana, Arnaud Iradukunda, Nahlah Elkudssiah Ismail, Gaetano Isola, Linda Merin J, Mihajlo Jakovljevic, Mahsa Jalili, Manthan Dilipkumar Janodia, Tahereh Javaheri, Sathish Kumar Jayapal, Digisie Mequanint Jemere, Tamas Joo, Nitin Joseph, Jacek Jerzy Jozwiak, Mikk Jürisson, Billingsley Kaambwa, Vidya Kadashetti, Rajendra Kadel, Dler Hussein Kadir, Laleh R Kalankesh, Rajesh Kamath, Himal Kandel, Rami S Kantar, Shama D Karanth, Ibraheem M Karaye, Salah Eddin Karimi, Bekalu Getnet Kassa, Gbenga A Kayode, Leila Keikavoosi-Arani, Vikash Ranjan Keshri, Cumali Keskin, Yousef Saleh Khader, Morteza Abdullatif Khafaie, Himanshu Khajuria, Hamid Reza Khayat Kashani, Zemene Demelash Kifle, Hanna Kim, Jihee Kim, Min Seo Kim, Yun Jin Kim, Adnan Kisa, Stefan Kohler, Farzad Kompani, Soewarta Kosen, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Dian Kusuma, Judit Lám, Demetris Lamnisos, Anders O Larsson, Sang-woong Lee, Shaun Wen Huey Lee, Wei-Chen Lee, Yo Han Lee, Jacopo Lenzi, Lee-Ling Lim, László Lorenzovici, Rafael Lozano, Vanessa Sintra Machado Machado, Farzan Madadizadeh, Mohammed Magdy Abd El Razek, Razzagh Mahmoudi, Azeem Majeed, Mohammad-Reza Malekpour, Ana Laura Manda, Borhan Mansouri, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Carlos Alberto Marrugo Arnedo, Miquel Martorell, Ali Masoud, Elezebeth Mathews, Richard James Maude, Enkeleint A Mechili, Entezar Mehrabi Nasab, José João João Mendes Mendes, Atte Meretoja, Tuomo J Meretoja, Mohamed Kamal Mesregah, Tomislav Mestrovic, Andreea Mirica, Erkin M Mirrakhimov, Mizan Kiros Mirutse, Moonis Mirza, Mohammad Mirza-Aghazadeh-Attari, Awoke Misganaw, Marcello Moccia, Javad Moghadasi, Esmaeil Mohammadi, Mokhtar Mohammadi, Abdollah Mohammadian-Hafshejani, Marita Mohammadshahi, Shafiu Mohammed, Mohammad Mohseni, Ali H Mokdad, Lorenzo Monasta, Elias Mossialos, Ebrahim Mostafavi, Haleh Mousavi Isfahani, Christine Mpundu-Kaambwa, Shruti Murthy, Saravanan Muthupandian, Ahamarshan Jayaraman Nagarajan, Kovin S Naidoo, Mukhammad David Naimzada, Vinay Nangia, Atta Abbas Naqvi, Biswa Prakash Nayak, Rawlance Ndejjo, Trang Huyen Nguyen, Nafise Noroozi, Jean Jacques Noubiap, Khan M Nuruzzaman, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Felix Chukwudi Abrahams Obi, Abiola Ogunkoya, In-Hwan Oh, Osaretin Christabel Okonji, Andrew T Olagunju, Tinuke O Olagunju, Babayemi Oluwaseun Olakunde, Ahmed Omar Bali, Obinna E Onwujekwe, John Nelson Opio, Adrian Otoiu, Nikita Otstavnov, Stanislav S Otstavnov, Mayowa O Owolabi, Tamás Palicz, Raffaele Palladino, Adrian Pana, Tarang Parekh, Deepak Kumar Pasupula, Jay Patel, George C Patton, Uttam Paudel, Mihaela Paun, Shrikant Pawar, Simone Perna, Navaraj Perumalsamy, Ionela-Roxana Petcu, Zahra Zahid Piracha, Mohsen Poursadeqiyan, Naeimeh Pourtaheri, Sergio I Prada, Sima Rafiei, Pankaja Raghav Raghav, Fakher Rahim, Mohammad Hifz Ur Rahman, Mosiur Rahman, Amir Masoud Rahmani, Chhabi Lal Ranabhat, Temam Beshir Raru, Sina Rashedi, Mohammad-Mahdi Rashidi, Ramin Ravangard, Salman Rawaf, Reza Rawassizadeh, Elrashdy Moustafa Mohamed Redwan, Robert C Reiner, Andre M N Renzaho, Maryam Rezaei, Nazila Rezaei, Mavra A Riaz, Jefferson Antonio Buendia Rodriguez, Aly M A Saad, Basema Saddik, Saeid Sadeghian, Mohammad Reza Saeb, Umar Saeed, Maitreyi Sahu, Morteza Saki, Payman Salamati, Hedayat Salari, Sana Salehi, Abdallah M Samy, Juan Sanabria, Francesco Sanmarchi, João Vasco Santos, Milena M Santric-Milicevic, Bruno Piassi Sao Jose, Yaser Sarikhani, Brijesh Sathian, Maheswar Satpathy, Miloje Savic, Yaser Sayadi, Falk Schwendicke, Subramanian Senthilkumaran, Sadaf G Sepanlou, Edson Serván-Mori, Naomi Setshegetso, Allen Seylani, Saeed Shahabi, Masood Ali Shaikh, Murad Ziyaudinovich Shakhmardanov, Mohd Shanawaz, Mequannent Melaku Sharew Sharew, Nigussie Tadesse Sharew, Rajesh Sharma, Maryam Shayan, Aziz Sheikh, Suchitra M Shenoy, Adithi Shetty, Pavanchand H Shetty, K M Shivakumar, Luís Manuel Lopes Rodrigues Silva, Wudneh Simegn, Jasvinder A Singh, Kuldeep Singh, Natia Skhvitaridze, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Bogdan Socea, Yonatan Solomon, Suhang Song, Simona Cătălina Ștefan, Muhammad Suleman, Rafael Tabarés-Seisdedos, Nathan Y Tat, Vivian Y Tat, Belay Negash Tefera, Ales Tichopad, Ruoyan Tobe-Gai, Marcos Roberto Tovani-Palone, Lorainne Tudor Car, Derara Girma Tufa, Tommi Juhani Vasankari, Milena Vasic, Dominique Vervoort, Vasily Vlassov, Bay Vo, Linh Gia Vu, Yasir Waheed, Richard G Wamai, Cong Wang, Gizachew Tadesse Wassie, Nuwan Darshana Wickramasinghe, Sanni Yaya, Arzu Yigit, Vahit Yiğit, Naohiro Yonemoto, Mustafa Z Younis, Chuanhua Yu, Ismaeel Yunusa, Leila Zaki, Burhan Abdullah Zaman, Alireza Zangeneh, Ali Zare Dehnavi, Mikhail Sergeevich Zastrozhin, Wu Zeng, Zhi-Jiang Zhang, Liesl J Zuhlke, Yves Miel H Zuniga, Simon I Hay, Christopher J L Murray, Joseph L Dieleman, Micah, Angela E, Bhangdia, Kayleigh, Cogswell, Ian E, Lasher, Dylan, Lidral-Porter, Brendan, Maddison, Emilie R, Nguyen, Trang Nhu Ngoc, Patel, Nishali, Pedroza, Paola, Solorio, Juan, Stutzman, Hayley, Tsakalos, Golsum, Wang, Yifeng, Warriner, Wesley, Zhao, Yingxi, Zlavog, Bianca S, Abbafati, Cristiana, Abbas, Jaffar, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abdelmasseh, Michael, Abdulah, Deldar Morad, Abedi, Aidin, Abegaz, Kedir Hussein, Abhilash, E S, Aboagye, Richard Gyan, Abolhassani, Hassan, Abrigo, Michael R M, Abubaker Ali, Hiwa, Abu-Gharbieh, Eman, Adem, Mohammed Hussien, Afzal, Muhammad Sohail, Ahmadi, Ali, Ahmed, Haroon, Ahmed Rashid, Tarik, Aji, Budi, Akbarialiabad, Hossein, Akelew, Yibeltal, Al Hamad, Hanadi, Alam, Khurshid, Alanezi, Fahad Mashhour, Alanzi, Turki M, Al-Hanawi, Mohammed Khaled, Alhassan, Robert Kaba, Aljunid, Syed Mohamed, Almustanyir, Sami, Al-Raddadi, Rajaa M, Alvis-Guzman, Nelson, Alvis-Zakzuk, Nelson J, Amare, Azmeraw T, Ameyaw, Edward Kwabena, Amini-Rarani, Mostafa, Amu, Hubert, Ancuceanu, Robert, Andrei, Tudorel, Anwar, Sumadi Lukman, Appiah, Franci, Aqeel, Muhammad, Arabloo, Jalal, Arab-Zozani, Morteza, Aravkin, Aleksandr Y, Aremu, Olatunde, Aruleba, Raphael Taiwo, Athari, Seyyed Shamsadin, Avila-Burgos, Leticia, Ayanore, Martin Amogre, Azari, Samad, Baig, Atif Amin, Bantie, Abere Tilahun, Barrow, Amadou, Baskaran, Pritish, Basu, Sanjay, Batiha, Abdul-Monim Mohammad, Baune, Bernhard T, Berezvai, Zombor, Bhardwaj, Nikha, Bhardwaj, Pankaj, Bhaskar, Sonu, Boachie, Micheal Kofi, Bodolica, Virginia, Botelho, João Silva Botelho, Braithwaite, Dejana, Breitborde, Nicholas J K, Busse, Reinhard, Cahuana-Hurtado, Lucero, Catalá-López, Ferrán, Chansa, Collin, Charan, Jaykaran, Chattu, Vijay Kumar, Chen, Simiao, Chukwu, Isaac Sunday, Dadras, Omid, Dandona, Lalit, Dandona, Rakhi, Dargahi, Abdollah, Debela, Sisay Abebe, Denova-Gutiérrez, Edgar, Desye, Belay, Dharmaratne, Samath Dhamminda, Diao, Nancy, Doan, Linh Phuong, Dodangeh, Milad, dos Santos, Wendel Mombaque, Doshmangir, Leila, Dube, John, Eini, Ebrahim, El Sayed Zaki, Maysaa, El Tantawi, Maha, Enyew, Daniel Berhanie, Eskandarieh, Sharareh, Ezati Asar, Mohamad, Fagbamigbe, Adeniyi Franci, Faraon, Emerito Jose A, Fatehizadeh, Ali, Fattahi, Hamed, Fekadu, Ginenu, Fischer, Florian, Foigt, Nataliya A, Fowobaje, Kayode Raphael, Freitas, Alberto, Fukumoto, Takeshi, Fullman, Nancy, Gaal, Peter Andra, Gamkrelidze, Amiran, Garcia-Gordillo, M A, Gebrehiwot, Mesfin, Gerema, Urge, Ghafourifard, Mansour, Ghamari, Seyyed-Hadi, Ghanbari, Reza, Ghashghaee, Ahmad, Gholamrezanezhad, Ali, Golechha, Mahaveer, Golinelli, Davide, Goshu, Yitayal Ayalew, Goyomsa, Girma Garedew, Guha, Avirup, Gunawardane, Damitha Asanga, Gupta, Bhawna, Hamidi, Samer, Harapan, Harapan, Hashempour, Reza, Hayat, Khezar, Heidari, Golnaz, Heredia-Pi, Ileana, Herteliu, Claudiu, Heyi, Demisu Zenbaba, Hezam, Kamal, Hiraike, Yuta, Hlongwa, Mbuzeleni Mbuzeleni, Holla, Ramesh, Hoque, Mohammad Enamul, Hosseinzadeh, Mehdi, Hostiuc, Sorin, Hussain, Salman, Ilesanmi, Olayinka Stephen, Immurana, Mustapha, Iradukunda, Arnaud, Ismail, Nahlah Elkudssiah, Isola, Gaetano, J, Linda Merin, Jakovljevic, Mihajlo, Jalili, Mahsa, Janodia, Manthan Dilipkumar, Javaheri, Tahereh, Jayapal, Sathish Kumar, Jemere, Digisie Mequanint, Joo, Tama, Joseph, Nitin, Jozwiak, Jacek Jerzy, Jürisson, Mikk, Kaambwa, Billingsley, Kadashetti, Vidya, Kadel, Rajendra, Kadir, Dler Hussein, Kalankesh, Laleh R, Kamath, Rajesh, Kandel, Himal, Kantar, Rami S, Karanth, Shama D, Karaye, Ibraheem M, Karimi, Salah Eddin, Kassa, Bekalu Getnet, Kayode, Gbenga A, Keikavoosi-Arani, Leila, Keshri, Vikash Ranjan, Keskin, Cumali, Khader, Yousef Saleh, Khafaie, Morteza Abdullatif, Khajuria, Himanshu, Khayat Kashani, Hamid Reza, Kifle, Zemene Demelash, Kim, Hanna, Kim, Jihee, Kim, Min Seo, Kim, Yun Jin, Kisa, Adnan, Kohler, Stefan, Kompani, Farzad, Kosen, Soewarta, Koulmane Laxminarayana, Sindhura Lakshmi, Koyanagi, Ai, Krishan, Kewal, Kusuma, Dian, Lám, Judit, Lamnisos, Demetri, Larsson, Anders O, Lee, Sang-woong, Lee, Shaun Wen Huey, Lee, Wei-Chen, Lee, Yo Han, Lenzi, Jacopo, Lim, Lee-Ling, Lorenzovici, László, Lozano, Rafael, Machado, Vanessa Sintra Machado, Madadizadeh, Farzan, Magdy Abd El Razek, Mohammed, Mahmoudi, Razzagh, Majeed, Azeem, Malekpour, Mohammad-Reza, Manda, Ana Laura, Mansouri, Borhan, Mansournia, Mohammad Ali, Mantovani, Lorenzo Giovanni, Marrugo Arnedo, Carlos Alberto, Martorell, Miquel, Masoud, Ali, Mathews, Elezebeth, Maude, Richard Jame, Mechili, Enkeleint A, Mehrabi Nasab, Entezar, Mendes, José João João Mende, Meretoja, Atte, Meretoja, Tuomo J, Mesregah, Mohamed Kamal, Mestrovic, Tomislav, Mirica, Andreea, Mirrakhimov, Erkin M, Mirutse, Mizan Kiro, Mirza, Mooni, Mirza-Aghazadeh-Attari, Mohammad, Misganaw, Awoke, Moccia, Marcello, Moghadasi, Javad, Mohammadi, Esmaeil, Mohammadi, Mokhtar, Mohammadian-Hafshejani, Abdollah, Mohammadshahi, Marita, Mohammed, Shafiu, Mohseni, Mohammad, Mokdad, Ali H, Monasta, Lorenzo, Mossialos, Elia, Mostafavi, Ebrahim, Mousavi Isfahani, Haleh, Mpundu-Kaambwa, Christine, Murthy, Shruti, Muthupandian, Saravanan, Nagarajan, Ahamarshan Jayaraman, Naidoo, Kovin S, Naimzada, Mukhammad David, Nangia, Vinay, Naqvi, Atta Abba, Nayak, Biswa Prakash, Ndejjo, Rawlance, Nguyen, Trang Huyen, Noroozi, Nafise, Noubiap, Jean Jacque, Nuruzzaman, Khan M, Nzoputam, Chimezie Igwegbe, Nzoputam, Ogochukwu Janet, Oancea, Bogdan, Obi, Felix Chukwudi Abraham, Ogunkoya, Abiola, Oh, In-Hwan, Okonji, Osaretin Christabel, Olagunju, Andrew T, Olagunju, Tinuke O, Olakunde, Babayemi Oluwaseun, Omar Bali, Ahmed, Onwujekwe, Obinna E, Opio, John Nelson, Otoiu, Adrian, Otstavnov, Nikita, Otstavnov, Stanislav S, Owolabi, Mayowa O, Palicz, Tamá, Palladino, Raffaele, Pana, Adrian, Parekh, Tarang, Pasupula, Deepak Kumar, Patel, Jay, Patton, George C, Paudel, Uttam, Paun, Mihaela, Pawar, Shrikant, Perna, Simone, Perumalsamy, Navaraj, Petcu, Ionela-Roxana, Piracha, Zahra Zahid, Poursadeqiyan, Mohsen, Pourtaheri, Naeimeh, Prada, Sergio I, Rafiei, Sima, Raghav, Pankaja Raghav, Rahim, Fakher, Rahman, Mohammad Hifz Ur, Rahman, 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Subjects: coordination, communication, outbreak response, COVID-19, GBD, response plan, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, contact management, pandemic Covid 19, financing, epidemic alert, epidemiological investigation, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, international health regulation, surveillance, Global burden disease, global spending, preparedne
Abstract: Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9 center dot 2 trillion (95% uncertainty interval [UI] 9 center dot 1-9 center dot 3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7 center dot 3 trillion (95% UI 7 center dot 2-7 center dot 4) in 2019; 293 center dot 7 times the $24 center dot 8 billion (95% UI 24 center dot 3-25 center dot 3) spent by low-income countries in 2019. That same year, $43 center dot 1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1 center dot 8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37 center dot 8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12 center dot 2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health -related COVID-19 response is 252 center dot 2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11-21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained. For complete list of authors see http://dx.doi.org/10.1016/S2214-109X(23)00007-4
Published: 2023

215. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Author: Abbafati, C., Machado, D.B., Cislaghi, B., Salman, O.M., Karanikolos, M., McKee, M., Abbas, K.M., Brady, O.J., Larson, H.J., Trias-Llimós, S., Cummins, S., Langan, S.M., Sartorius, B., Hafiz, A., Jenabi, E., Mohammad Gholi Mezerji, N., Borzouei, S., Azarian, G., Khazaei, S., Abbasi, M., Asghari, B., Masoumi, S., Komaki, H., Taherkhani, A., Adabi, M., Abbasifard, M., Bazmandegan, G., Kamiab, Z., Vakilian, A., Anjomshoa, M., Mokari, A., Sabour, S., Shahbaz, M., Saeedi, R., Ahmadieh, H., Yousefinezhadi, T., Haj-Mirzaian, A., Nikbakhsh, R., Safi, S., Asgari, S., Irvani, S.N., Jahanmehr, N., Ramezanzadeh, K., Abbasi-Kangevari, M., Khayamzadeh, M., Abbastabar, H., Shirkoohi, R., Fazlzadeh, M., Janjani, H., Hosseini, M., Mansournia, M., Tohidinik, H., Bakhtiari, A., Fazaeli, A., Mousavi, S., Hasanzadeh, A., Nabavizadeh, B., Malekzadeh, R., Hashemian, M., Pourshams, A., Salimzadeh, H., Sepanlou, S.G., Afarideh, M., Esteghamati, A., Esteghamati, S., Ghajar, A., Heidari, B., Rezaei, N., Mohamadi, E., Rahimi-Movaghar, A., Rahim, F., Eskandarieh, S., Sahraian, M., Mohebi, F., Aminorroaya, A., Ebrahimi, H., Farzadfar, F., Mohajer, B., Pishgar, F., Saeedi Moghaddam, S., Shabani, M., Zarafshan, H., Abolhassani, H., Hafezi-Nejad, N., Heidari-Soureshjani, R., Abdollahi, M., Farahmand, M., Salamati, P., Mehrabi Nasab, E., Tajdini, M., Aghamir, S., Mirzaei, R., Dibaji Forooshani, Z., Khater, M.M., Abd-Allah, F., Abdelalim, A., Abualhasan, A., El-Jaafary, S.I., Hassan, A., Elsharkawy, A., Khater, A.M., Elhabashy, H.R., Salem, M.R.R., Salem, H., Sadeghi, M., Jafarinia, M., Amini-Rarani, M., Mohammadifard, N., Sarrafzadegan, N., Abdollahpour, I., Sarveazad, A., Tehrani-Banihashemi, A., Yoosefi Lebni, J., Manafi, N., Pazoki Toroudi, H., Dorostkar, F., Alipour, V., Sheikhtaheri, A., Arabloo, J., Azari, S., Ghashghaee, A., Rezapour, A., Naserbakht, M., Kabir, A., Mehri, F., Yousefifard, M., Asadi-Aliabadi, M., Babaee, E., Eshrati, B., Goharinezhad, S., Moradi-Lakeh, M., Abedi, P., 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Mokari, Amin, Mokdad, Ali H, Momen, Natalie C, Monasta, Lorenzo, Mooney, Meghan D, Moradi, Ghobad, Moradi, Masoud, Moradi-Joo, Mohammad, Moradi-Lakeh, Maziar, Moradzadeh, Rahmatollah, Moraga, Paula, Moreno Velásquez, Ilai, Morgado-da-Costa, Joana, Morrison, Shane Dougla, Mosser, Jonathan F, Mouodi, Simin, Mousavi, Seyyed Meysam, Mousavi Khaneghah, Amin, Mueller, Ulrich Otto, Musa, Kamarul Imran, Muthupandian, Saravanan, Nabavizadeh, Behnam, Naderi, Mehdi, Nagarajan, Ahamarshan Jayaraman, Naghavi, Mohsen, Naghshtabrizi, Behshad, Naik, Gurudatta, Najafi, Farid, Nangia, Vinay, Nansseu, Jobert Richie, Ndwandwe, Duduzile Edith, Negoi, Ionut, Negoi, Ruxandra Irina, Ngunjiri, Josephine W, Nguyen, Huong Lan Thi, Nguyen, Trang Huyen, Nigatu, Yeshambel T, Nikbakhsh, Rajan, Nikpoor, Amin Reza, Nixon, Molly R, Nnaji, Chukwudi A, Nomura, Shuhei, Noubiap, Jean Jacque, Nouraei Motlagh, Soraya, Nowak, Christoph, Oţoiu, Adrian, Odell, Christopher M, Oh, In-Hwan, Oladnabi, Morteza, Olagunju, Andrew T, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Omar Bali, Ahmed, Ong, Kanyin L, Onwujekwe, Obinna E, Ortiz, Alberto, Otstavnov, Nikita, Otstavnov, Stanislav S, Øverland, Simon, Owolabi, Mayowa O, P A, Mahesh, Padubidri, Jagadish Rao, Pakshir, Keyvan, Palladino, Raffaele, Pana, Adrian, Panda-Jonas, Songhomitra, Park, Jame, Pasupula, Deepak Kumar, Patel, Jenil R, Patel, Sangram Kishor, Patton, George C, Paulson, Katherine R, Pazoki Toroudi, Hamidreza, Pease, Spencer A, Peden, Amy E, Pepito, Veincent Christian Filipino, Peprah, Emmanuel K, Pereira, Alexandre, Pereira, David M, Perico, Norberto, Pigott, David M, Pilgrim, Thoma, Pilz, Tessa M, Piradov, Michael A, Pirsaheb, Meghdad, Pokhrel, Khem Narayan, Postma, Maarten J, Pourjafar, Hadi, Pourmalek, Farshad, Pourshams, Akram, Poznańska, Anna, Prada, Sergio I, Prakash, Sanjay, Preotescu, Liliana, Quazi Syed, Zahiruddin, Rabiee, Mohammad, Rabiee, Navid, Radfar, Amir, Rafiei, Alireza, Raggi, Alberto, Rahman, Muhammad Aziz, Rajabpour-Sanati, Ali, Ram, Pradhum, Ranabhat, Chhabi Lal, Rao, Sowmya J, Rasella, Davide, Rashedi, Vahid, Rastogi, Prateek, Rathi, Priya, Rawal, Lal, Remuzzi, Giuseppe, Renjith, Vishnu, Renzaho, Andre M N, Resnikoff, Serge, Rezaei, Nima, Rezai, Mohammad sadegh, Rezapour, Aziz, Rickard, Jennifer, Roever, Leonardo, Ronfani, Luca, Roshandel, Gholamreza, Rostamian, Morteza, Rubagotti, Enrico, Rwegerera, Godfrey M, Sabour, Siamak, Saddik, Basema, Sadeghi, Ehsan, Sadeghi, Masoumeh, Saeedi Moghaddam, Sahar, Safari, Yahya, Safi, Sare, Safiri, Saeid, Sagar, Rajesh, Sahebkar, Amirhossein, Sahraian, Mohammad Ali, Sajadi, S Mohammad, Salahshoor, Mohammad Reza, Salama, Joseph S, Salamati, Payman, Salem, Marwa R Rashad, Salimi, Yahya, Salomon, Joshua A, Salz, Inbal, Samad, Zainab, Samy, Abdallah M, Sanabria, Juan, Santric-Milicevic, Milena M, Saraswathy, Sivan Yegnanarayana Iyer, Sartorius, Benn, Sarveazad, Arash, Sathian, Brijesh, Sathish, Thirunavukkarasu, Sattin, Davide, Saylan, Mete, Schaeffer, Lauren E, Schiavolin, Silvia, Schwebel, David C, Schwendicke, Falk, Sekerija, Mario, Senbeta, Anbissa Muleta, Senthilkumaran, Subramanian, Sepanlou, Sadaf G, Serván-Mori, Edson, Shabani, Mahsima, Shahabi, Saeed, Shahbaz, Mohammad, Shaheen, Amira A, Shaikh, Masood Ali, Shalash, Ali S, Shams-Beyranvand, Mehran, Shamsi, Mohammadbagher, Shamsizadeh, Morteza, Shannawaz, Mohammed, Sharafi, Kiomar, Sharafi, Zeinab, Sharara, Fablina, Sharma, Rajesh, Shaw, David H, Sheikh, Aziz, Shin, Jae Il, Shiri, Rahman, Shrime, Mark G, Shuval, Kerem, Siabani, Soraya, Sigfusdottir, Inga Dora, Sigurvinsdottir, Rannveig, Silva, Diego Augusto Santo, Simonetti, Biagio, Simpson, Kyle E, Singh, Jasvinder A, Skiadaresi, Eirini, Skryabin, Valentin Yurievich, Soheili, Amin, Sokhan, Anton, Sorensen, Reed J D, Soriano, Joan B, Sorrie, Muluken Bekele, Soyiri, Ireneous N, Spurlock, Emma Elizabeth, Sreeramareddy, Chandrashekhar T, Stockfelt, Leo, Stokes, Mark A, Stubbs, Jacob L, Sudaryanto, Agu, Sufiyan, Mu'awiyyah Babale, Suliankatchi Abdulkader, Rizwan, Sykes, Bryan L, Tabarés-Seisdedos, Rafael, Tabb, Karen M, Tadakamadla, Santosh Kumar, Taherkhani, Amir, Tang, Muming, Taveira, Nuno, Taylor, Heather Jean, Teagle, Whitney L, Tehrani-Banihashemi, Arash, Teklehaimanot, Berhane Fseha, Tessema, Zemenu Tadesse, Thankappan, Kavumpurathu Raman, Thomas, Nihal, Thrift, Amanda G, Titova, Mariya Vladimirovna, Tohidinik, Hamid Reza, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Tovani-Palone, Marcos Roberto Roberto, Traini, Eugenio, Tran, Bach Xuan, Travillian, Ravensara, Trias-Llimós, Sergi, Truelsen, Thomas Clement, Tudor Car, Lorainne, Unnikrishnan, Bhaskaran, Upadhyay, Era, Vacante, Marco, Vakilian, Alireza, Valdez, Pascual R, Valli, Alessandro, Vardavas, Constantine, Vasankari, Tommi Juhani, Vasconcelos, Ana Maria Nogale, Vasseghian, Yasser, Veisani, Yousef, Venketasubramanian, Narayanaswamy, Vidale, Simone, Violante, Francesco S, Vlassov, Vasily, Vollset, Stein Emil, Vos, Theo, Vujcic, Isidora S, Vukovic, Ana, Vukovic, Rade, Waheed, Yasir, Wallin, Mitchell Taylor, Walters, Magdalene K, Wang, Hongbo, Wang, Yuan-Pang, Watson, Stefanie, Wei, Jingkai, Weiss, Jordan, Weldesamuel, Girmay Teklay, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Wiangkham, Taweewat, Wiens, Kirsten E, Wijeratne, Tissa, Wiysonge, Charles Shey, Wojtyniak, Bogdan, Wolfe, Charles D A, Wondmieneh, Adam Belay, Wool, Eve E, Wu, Ai-Min, Wu, Junjie, Xu, Gelin, Yamada, Tomohide, Yamagishi, Kazumasa, Yano, Yuichiro, Yaya, Sanni, Yazdi-Feyzabadi, Vahid, Yearwood, Jamal A, Yeheyis, Tomas Y, Yilgwan, Christopher Sabo, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Yoosefi Lebni, Javad, York, Hunter W, Younis, Mustafa Z, Younker, Theodore Patrick, Yousefi, Zabihollah, Yousefinezhadi, Taraneh, Yousuf, Abdilahi Yousuf, Yusefzadeh, Hasan, Zahirian Moghadam, Telma, Zakzuk, Josefina, Zaman, Sojib Bin, Zamani, Mohammad, Zamanian, Maryam, Zandian, Hamed, Zhang, Zhi-Jiang, Zheng, Peng, Zhou, Maigeng, Ziapour, Arash, Murray, Christopher J L, Collaborators, GBD 2019 Demographics, GBD 2019 Demographics Collaborator, Violante FS, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Microbes in Health and Disease (MHD), Department of Earth Systems Analysis, Biomechanical Engineering, TechMed Centre, Biomolecular Nanotechnology, Research Methodology, Measurement and Data Analysis, Materials Science and Technology of Polymers, Inorganic Materials Science, MESA+ Institute, Biomedical and Environmental Sensorsystems, Mesoscale Chemical Systems, Faculty of Engineering Technology, Nonlinear Solid Mechanics, Digital Society Institute, Pervasive Systems, Nanobiophysics, Faculty of Geo-Information Science and Earth Observation, Multi Scale Mechanics, Engineering Fluid Dynamics, Physics of Complex Fluids, Developmental BioEngineering, Physics of Fluids, Elastomer Technology and Engineering, Medical Cell Biophysics, European Membrane Institute, Department of Earth Observation Science, Biomaterials Science and Technology, Sustainable Process Technology, Department of Urban and Regional Planning and Geo-Information Management, Department of Natural Resources, XUV Optics, Databases (Former), Department of Water Resources, Psychology, Health & Technology, Membrane Science & Technology, Department of Public Health, Clinicum, HUS Neurocenter, HUS Comprehensive Cancer Center, and Environmental Sciences
Subjects: Male, very elderly, Demographic transition, HALE, 030204 cardiovascular system & hematology, preschool child, Global Burden of Disease, Carga Global de Enfermedades, 0302 clinical medicine, newborn, Risk Factors, Surveys and Questionnaires, and Risk Factors Study, 80 and over, 030212 general & internal medicine, Birth Rate, Child, Migration, 11 Medical and Health Sciences, Aged, 80 and over, education.field_of_study, Injuries, Geography, Mortality rate, 1. No poverty, DEATH, Censuses, General Medicine, SDG 10 - Reduced Inequalities, Middle Aged, Demographic analysis, 3142 Public health care science, environmental and occupational health, 3. Good health, demographic analysis, Estilo de Vida Saludable, risk factor, Child, Preschool, Demography/statistics & numerical data, Global Burden of Diseases, Injuries, Risk Factors, Fertility, Mortality, Migration, Population, epidemiology, Female, A990 Medicine and Dentistry not elsewhere classified, CHILD-MORTALITY, Live Birth, Global Health Metrics, TRANSITION, demographics, GBD, fertility, mortality, hale, Adult, Adolescent, Total fertility rate, Population, Global Burden of Diseases, Injuries, and Risk Factors Study, Birth rate, 03 medical and health sciences, Young Adult, Life Expectancy, SDG 3 - Good Health and Well-being, General & Internal Medicine, SYSTEMATIC ANALYSIS, Demografía, Humans, Global Burden of Disease Study, human, Mortality, education, Preschool, Aged, Demography, Spatial Analysis, questionnaire, Infant, Newborn, Klinisk medicin, HIV, Infant, Global Burden of Diseases, sex-specific fertility, Live Birth/epidemiology, purl.org/pe-repo/ocde/ford#3.02.00 [https], MODEL, Fertilidad, Fertility, Demographic change, Life expectancy, NA, global disease burden, Clinical Medicine, population research
Abstract: Background Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings The global TFR decreased from 2.72 (95% uncertainty interval [UI] 2.66-2.79) in 2000 to 2.31 (2.17-2.46) in 2019. Global annual livebirths increased from 134.5 million (131.5-137.8) in 2000 to a peak of 139.6 million (133.0-146.9) in 2016. Global livebirths then declined to 135.3 million (127.2-144.1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2.1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27.1% (95% UI 26.4-27.8) of global livebirths. Global life expectancy at birth increased from 67.2 years (95% UI 66.8-67.6) in 2000 to 73.5 years (72.8-74.3) in 2019. The total number of deaths increased from 50.7 million (49.5-51.9) in 2000 to 56.5 million (53.7-59.2) in 2019. Under-5 deaths declined from 9.6 million (9.1-10.3) in 2000 to 5.0 million (4.3-6.0) in 2019. Global population increased by 25.7%, from 6.2 billion (6.0-6.3) in 2000 to 7.7 billion (7.5-8.0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58.6 years (56.1-60.8) in 2000 to 63.5 years (60.8-66.1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
Published: 2020

216. 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

Author: Lozano, R., Haakenstad, A., Yearwood, J. A., Fullman, N., Bintz, C., Bienhoff, K., Weaver, M. R., Nandakumar, V., Joffe, J. N., LeGrand, K. E., Knight, M., Abbafati, C., Abbasi-Kangevari, M., Abdoli, A., Zuniga, R. A. A., Adedeji, I. A., Adekanmbi, V., Adetokunboh, O. O., Afzal, M. S., Afzal, S., Agudelo-Botero, M., Ahinkorah, B. O., Ahmad, S., Ahmadi, A., Ahmadi, S., Ahmed, A., Rashid, T. A., Aji, B., Akande-Sholabi, W., Alam, K., Al Hamad, H., Alhassan, R. K., Ali, L., Alipour, V., Aljunid, S. M., Ameyaw, E. K., Amin, T. T., Amu, H., Amugsi, D. A., Ancuceanu, R., Andrade, P. P., Anjum, A., Arabloo, J., Arab-Zozani, M., Ariffin, H., Arulappan, J., Aryan, Z., Ashraf, T., Atnafu, D. D., Atreya, A., Ausloos, M., Avila-Burgos, L., Ayano, G., Ayanore, M. A., Azari, S., Badiye, A. D., Baig, A. A., Bairwa, M., Bakkannavar, S. M., Baliga, S., Banik, P. C., Barnighausen, T. W., Barra, F., Barrow, A., Basu, S., Bayati, M., Belete, R., Bell, A. W., Bhagat, D. S., Bhagavathula, A. S., Bhardwaj, P., Bhardwaj, N., Bhaskar, S., Bhattacharyya, K., Bhutta, Z. A., Bibi, S., Bijani, A., Bikbov, B., Biondi, A., Bolarinwa, O. A., Bonny, A., Brenner, H., Buonsenso, D., Burkart, K., Busse, R., Butt, Z. A., Butt, N. S., dos Santos, F. L. C., Cahuana Hurtado, Lucero, Camera, Luis Alberto, Cardenas, R., Carneiro, V. L. A., Catala-Lopez, F., Chandan, J. S., Charan, J., Chavan, P. P., Chen, S. M., Chen, S., Choudhari, S. G., Chowdhury, E. K., Chowdhury, M. A. K., Cirillo, M., Corso, B., Dadras, O., Dahlawi, S. M. A., Dai, X. C., Dandona, L., Dandona, R., Dangel, W. J., Davila-Cervantes, C. A., Davletov, K., Deuba, K., Dhimal, M., Dhimal, M. L., Djalalinia, S., Do, H. P., Doshmangir, L., Duncan, B. B., Effiong, A., Ehsani-Chimeh, E., Elgendy, I. Y., Elhadi, M., El Sayed, I., El Tantawi, M., Erku, D. A., Eskandarieh, S., Fares, J., Farzadfar, F., Ferrero, S., Desideri, L. F., Fischer, F., Foigt, N. A., Foroutan, M., Fukumoto, T., Gaal, P. A., Gaihre, S., Gardner, W. 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S., Kapoor, N., Karanikolos, M., Katikireddi, S. V., Kavetskyy, T., Kawakami, N., Kayode, G. A., Keikavoosi-Arani, L., Keykhaei, M., Khader, Y. S., Khajuria, H., Khalilov, R., Khammarnia, M., Khan, M. N., Khan, M. A. B., Khan, M., Khezeli, M., Kim, M. S., Kim, Y. J., Kisa, S., Kisa, A., Klymchuk, V., Koly, K. N., Korzh, O., Kosen, S., Koul, P. A., Defo, B. K., Kumar, G. A., Kusuma, D., Kyu, H. H., Larsson, A. O., Lasrado, S., Lee, W. C., Lee, Y. H., Lee, C. B., Li, S. S., Lucchetti, G., Mahajan, P. B., Majeed, A., Makki, A., Malekzadeh, R., Malik, A. A., Malta, D. C., Mansournia, M. A., Mantovani, L. G., Martinez-Valle, A., Martins-Melo, F. R., Masoumi, S. Z., Mathur, M. R., Maude, R. J., Maulik, P. K., McKee, M., Mendoza, W., Menezes, R. G., Mensah, G. A., Meretoja, A., Meretoja, T. J., Mestrovic, T., Michalek, I. M., Mirrakhimov, E. M., Misganaw, A., Misra, S., Moazen, B., Mohammadi, M., Mohammed, S., Moitra, M., Mokdad, A. H., Molokhia, M., Monasta, L., Moni, M. A., Moradi, G., Moreira, R. S., Mosser, J. F., Mostafavi, E., Mouodi, S., Nagarajan, A. J., Nagata, C., Naghavi, M., Nangia, V., Swamy, S. N., Narayana, A. I., Nascimento, B. R., Nassereldine, H., Nayak, B. P., Nazari, J., Negoi, I., Nepal, S., Kandel, S. N., Ngunjiri, J. W., Nguyen, H. L. T, Nguyen, C. T., Ningrum, D. N. A., Noubiap, J. J., Oancea, B., Oghenetega, O. B., Oh, I. H., Olagunju, A. T., Olakunde, B. O., Bali, A. O., Omer, E., Onwujekwe, O. E., Otoiu, A., Padubidri, J. R., Palladino, R., Pana, A., Panda-Jonas, S., Pandi-Perumal, S. R., Pardhan, S., Pasupula, D. K., Pathak, P. K., Patton, G. C., Pawar, S., Pereira, J., Pilania, M., Piroozi, B., Podder, V., Pokhrel, K. N., Postma, M. J., Prada, S. I., Syed, Z. Q., Rabiee, N., Radhakrishnan, R. A., Rahman, M. M., Rahman, M., Rahman, M. H. U., Rahmani, A. M., Ranabhat, C. L., Rao, C. R., Rao, S. J., Rasella, D., Rawaf, S., Rawaf, D. L., Rawal, L., Renzaho, A. M. N., Reshmi, B., Resnikoff, S., Rezapour, A., Riahi, S. M., Ripon, R. K., Sacco, S., Sadeghi, M., Saeed, U., Sahebkar, A., Sahiledengle, B., Sahoo, H., Sahu, M., Salama, J. S., Salamati, P., Samy, A. M., Sanabria, J., Santric-Milicevic, M. M., Sathian, B., Sawhney, M., Schmidt, M. I., Seidu, A. A., Sepanlou, S. G., Seylani, A., Shaikh, M. A., Sheikh, A., Shetty, A., Shigematsu, M., Shiri, R., Shivakumar, K. M., Shokri, A., Singh, J. A., Sinha, D. N., Skryabin, V. Y., Skryabina, A. A., Sofi-Mahmudi, A., Sousa, R. A. R. C., Stephens, J. H., Sun, J., Szocska, M., Tabares-Seisdedos, R., Tadbiri, H., Tamiru, A. T., Thankappan, K. R., Topor-Madry, R., Tovani-Palone, M. R., Tran, M. T. N., Tran, B. X., Tripathi, N., Tripathy, J. P., Troeger, C. E., Uezono, D. R., Ullah, S., Ullah, A., Unnikrishnan, B., Vacante, M., Tahbaz, S. V., Valdez, P. R., Vasic, M., Veroux, M., Vervoort, D., Violante, F. S., Vladimirov, S. K., Vlassov, V., Vo, B., Waheed, Y., Wamai, R. G., Wang, Y. P., Wang, Y. Z., Ward, P., Wiangkham, T., Yadav, L., Jabbari, S. H. Y., Yamagishi, K., Yaya, S., Yazdi-Feyzabadi, V., Yi, S. Y., Yigit, V., Yonemoto, N., Younis, M. Z., Yu, C. H., Yunusa, I., Bin Zaman, S., Zastrozhin, M. S., Zhang, Z. J., Zhong, C. W., Zuniga, Y. M. H., Lim, S. S., Murray, C. J. L., GBD 2019 Healthcare Access Quality, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Haakenstad, Annie, Yearwood, Jamal Akeem, Fullman, Nancy, Bintz, Corinne, Bienhoff, Kelly, Weaver, Marcia R, Nandakumar, Vishnu, Joffe, Jonah N, Legrand, Kate E, Knight, Megan, Abbafati, Cristiana, Abbasi-Kangevari, Mohsen, Abdoli, Amir, Abeldaño Zuñiga, Roberto Ariel, Adedeji, Isaac Akinkunmi, Adekanmbi, Victor, Adetokunboh, Olatunji O, Afzal, Muhammad Sohail, Afzal, Saira, Agudelo-Botero, Marcela, Ahinkorah, Bright Opoku, Ahmad, Sajjad, Ahmadi, Ali, Ahmadi, Sepideh, Ahmed, Ali, Ahmed Rashid, Tarik, Aji, Budi, Akande-Sholabi, Wuraola, Alam, Khurshid, Al Hamad, Hanadi, Alhassan, Robert Kaba, Ali, Liaqat, Alipour, Vahid, Aljunid, Syed Mohamed, Ameyaw, Edward Kwabena, Amin, Tarek Tawfik, Amu, Hubert, Amugsi, Dickson A, Ancuceanu, Robert, Andrade, Pedro Prata, Anjum, Afifa, Arabloo, Jalal, Arab-Zozani, Morteza, Ariffin, Hany, Arulappan, Judie, Aryan, Zahra, Ashraf, Tahira, Atnafu, Desta Debalkie, Atreya, Alok, Ausloos, Marcel, Avila-Burgos, Leticia, Ayano, Getinet, Ayanore, Martin Amogre, Azari, Samad, Badiye, Ashish D, Baig, Atif Amin, Bairwa, Mohan, Bakkannavar, Shankar M, Baliga, Shrikala, Banik, Palash Chandra, Bärnighausen, Till Winfried, Barra, Fabio, Barrow, Amadou, Basu, Sanjay, Bayati, Mohsen, Belete, Rebuma, Bell, Arielle Wilder, Bhagat, Devidas S, Bhagavathula, Akshaya Srikanth, Bhardwaj, Pankaj, Bhardwaj, Nikha, Bhaskar, Sonu, Bhattacharyya, Krittika, Bhutta, Zulfiqar A, Bibi, Sadia, Bijani, Ali, Bikbov, Bori, Biondi, Antonio, Bolarinwa, Obasanjo Afolabi, Bonny, Aime, Brenner, Hermann, Buonsenso, Danilo, Burkart, Katrin, Busse, Reinhard, Butt, Zahid A, Butt, Nadeem Shafique, Caetano dos Santos, Florentino Luciano, Cahuana-Hurtado, Lucero, Cámera, Luis Alberto, Cárdenas, Rosario, Carneiro, Vera L A, Catalá-López, Ferrán, Chandan, Joht Singh, Charan, Jaykaran, Chavan, Prachi P, Chen, Simiao, Chen, Shu, Choudhari, Sonali Gajanan, Chowdhury, Enayet Karim, Chowdhury, Mohiuddin Ahsanul Kabir, Cirillo, Massimo, Corso, Barbara, Dadras, Omid, Dahlawi, Saad M A, Dai, Xiaochen, Dandona, Lalit, Dandona, Rakhi, Dangel, William Jame, Dávila-Cervantes, Claudio Alberto, Davletov, Kairat, Deuba, Keshab, Dhimal, Meghnath, Dhimal, Mandira Lamichhane, Djalalinia, Shirin, Do, Huyen Phuc, Doshmangir, Leila, Duncan, Bruce B, Effiong, Andem, Ehsani-Chimeh, Elham, Elgendy, Islam Y, Elhadi, Muhammed, El Sayed, Iman, El Tantawi, Maha, Erku, Daniel Asfaw, Eskandarieh, Sharareh, Fares, Jawad, Farzadfar, Farshad, Ferrero, Simone, Ferro Desideri, Lorenzo, Fischer, Florian, Foigt, Nataliya A, Foroutan, Masoud, Fukumoto, Takeshi, Gaal, Peter Andra, Gaihre, Santosh, Gardner, William M, Garg, Tushar, Getachew Obsa, Abera, Ghafourifard, Mansour, Ghashghaee, Ahmad, Ghith, Nermin, Gilani, Syed Amir, Gill, Paramjit Singh, Goharinezhad, Salime, Golechha, Mahaveer, Guadamuz, Jenny S, Guo, Yuming, Gupta, Rajat Da, Gupta, Rajeev, Gupta, Vivek Kumar, Gupta, Veer Bala, Hamiduzzaman, Mohammad, Hanif, Asif, Haro, Josep Maria, Hasaballah, Ahmed I, Hasan, Md Mehedi, Hasan, M Tasdik, Hashi, Abdiwahab, Hay, Simon I, Hayat, Khezar, Heidari, Mohammad, Heidari, Golnaz, Henry, Nathaniel J, Herteliu, Claudiu, Holla, Ramesh, Hossain, Sahadat, Hossain, Sheikh Jamal, Hossain, Mohammad Bellal Hossain, Hosseinzadeh, Mehdi, Hostiuc, Sorin, Hoveidamanesh, Soodabeh, Hsieh, Vivian Chia-rong, Hu, Guoqing, Huang, Junjie, Huda, M Mamun, Ifeagwu, Susan C, Ikuta, Kevin S, Ilesanmi, Olayinka Stephen, Irvani, Seyed Sina Naghibi, Islam, Rakibul M, Islam, Sheikh Mohammed Shariful, Ismail, Nahlah Elkudssiah, Iso, Hiroyasu, Isola, Gaetano, Itumalla, Ramaiah, Iwagami, Masao, Jahani, Mohammad Ali, Jahanmehr, Nader, Jain, Rajesh, Jakovljevic, Mihajlo, Janodia, Manthan Dilipkumar, Jayapal, Sathish Kumar, Jayaram, Shubha, Jha, Ravi Prakash, Jonas, Jost B, Joo, Tama, Joseph, Nitin, Jürisson, Mikk, Kabir, Ali, Kalankesh, Leila R, Kalhor, Rohollah, Kamath, Aruna M, Kamenov, Kaloyan, Kandel, Himal, Kantar, Rami S, Kapoor, Neeti, Karanikolos, Marina, Katikireddi, Srinivasa Vittal, Kavetskyy, Tara, Kawakami, Norito, Kayode, Gbenga A, Keikavoosi-Arani, Leila, Keykhaei, Mohammad, Khader, Yousef Saleh, Khajuria, Himanshu, Khalilov, Rovshan, Khammarnia, Mohammad, Khan, Md Nuruzzaman, Khan, Moien AB, Khan, Maseer, Khezeli, Mehdi, Kim, Min Seo, Kim, Yun Jin, Kisa, Sezer, Kisa, Adnan, Klymchuk, Vitalii, Koly, Kamrun Nahar, Korzh, Oleksii, Kosen, Soewarta, Koul, Parvaiz A, Kuate Defo, Barthelemy, Kumar, G Anil, Kusuma, Dian, Kyu, Hmwe Hmwe, Larsson, Anders O, Lasrado, Savita, Lee, Wei-Chen, Lee, Yo Han, Lee, Chiachi Bonnie, Li, Shanshan, Lucchetti, Giancarlo, Mahajan, Preetam Bhalchandra, Majeed, Azeem, Makki, Alaa, Malekzadeh, Reza, Malik, Ahmad Azam, Malta, Deborah Carvalho, Mansournia, Mohammad Ali, Mantovani, Lorenzo Giovanni, Martinez-Valle, Adolfo, Martins-Melo, Francisco Rogerlândio, Masoumi, Seyedeh Zahra, Mathur, Manu Raj, Maude, Richard Jame, Maulik, Pallab K, Mckee, Martin, Mendoza, Walter, Menezes, Ritesh G, Mensah, George A, Meretoja, Atte, Meretoja, Tuomo J, Mestrovic, Tomislav, Michalek, Irmina Maria, Mirrakhimov, Erkin M, Misganaw, Awoke, Misra, Sanjeev, Moazen, Babak, Mohammadi, Mokhtar, Mohammed, Shafiu, Moitra, Modhurima, Mokdad, Ali H, Molokhia, Mariam, Monasta, Lorenzo, Moni, Mohammad Ali, Moradi, Ghobad, Moreira, Rafael Silveira, Mosser, Jonathan F, Mostafavi, Ebrahim, Mouodi, Simin, Nagarajan, Ahamarshan Jayaraman, Nagata, Chie, Naghavi, Mohsen, Nangia, Vinay, Narasimha Swamy, Sreeniva, Narayana, Aparna Ichalangod, Nascimento, Bruno Ramo, Nassereldine, Hasan, Nayak, Biswa Prakash, Nazari, Javad, Negoi, Ionut, Nepal, Samata, Neupane Kandel, Sandhya, Ngunjiri, Josephine W, Nguyen, Huong Lan Thi, Nguyen, Cuong Tat, Ningrum, Dina Nur Anggraini, Noubiap, Jean Jacque, Oancea, Bogdan, Oghenetega, Onome Bright, Oh, In-Hwan, Olagunju, Andrew T, Olakunde, Babayemi Oluwaseun, Omar Bali, Ahmed, Omer, Emad, Onwujekwe, Obinna E, Otoiu, Adrian, Padubidri, Jagadish Rao, Palladino, Raffaele, Pana, Adrian, Panda-Jonas, Songhomitra, Pandi-Perumal, Seithikurippu R, Pardhan, Shahina, Pasupula, Deepak Kumar, Pathak, Praveen Kumar, Patton, George C, Pawar, Shrikant, Pereira, Jeevan, Pilania, Manju, Piroozi, Bakhtiar, Podder, Vivek, Pokhrel, Khem Narayan, Postma, Maarten J, Prada, Sergio I, Quazi Syed, Zahiruddin, Rabiee, Navid, Radhakrishnan, Raghu Anekal, Rahman, Md Mosfequr, Rahman, Mosiur, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahmani, Amir Masoud, Ranabhat, Chhabi Lal, Rao, Chythra R, Rao, Sowmya J, Rasella, Davide, Rawaf, Salman, Rawaf, David Laith, Rawal, Lal, Renzaho, Andre M N, Reshmi, Bhageerathy, Resnikoff, Serge, Rezapour, Aziz, Riahi, Seyed Mohammad, Ripon, Rezaul Karim, Sacco, Simona, Sadeghi, Masoumeh, Saeed, Umar, Sahebkar, Amirhossein, Sahiledengle, Biniyam, Sahoo, Harihar, Sahu, Maitreyi, Salama, Joseph S, Salamati, Payman, Samy, Abdallah M, Sanabria, Juan, Santric-Milicevic, Milena M, Sathian, Brijesh, 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Ward, Paul, Wiangkham, Taweewat, Yadav, Lalit, Yahyazadeh Jabbari, Seyed Hossein, Yamagishi, Kazumasa, Yaya, Sanni, Yazdi-Feyzabadi, Vahid, Yi, Siyan, Yiğit, Vahit, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Yunusa, Ismaeel, Zaman, Sojib Bin, Zastrozhin, Mikhail Sergeevich, Zhang, Zhi-Jiang, Zhong, Chenwen, Zuniga, Yves Miel H, Lim, Stephen S, Murray, Christopher J L, Lozano, Rafael, Haakenstad, A, Yearwood, J, Fullman, N, Bintz, C, Bienhoff, K, Weaver, M, Nandakumar, V, Joffe, J, Legrand, K, Knight, M, Abbafati, C, Abbasi-Kangevari, M, Abdoli, A, Abeldano Zuniga, R, Adedeji, I, Adekanmbi, V, Adetokunboh, O, Afzal, M, Afzal, S, Agudelo-Botero, M, Ahinkorah, B, Ahmad, S, Ahmadi, A, Ahmadi, S, Ahmed, A, Ahmed Rashid, T, Aji, B, Akande-Sholabi, W, Alam, K, Al Hamad, H, Alhassan, R, Ali, L, Alipour, V, Aljunid, S, Ameyaw, E, Amin, T, Amu, H, Amugsi, D, Ancuceanu, R, Andrade, P, Anjum, A, Arabloo, J, Arab-Zozani, M, Ariffin, H, Arulappan, J, Aryan, Z, Ashraf, T, Atnafu, D, Atreya, A, Ausloos, M, Avila-Burgos, L, Ayano, G, Ayanore, M, Azari, S, Badiye, A, Baig, A, Bairwa, M, Bakkannavar, S, Baliga, S, Banik, P, Barnighausen, T, Barra, F, Barrow, A, Basu, S, Bayati, M, Belete, R, Bell, A, Bhagat, D, Bhagavathula, A, Bhardwaj, P, Bhardwaj, N, Bhaskar, S, Bhattacharyya, K, Bhutta, Z, Bibi, S, Bijani, A, Bikbov, B, Biondi, A, Bolarinwa, O, Bonny, A, Brenner, H, Buonsenso, D, Burkart, K, Busse, R, Butt, Z, Butt, N, Caetano dos Santos, F, Cahuana-Hurtado, L, Camera, L, Cardenas, R, Carneiro, V, Catala-Lopez, F, Chandan, J, Charan, J, Chavan, P, Chen, S, Choudhari, S, Chowdhury, E, Chowdhury, M, Cirillo, M, Corso, B, Dadras, O, Dahlawi, S, Dai, X, Dandona, L, Dandona, R, Dangel, W, Davila-Cervantes, C, Davletov, K, Deuba, K, Dhimal, M, Djalalinia, S, Do, H, Doshmangir, L, Duncan, B, Effiong, A, Ehsani-Chimeh, E, Elgendy, I, Elhadi, M, El Sayed, I, El Tantawi, M, Erku, D, Eskandarieh, S, Fares, J, Farzadfar, F, Ferrero, S, Ferro Desideri, L, Fischer, F, Foigt, N, Foroutan, M, Fukumoto, T, Gaal, P, Gaihre, S, Gardner, W, Garg, T, Getachew Obsa, A, Ghafourifard, M, Ghashghaee, A, Ghith, N, Gilani, S, Gill, P, Goharinezhad, S, Golechha, M, Guadamuz, J, Guo, Y, Gupta, R, Gupta, V, Hamiduzzaman, M, Hanif, A, Haro, J, Hasaballah, A, Hasan, M, Hashi, A, Hay, S, Hayat, K, Heidari, M, Heidari, G, Henry, N, Herteliu, C, Holla, R, Hossain, S, Hossain, M, Hosseinzadeh, M, Hostiuc, S, Hoveidamanesh, S, Hsieh, V, Hu, G, Huang, J, Huda, M, Ifeagwu, S, Ikuta, K, Ilesanmi, O, Irvani, S, Islam, R, Islam, S, Ismail, N, Iso, H, Isola, G, Itumalla, R, Iwagami, M, Jahani, M, Jahanmehr, N, Jain, R, Jakovljevic, M, Janodia, M, Jayapal, S, Jayaram, S, Jha, R, Jonas, J, Joo, T, Joseph, N, Jurisson, M, Kabir, A, Kalankesh, L, Kalhor, R, Kamath, A, Kamenov, K, Kandel, H, Kantar, R, Kapoor, N, Karanikolos, M, Katikireddi, S, Kavetskyy, T, Kawakami, N, Kayode, G, Keikavoosi-Arani, L, Keykhaei, M, Khader, Y, Khajuria, H, Khalilov, R, Khammarnia, M, Khan, M, Khezeli, M, Kim, M, Kim, Y, Kisa, S, Kisa, A, Klymchuk, V, Koly, K, Korzh, O, Kosen, S, Koul, P, Kuate Defo, B, Kumar, G, Kusuma, D, Kyu, H, Larsson, A, Lasrado, S, Lee, W, Lee, Y, Lee, C, Li, S, Lucchetti, G, Mahajan, P, Majeed, A, Makki, A, Malekzadeh, R, Malik, A, Malta, D, Mansournia, M, Mantovani, L, Martinez-Valle, A, Martins-Melo, F, Masoumi, S, Mathur, M, Maude, R, Maulik, P, Mckee, M, Mendoza, W, Menezes, R, Mensah, G, Meretoja, A, Meretoja, T, Mestrovic, T, Michalek, I, Mirrakhimov, E, Misganaw, A, Misra, S, Moazen, B, Mohammadi, M, Mohammed, S, Moitra, M, Mokdad, A, Molokhia, M, Monasta, L, Moni, M, Moradi, G, Moreira, R, Mosser, J, Mostafavi, E, Mouodi, S, Nagarajan, A, Nagata, C, Naghavi, M, Nangia, V, Narasimha Swamy, S, Narayana, A, Nascimento, B, Nassereldine, H, Nayak, B, Nazari, J, Negoi, I, Nepal, S, Neupane Kandel, S, Ngunjiri, J, Nguyen, H, Nguyen, C, Ningrum, D, Noubiap, J, Oancea, B, Oghenetega, O, Oh, I, Olagunju, A, Olakunde, B, Omar Bali, A, Omer, E, Onwujekwe, O, Otoiu, A, Padubidri, J, Palladino, R, Pana, A, Panda-Jonas, S, Pandi-Perumal, S, Pardhan, S, Pasupula, D, Pathak, P, Patton, G, Pawar, S, Pereira, J, Pilania, M, Piroozi, B, Podder, V, Pokhrel, K, Postma, M, Prada, S, Quazi Syed, Z, Rabiee, N, Radhakrishnan, R, Rahman, M, Rahmani, A, Ranabhat, C, Rao, C, Rao, S, Rasella, D, Rawaf, S, Rawaf, D, Rawal, L, Renzaho, A, Reshmi, B, Resnikoff, S, Rezapour, A, Riahi, S, Ripon, R, Sacco, S, Sadeghi, M, Saeed, U, Sahebkar, A, Sahiledengle, B, Sahoo, H, Sahu, M, Salama, J, Salamati, P, Samy, A, Sanabria, J, Santric-Milicevic, M, Sathian, B, Sawhney, M, Schmidt, M, Seidu, A, Sepanlou, S, Seylani, A, Shaikh, M, Sheikh, A, Shetty, A, Shigematsu, M, Shiri, R, Shivakumar, K, Shokri, A, Singh, J, Sinha, D, Skryabin, V, Skryabina, A, Sofi-Mahmudi, A, Sousa, R, Stephens, J, Sun, J, Szocska, M, Tabares-Seisdedos, R, Tadbiri, H, Tamiru, A, Thankappan, K, Topor-Madry, R, Tovani-Palone, M, Tran, M, Tran, B, Tripathi, N, Tripathy, J, Troeger, C, Uezono, D, Ullah, S, Ullah, A, Unnikrishnan, B, Vacante, M, Valadan Tahbaz, S, Valdez, P, Vasic, M, Veroux, M, Vervoort, D, Violante, F, Vladimirov, S, Vlassov, V, Vo, B, Waheed, Y, Wamai, R, Wang, Y, Ward, P, Wiangkham, T, Yadav, L, Yahyazadeh Jabbari, S, Yamagishi, K, Yaya, S, Yazdi-Feyzabadi, V, Yi, S, Yigit, V, Yonemoto, N, Younis, M, Yu, C, Yunusa, I, Zaman, S, Zastrozhin, M, Zhang, Z, Zhong, C, Zuniga, Y, Lim, S, Murray, C, Lozano, R, Bill & Melinda Gates Foundation, King Edward Medical University (Pakistán), Kuwait University (Kuwait), Romanian National Authority for Scientific Research and Innovation, Romanian Ministry of Research Innovation and Digitalization, Alexander von Humboldt Foundation, Federal Ministry of Education & Research (Alemania), Unión Europea. Comisión Europea. H2020, University of Aberdeen (Reino Unido), Novo Nordisk Foundation, National Health and Medical Research Council (Australia), National Research, Development and Innovation Office (Hungria), National Records of Scotland (Reino Unido), Medical Research Council (Reino Unido), Scottish Government (Reino Unido), Jatiya Kabi Kazi Nazrul Islam University (Bangladesh), Xiamen University Malaysia (Malasia), National Council for Scientific and Technological Development (Brasil), Ministero della Salute (Italia), Fondazione IRCCS. Istituto Nazionale dei Tumori, King College London, IRCCS Materno Infantile Burlo Garofolo (Italia), Edwards Lifesciences Foundation, Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Brasil), Manipal Academy of Higher Education (India), Ministerio de Ciencia e Innovación. Centro de Excelencia Severo Ochoa (España), Government of Catalonia (España), International Center of Medical Sciences Research (Pakistán), Ain Shams University (Egipto), Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red - CIBERSAM (Salud Mental), INCLIVA Health Research Institute (España), Canadian Institutes of Health Research, Australian Government, and Ministry of Education, Science and Technological Development (Serbia)
Subjects: Adult, Adolescent, Population, Global Health, Health Services Accessibility, Global Burden of Disease, Health system quality, Young Adult, Nations, Health systems, health care access, Risk Factors, Quality-Adjusted Life Year, Humans, Child, Global Burden of Disease Study 2019, Health-care access, Aged, Quality of Health Care, quality, performance, The Healthcare Access and Quality Index, Risk Factor, Infant, Newborn, Infant, eu-repo/semantics/review [info], Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Health-care quality, Middle Aged, 3141 Health care science, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Indicator, Medical-care, Child, Preschool, Deaths, Amenable mortality, Quality-Adjusted Life Years, Age groups, Trends, Human
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. O Adetokunboh acknowledges support from Department of Science and Innovation and National Research Foundation. S Afzal acknowledges the institutional support of King Edward Medical University. S Aljunid acknowledges Department of Health Policy and Management, College of Public Health, Health Science Centre, Kuwait University for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu also acknowledges partial support by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. T Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the Federal Ministry of Education and Research. B Bikbov acknowledges funding from the European Union’s Horizon 2020 research and innovation programme under Marie Sklodowska-Curie grant agreement No. 703226. Institute of Applied Health Sciences; School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland. The salary for N Ghith is covered by a grant from Novo Nordisk Foundation (NNF16OC0021856). V B Gupta acknowledges funding support from National Health and Medical Research Council (NHMRC) Australia. V K Gupta acknowledges funding support from National Health and Medical Research Council (NHMRC) Australia. T Joo acknowledges support from the National Research, Development and Innovation Office of Hungary under grant RRF-2.3.1-21-2022-00006 (Data-driven Health Division of Health Security National Laboratory). S Vittal Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). M N Khan acknowledges the support of Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh. Y J Kim acknowledges support from the Research Management Centre Xiamen University Malaysia [XMUMRF/2020-C6/ITCM/0004]. G Lucchetti is a grantee of the Brazilian National Council for Scientific and Technological Development Research Productivity - Level 1D. L Mantovani acknowledges support by Italian Ministry of Health Ricerca Corrente - IRCCS Multimedica. M Molokhia acknowledges support by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. L Monasta reports support for the present manuscript from the Italian Ministry of Health on project Ricerca Corrente 34/2017 and payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. R Moreira acknowledges the CNPQ productivity grant (316607/2021-5). B R Nascimento is partially supported by CNPq (Research Productivity Grant, 312382/2019-7), the Edwards Lifesciences Foundation (Improving the prevention and detection of Heart Valve disease across the Lifespan, 2021), and FAPEMIG (grant APQ-000627-20). J R Padubidri acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India for their constant support in conducting research. D Rasella reports financial support from the Spanish Ministry of Science and Innovation and State Research Agency through the Centro de Excelencia Severo Ochoa 2019-2023 programme (CEX2018-000806-S), and financial support from the Generalitat de Catalunya through the Centres de Recerca de Catalunya programme. U Saeed would like to acknowledge the International Center of Medical Sciences Research (ICMSR), Islamabad (44000), Pakistan. A M Samy acknowledges the support from Ain Shams University and the Egyptian Fulbright Mission Program. U Saeed would like to acknowledge Kasturba Medical College, Mangalore. Manipal Academy of Higher Education, Manipal for supporting research activities. R T-S is supported by the Spanish Ministry of Science and Innovation, Institute of Health Carlos III, CIBERSAM, INCLIVA (PID2021-129099OB-I00). D Vervoort is supported by the Canadian Institutes of Health Research (CIHR) Vanier Canada Graduate Scholarship. S B Zaman acknowledges receiving a scholarship from the Australian Government Research Training Program (RTP) in support of his academic career. Serbian part of this GBD contribution was co-financed through Grant OI 175 014 of the Ministry of Education Science and Technological Development of The Republic of Serbia. This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation OPP1152504. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Sí
Published: 2022

217. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Sorin Hostiuc, Shaun Wen Huey Lee, Jorge R. Ledesma, Carsten Flohr, Masoumeh Sadeghi, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Mehdi Bohluli, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Seyyed Meysam Mousavi, Bernhard T. Baune, Ehsan Ahmadpour, Dinh-Toi Chu, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Mohammad Taghi Khodayari, Gianna Gayle Herrera Amul, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Michael K. Hole, Azeem Majeed, Iman Halvaei, Saqib Ali, Arianna Maever L. Amit, Tomas Y. Yeheyis, John S. Ji, Martin McKee, Jamileh Shadid, Leonardo Roever, Peng Jia, Ettore Beghi, Pablo M. Lavados, Young Eun Kim, Vahid Alipour, Sowmya J. Rao, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nicole K. DeCleene, Ebrahim Babaee, Saman Esmaeilnejad, Boris Bikbov, William M. Gardner, Lydia M. Haile, Luca Ronfani, Azalea M. Thomson, Irena Ilic, Ruth W. Kimokoti, Yingxi Zhao, Guoqing Hu, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Nathaniel J. Henry, Brijesh Sathian, Daniel Kim, Peter Memiah, Mohammad Hadi Abbasi, Andrea Farioli, Zahra Kamiab, Bolajoko O. Olusanya, Matthew C. Doxey, Tommi Vasankari, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Shanshan Li, Tanvir M. Huda, Dillon O Sylte, Rosario Cárdenas, Agegnehu Bante, Helen Ippolito, Alyssa Acebedo, Jeffrey D. Stanaway, Anwar Faraj, João Pedro Silva, Amin Mousavi Khaneghah, Pushpendra Kumar, Sangram Kishor Patel, Josephine W. Ngunjiri, Holly E. Erskine, Eugene Sobngwi, Filippo Ariani, Shane D. Morrison, Mohammad Aghaali, Meghan D. Mooney, Vera Marisa Costa, Palash Chandra Banik, Rupak Desai, Ken Takahashi, Maigeng Zhou, Morteza Oladnabi, Bogdan Oancea, Daniela Ribeiro, Mohammad Farahmand, Irmina Maria Michalek, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Emilie R Maddison, Syed Mohamed Aljunid, Damian G. Hoy, Hosni Salem, V. Prakash, Shuhei Nomura, Inga Dora Sigfusdottir, Anders Larsson, Sharareh Eskandarieh, Abdollah Mohammadian-Hafshejani, Somayeh Bohlouli, Joana Morgado-da-Costa, Siamak Sabour, Theo Vos, Han Yong Wunrow, Khaled Khatab, Alireza Zangeneh, Ann Kristin Knudsen, Marissa B Reitsma, Hannah J. Henrikson, Randah R. Hamadeh, Tuomo J. Meretoja, Ireneous N. Soyiri, Giuseppe Grosso, Ziyad Al-Aly, Taraneh Yousefinezhadi, Joseph L Ward, Roba Khundkar, Ricardo Santiago Gomez, Reza Malekzadeh, John J. McGrath, Sandra B. Munro, Shahin Soltani, Amy E. Peden, Rufus Akinyemi, Marcel Ausloos, Naohiro Yonemoto, Bogdan Wojtyniak, Ahmad Ghashghaee, Guilherme Borges, Sadia Bibi, Farhad Islami, Hamed Mirzaei, Mohammad Ali Sahraian, M. Ashworth Dirac, Hosna Janjani, Kairat Davletov, Hermann Brenner, Yuichiro Yano, Elissa M. Abrams, Ana Vukovic, Bartosz Miazgowski, Jobert Richie Nansseu, Jennifer O Lam, Mona Pathak, Leeberk Raja Inbaraj, Thirunavukkarasu Sathish, Asadollah Gholamian, Carlos A Castañeda-Orjuela, Babak Eshrati, Edgar Denova-Gutiérrez, Atte Meretoja, Lorenzo Monasta, Ronan A. Lyons, Neda Kianipour, Desalegn Getnet Demsie, Yasir Waheed, Desta Debalkie Atnafu, Davide Sattin, Kevin S Ikuta, Ghobad Moradi, Srinivas Goli, Krittika Bhattacharyya, Mika Kivimäki, Christopher Troeger, Jordi Alonso, Alireza Ahmadi, Navid Manafi, Caroline Stein, Songhomitra Panda-Jonas, Jason Nguyen, Moses K. Muriithi, Aziz Rezapour, Ismael R. Campos-Nonato, Adrian Pana, H. Dean Hosgood, Noore Alam, James L. Fisher, Mariam Molokhia, Susan F. Rumisha, Ernoiz Antriyandarti, Ayman Grada, Emma Nichols, Babak Asghari, André Luiz Sena Guimarães, Ferrán Catalá-López, Aletta E. Schutte, Fiona B. 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L., Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Public Health, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, GBD 2019 Diseases and Injuries Collaborator, Violante FS, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, and UT-I-ITC-ACQUAL
Subjects: Male, Life expectancy, Disability-Adjusted Life Year, Diseases, Disease, communicable disease, systematic analysis, Global Burden of Disease, 0302 clinical medicine, 80 and over, Medicine, 10. No inequality, Child, 11 Medical and Health Sciences, injuries, Aged, 80 and over, education.field_of_study, Sjúkdómar, DEMENTIA, FALLS, General Medicine, Forvarnir, 3. Good health, Child, Preschool, Human, GBD, Population health, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Humans, Global Burden of Disease Study, education, Aged, Spatial Analysis, Global burden, Disability, Prevention, DISABILITY, Infant, Spatial Analysi, Mortality rate, Global Burden of Disease, Diseases, Injuries, Systematic analysis, PREVENTION, Years of potential life lost, Risk factors, Disease study, ITC-ISI-JOURNAL-ARTICLE, RISK-FACTORS, Clinical Medicine, RA, Demography, Fötlun, Dánartíðni, Áhættuþættir, 030204 cardiovascular system & hematology, Risk Factors, Cause of Death, Global health, 030212 general & internal medicine, 1. No poverty, Disability-Adjusted Life Years, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 3142 Public health care science, environmental and occupational health, Adolescent, Adult, Age Distribution, Female, Infant, Newborn, Young Adult, Lýðheilsa, CLINICAL-TRIALS, Population, Settore MED/01 - Statistica Medica, diseases, ITC-HYBRID, Heilbrigðisvísindi, General & Internal Medicine, Mortality, Preschool, Disease burden, business.industry, Risk Factor, Klinisk medicin, Newborn, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Áverkar, Systematic analysis, NA, business
Abstract: Publisher's version (útgefin grein), Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd., Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career., "Peer Reviewed"
Published: 2020

218. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: William M. Gardner, Rawlance Ndejjo, Govinda Prasad Dhungana, Fereshteh Ansari, Kathleen Pillsbury Hopf, João Pedro Silva, M. Mofizul Islam, Cong Zhu, Abdul Hafiz, Irmina Maria Michalek, Syed Mohamed Aljunid, Leonardo Roever, Mustefa Glagn, Davood Anvari, Tessa M. Pilz, Sameer Vali Gopalani, Joel M. Francis, Man Mohan Mehndiratta, Rakhi Dandona, Abbas Sheikhtaheri, Mansour Ghafourifard, Simon Øverland, David Laith Rawaf, Jaykaran Charan, Akram Pourshams, Mostafa Dianatinasab, Morteza Mahmoudi, Alton Lu, Alyssa N. Sbarra, Lorainne Tudor Car, Franz Castro, Hafiz Ansar Rasul Suleria, Luca Ronfani, Marina Pinheiro, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Hoa Thi Do, Whitney L. Teagle, Sofia Androudi, Carl Abelardo T. Antonio, Myron Anthony Godinho, Bhaskaran Unnikrishnan, Oluchi Ezekannagha, Getinet Ayano, Seyyed Shamsadin Athari, Dimas Ria Angga Pribadi, Kyle E. Simpson, Muluken Bekele Sorrie, Vivekanand Jha, Chukwuma David Umeokonkwo, Akshaya Srikanth Bhagavathula, Cuong Tat Nguyen, Amr Hassan, Akine Eshete Abosetugn, Hailay Abrha Gesesew, Anna V. Korotkova, Brijesh Sathian, Marcello Tonelli, Olatunde Aremu, Mohammad Reza Salahshoor, Juan Jesus Carrero, Cameron J. Kneib, Ravi Prakash Jha, David H. Shaw, Hossein Samadi Kafil, Tanuj Kanchan, Khezar Hayat, Hamid Sharifi, Morteza Shamsizadeh, Muktar Omer Omer, Fatemeh Amiri, Hamidreza Pazoki Toroudi, David Edvardsson, Xiu Ju George Zhao, Hannah Han, Leticia Avila-Burgos, Adam E. Berman, Jemal Abdu Mohammed, Thomas Pilgrim, Leila Doshmangir, Mu'awiyyah Babale Sufiyan, David M. Pigott, Hadi Hassankhani, Beatriz Paulina Ayala Quintanilla, Teklemariam Gultie, Arash Ziapour, Seyed Sina Naghibi Irvani, Ilse N. Dippenaar, Jean Jacques Noubiap, Emmanuela Gakidou, Abiyu Mekonnen Gebrehiwot, Maha El Tantawi, Xuefeng Liu, Zulfiqar A. Bhutta, Keyghobad Ghadiri, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Yunquan Zhang, Vera Marisa Costa, Iyad Sultan, Mostafa Hosseini, Abdulaziz Khalid Abu Haimed, Haidong Wang, Kaleab Alemayehu Zewdie, Celine M. Barthelemy, Hosna Janjani, Bartosz Miazgowski, Jobert Richie Nansseu, Arianna Maever L. Amit, John S. Ji, Ata Rafiee, Maria Inês Schmidt, Alireza Rafiei, Somayeh Bohlouli, Joana Morgado-da-Costa, Huong Lan Thi Nguyen, Pradyumna Agasthi, Tiffany K. Gill, Martin McKee, Khaled Khatab, Jae Il Shin, Animut Tagele Tamiru, Giancarlo Logroscino, Hassan Abolhassani, Syed Saoud Zaidi, Sivan Yegnanarayana Iyer Saraswathy, Garumma Tolu Feyissa, Ahmad Daryani, Ziyad Al-Aly, Gebreamlak Gebremedhn Gebremeskel, Michael T. Chung, Amirhossein Sahebkar, Mehedi Hasan, Saeed Shahabi, Diep Ngoc Nguyen, Yohannes Kinfu, Nicholas L S Roberts, Jagadish Rao Padubidri, Mika Shigematsu, Lucero Cahuana-Hurtado, Deepa Jahagirdar, Islam Y. Elgendy, Erkin M. Mirrakhimov, Tanvir M. Huda, Fakher Rahim, Dara K. Mohammad, Yingxi Zhao, Ruxandra Irina Negoi, Vinod C. Nayak, Reinhard Busse, Andrew T. Leever, Muhammad Aziz Rahman, Kathryn Mei Ming Lau, Stefania Mondello, Vivian Chia-Rong Hsieh, Kris J. Krohn, Reza Rawassizadeh, Vishnu Renjith, Jianing Ma, Moses K. Muriithi, Mark G. Shrime, Mayowa O. Owolabi, Nobuyuki Horita, Seyed Hossein Yahyazadeh Jabbari, Daniel Y. Cho, Miloje Savic, Moslem Soofi, Iqbal R. F. Elyazar, Freweini Gebrearegay G. Tela, Jonathan F. Mosser, Palash Chandra Banik, Andre Rodrigues Duraes, Yuan-Pang Wang, Natalie C. Galles, Rashid Abdi Guled, Abdallah M. Samy, Hadi Pourjafar, Roman Topor-Madry, Ayesha Humayun, Leila Zaki, Nuworza Kugbey, Maryam Khayamzadeh, Naznin Hossain, Jiregna Darega Gela, Jordi Alonso, Ruth W Kimokoti, A. A. Fomenkov, Jalal Arabloo, Aletta E. Schutte, Biruk Wogayehu Taddele, Teklehaimanot Gereziher Haile, Diego Augusto Santos Silva, Seyed Mohammad Kazem Aghamir, Maciej Banach, Deanna Anderlini, Moses J. Bockarie, Saleem Muhammad Rana, Randah R. Hamadeh, Farhad Islami, Olalekan A. Uthman, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Kairat Davletov, Soraya Seedat, Alan D. Lopez, Masoud Behzadifar, Benjamin B. Massenburg, Santosh Varughese, Ingan Ukur Tarigan, Amin Soheili, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Caleb Mackay Salpeter Irvine, Mojgan Gitimoghaddam, G Anil Kumar, Rasmus J. Havmoeller, Hiroyasu Iso, Atte Meretoja, Yasir Waheed, João M. Furtado, Christian Razo, Neeti Kapoor, Mowafa Househ, Rajaa Al-Raddadi, Mohammad Khammarnia, Santi Martini, Feng Sha, Marco Vacante, Jacek A. Kopec, Hunduma Amensisa Bojia, Jacob Olusegun Olusanya, Kate E. LeGrand, Nikolay Ivanovich Briko, Robert S. Bernstein, Arun Balachandran, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Leake G. Gebremeskel, Smita Pakhale, Ejaz Ahmad Khan, Daniel Cury Ribeiro, Yousef Mohammad, Bernhard T. Baune, Azeem Majeed, Luis Camera, Mohammad Ali Jahani, Hasan Yusefzadeh, Rahman Shiri, Massimo Cirillo, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, Paolo Lauriola, Irfan Ullah, Aruna M Kamath, Maryam Mirzaei, Zabihollah Yousefi, Iman El Sayed, Mohammad Farahmand, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Felix Akpojene Ogbo, Megan Knight, Nelson J. Alvis-Zakzuk, Teferi Mekonnen, Iván Landires, Robert G. Weintraub, Chukwudi A Nnaji, Lauren E. Schaeffer, Paulo A. Lotufo, Mehdi Naderi, Tomislav Mestrovic, André Faro, Mohsen Bayati, Raffaele Palladino, Shahin Soltani, Vladimir Andreevich Korshunov, Birhanu Geta Meharie, Mihajlo Jakovljevic, Abdiwahab Hashi, Olatunji O. Adetokunboh, Dejana Braithwaite, Sergio I. Prada, Bárbara Niegia Garcia de Goulart, Reza Pourmirza Kalhori, Jee-Young Jasmine Choi, Ernoiz Antriyandarti, Ronny Westerman, Meghdad Pirsaheb, Paul S. F. Yip, Mehdi Mirzaei-Alavijeh, Gebremariam Woldu, Rashmi Gupta, Onome Bright Oghenetega, Shane D. Morrison, Inga Dora Sigfusdottir, Marcel Ausloos, Mehdi Hosseinzadeh, Marcos Roberto Tovani-Palone, K M Shivakumar, Alireza Ansari-Moghaddam, Archith Boloor, Aidin Abedi, Binyam Minuye Birihane, Mohammad Ali Mansournia, Nihad A. Almasri, Simachew Animen Bante, Carlo Eduardo Medina-Solís, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Antonio Biondi, Valentin Yurievich Skryabin, Srinivasa Vittal Katikireddi, Sarika Chaturvedi, Francesco Saverio Violante, Abhay Gaidhane, George A. Mensah, Naohiro Yonemoto, Ahmad Ghashghaee, Ebrahim Babaee, Saman Esmaeilnejad, Sharath Burugina Nagaraja, Avina Vongpradith, Javad Nazari, Amir Khater, Michael K. Hole, Ben Lacey, Razique Anwer, Łukasz Szumowski, Ai Koyanagi, Rajesh Sagar, Ali Rajabpour-Sanati, Seyed M Karimi, Yordanos Gizachew Yeshitila, Mona Pathak, Nithin Kumar, Masoud Foroutan, Mehdi Fazlzadeh, Anusha Ganapati Bhat, Abbas Mosapour, Kebede Deribe, Nermin Ghith, Vaman Kulkarni, Sanjay Zodpey, Asadollah Gholamian, Mohammed Shannawaz, Nancy Fullman, Benn Sartorius, Giulio Castelpietra, Ghulam Mustafa, Silvia Schiavolin, Nelson Alvis-Guzman, Jeffrey D. Stanaway, Rafael Lozano, Christopher J L Murray, Guoqing Hu, Andrew M. Briggs, Ashish Badiye, Yousef Khader, Masoud Moghadaszadeh, Rahmatollah Moradzadeh, Valery L. Feigin, Claudia I. Mastrogiacomo, Emma Smith, Yasser Vasseghian, Saeed Amini, Asif Hanif, Achala Upendra Jayatilleke, Maryam Adabi, Sarah Wulf Hanson, Bhaskar Thakur, Ravi Mehrotra, Virginia Núñez-Samudio, Lalit Dandona, Segun Emmanuel Ibitoye, Simon I. Hay, Kiirithio N. Ngari, Obinna Onwujekwe, Deborah Carvalho Malta, Lorenzo Monasta, Neda Kianipour, Khurshid Alam, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Khalid A Altirkawi, Jaimie Adelson, Hamed Zandian, Frank Tanser, Dharmesh Kumar Lal, John Everett Mumford, Morteza Oladnabi, Telma Zahirian Moghadam, Rodrigo Sarmiento-Suárez, Masoud Moradi, Maseer Khan, Mohammad Ali Sahraian, Amy E. Peden, Dhirendra N Sinha, Shanshan Li, Shailesh Advani, Behshad Naghshtabrizi, Matilde Leonardi, Lope H Barrero, Nicholas Steel, Dinh-Toi Chu, Claudio Alberto Dávila-Cervantes, Pushpendra Singh, Adrian Otoiu, Fabrizio Tediosi, Yonas Getaye Tefera, Pawan Faris, George C. Patton, Christopher Troeger, Mohammed Madadin, Jeffrey V. Lazarus, Paul H. Lee, Mohammad Amin Bahrami, Wondimeneh Shibabaw Shiferaw, Emmanuel Wandera Okunga, Biniyam Sahiledengle Geberemariyam, Samer Hamidi, Young-Ho Khang, Rufus Akinyemi, Farhad Jadidi-Niaragh, Godfrey Mutashambara Rwegerera, Naser Mohammad Gholi Mezerji, Rupak Desai, Eduardo Bernabé, Jamal A. Yearwood, Nima Rezaei, Emerito Jose A. Faraon, Vasily Vlassov, Stanislav S. Otstavnov, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Mukhammad David Naimzada, Tahereh Javaheri, Tamer H. Farag, Paolo Cortesi, Gbenga A. Kayode, Lucas Guimarães Abreu, Manu Raj Mathur, Getie Lake Aynalem, Narayanaswamy Venketasubramanian, Doris V.V. Ortega-Altamirano, Giorgia Giussani, Liliana G Ciobanu, Suraj Bhattarai, Basema Saddik, Mustafa Z. Younis, Ensiyeh Jenabi, Ira Martopullo, Mohamed M. Gad, Kanyin L. Ong, Addisu Melese, Fotis Topouzis, Hanne Christensen, In-Hwan Oh, Arash Sarveazad, Shuhei Nomura, Peter Memiah, Sergej M. Ostojic, Santosh Kumar Tadakamadla, Dinesh Bhandari, Ahmed Omar Bali, Farahnaz Joukar, Arielle Wilder Eagan, Emma Elizabeth Spurlock, Ferrán Catalá-López, Caroline Stein, Jonathan M. Kocarnik, Stephen S Lim, Siamak Sabour, Kelly Compton, Shoaib Hassan, Rannveig Sigurvinsdottir, Claudiu Herteliu, Aso Mohammad Darwesh, Muluken Altaye Ayza, Angela Y. Chang, Leila R Kalankesh, Rafael Alves Guimarães, Abdollah Mohammadian-Hafshejani, Lal B. Rawal, Soewarta Kosen, Degena Bahrey Tadesse, Theo Vos, Paula Moraga, Soheil Hassanipour, Abdelrahman Ibrahim Abushouk, Oladimeji Adebayo, Mikk Jürisson, Tuomo J. Meretoja, Ireneous N. Soyiri, Carlo La Vecchia, Khalil Eskandari, Aziz Sheikh, Jagdish Khubchandani, James Leigh, Morteza Arab-Zozani, Sheikh Mohammed Shariful Islam, Stefan Kohler, Olayinka Stephen Ilesanmi, Kazumasa Yamagishi, Michele Romoli, Jasvinder A. Singh, Neeraj Bedi, Ivo Iavicoli, Alyssa Pennini, Subas Neupane, Emmanuel Peprah, Sojib Bin Zaman, Marwa Rashad Salem, Mohammed Ibrahim Mohialdeen Gubari, Ramesh Holla, Bayisa Abdissa Baye, Robert Ancuceanu, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Ettore Beghi, Quique Bassat, B Reshmi, Masood Ali Shaikh, Ionut Negoi, Peter Azzopardi, Florian Fischer, Kerem Shuval, Sorin Hostiuc, Hmwe H Kyu, Ver Bilano, Siddhesh Zadey, Davide Rasella, Vahid Alipour, Sowmya J. Rao, Radoslaw Sierpinski, Irina Filip, Michelle L. Bell, Malke Asaad, Ravensara S. Travillian, Christopher R. Cederroth, Rafael Tabarés-Seisdedos, Ashkan Afshin, Saqib Ali, Mahalaqua Nazli Khatib, Saad M.A. Dahlawi, Hedayat Abbastabar, Zahid A Butt, Sagun Paudel, Vahid Rashedi, B. Suresh Kumar Shetty, Thomas R. Hird, Shokofeh Maleki, Atif Amin Baig, Reza Heidari-Soureshjani, Shaun Wen Huey Lee, Jorge R. Ledesma, Ai-Min Wu, Fablina Sharara, Zemenu Tadesse Tessema, Ratilal Lalloo, Rohollah Kalhor, Rosario Cárdenas, Amir Radfar, Salime Goharinezhad, Fereshteh Mehri, Katarzyna Kissimova-Skarbek, Spencer A. Pease, Diana Silva, Amir Hossein Goudarzian, Samath D Dharmaratne, Darshan B B, Mariya Vladimirovna Titova, Dickson A. Amugsi, Lee Ling Lim, Agegnehu Bante, Charles D.A. Wolfe, Majid A Almadi, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, Tauseef Ahmad, Platon D. Lopukhov, Takahiro Tabuchi, Nicholas J Kassebaum, Jacek Jerzy Jozwiak, Ritesh G. Menezes, Giovanni Damiani, Delia Hendrie, Mostafa Amini-Rarani, Sanjay Basu, Mohammad Hossein Bakhshaei, Gholamreza Roshandel, Borhan Mansouri, Enrico Rubagotti, Anurag Agrawal, Alireza Esteghamati, Paramjit Gill, Graeme J. Hankey, Mikhail Sergeevich Zastrozhin, Nima Hafezi-Nejad, Bruce Bartholow Duncan, Silvano Gallus, Jeevan Pereira, Ahamarshan Jayaraman Nagarajan, Giulia Carreras, Fariba Dorostkar, Pietro Ferrara, Andrea Farioli, Christoph Nowak, Ahmed I. Hasaballah, Vijay Kumar Chattu, Bolajoko O. Olusanya, Perminder S. Sachdev, Era Upadhyay, Tommi Vasankari, Susan M Sawyer, Adnan Kisa, Farshad Pourmalek, Kiomars Sharafi, Golnaz Heidari, Mohammad Abdollahi, Georges Nguefack-Tsague, Sajid Hameed, Sanni Yaya, Bach Xuan Tran, Ole Frithjof Norheim, Robert Kaba Alhassan, Morenike Oluwatoyin Folayan, Ismail Tareque, Phetole Walter Mahasha, Kewal Krishan, Soraya Siabani, Aleksandr Y. Aravkin, Helena Ullyartha Pangaribuan, Maryam Zamanian, Joshua A. Salomon, Bianca S. Zlavog, Vinay Nangia, Falk Schwendicke, Takeshi Fukumoto, Hung Chak Ho, Jordan Weiss, Maha Atout, Tariku Tesfaye Bekuma, Efat Mohamadi, Nikolaos Dervenis, Joan B. Soriano, Syed Amir Gilani, Victor Adekanmbi, Marina Karanikolos, Alberto Raggi, Michael R.M. Abrigo, Weijia Fu, Reza Shirkoohi, Aditya Prasad Dash, Peng Jia, Masoumeh Sadeghi, Ashraf Nabhan, Isabela M. Benseñor, Morteza Jafarinia, Joht Singh Chandan, Usman Iqbal, Amira Shaheen, Deepak Saxena, Lauren B. Wilner, Nataliya A. Foigt, Jeadran N. Malagón-Rojas, David C. Schwebel, Gail Davey, Milena Ilic, Josep Maria Haro, Peter Njenga Keiyoro, Stein Emil Vollset, Andrea Werdecker, Zahiruddin Quazi Syed, Yared Asmare Aynalem, Entezar Mehrabi Nasab, Yihun Mulugeta Alemu, Muhammad Ali, Mona M. Khater, Ehsan Sadeghi, Thirunavukkarasu Sathish, Pascual R. Valdez, Jennifer Rickard, Mark A. Stokes, Davide Sattin, Ewerton Cousin, Oliver J. Brady, Krittika Bhattacharyya, Mika Kivimäki, Andrew T Olagunju, Jost B. Jonas, Dian Kusuma, Goura Kishor Rath, Alberto Ortiz, Samad Azari, Nayu Ikeda, James L. Fisher, Peng Zheng, Elisabetta Pupillo, Pankaj Bhardwaj, Suzanne Lyn Barker-Collo, Riaz Uddin, Ester Cerin, Amir Taherkhani, Martin Amogre Ayanore, Richard G. Wamai, Anders Larsson, Josephine W. Ngunjiri, Hosni Salem, Hesham M. Al-Mekhlafi, Sharareh Eskandarieh, Taraneh Yousefinezhadi, Srikanta Banerjee, Yang Xie, Yuichiro Yano, Songhomitra Panda-Jonas, Themba G. Ginindza, Manasi Kumar, Babak Moazen, Bing-Fang Hwang, Cristiana Abbafati, Florentino Luciano Caetano dos Santos, Juan Sanabria, Milena Santric-Milicevic, Carla Sofia e.Sá Farinha, Samuel B. Albertson, Chieh Han, Parvaiz A Koul, Foad Abd-Allah, Mojisola Oluwasanu, Mihaela Hostiuc, Chinwe Juliana Iwu, Colm McAlinden, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Jalil Jaafari, Walter Mendoza, Abdulaziz M. Almulhim, Magdalene K. Walters, Ali H. Mokdad, Andre M. N. Renzaho, Catherine M. Antony, Ken Lee Chin, Ali A. Asadi-Pooya, Daniel Diaz, Adrian Pana, Salman Rawaf, Gina Agarwal, Demelash Woldeyohannes Handiso, Savita Lasrado, Amir Almasi-Hashiani, Praveen Hoogar, Srinivasa Rao Bolla, Fares Alahdab, Om P Kurmi, Sonali Kochhar, Van C. Lansingh, François Alla, Ali Almasi, Till Bärnighausen, Michael A. Piradov, Zubair Kabir, Boris Bikbov, Philip B. Mitchell, Amin Mousavi Khaneghah, Yahya Safari, Anirudh Kotlo, Jan-Walter De Neve, Biagio Simonetti, Carlos A Castañeda-Orjuela, Kenji Shibuya, GBD 2019 Universal Health Coverage Collaborator, Violante FS, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Department of Public Health, University of Helsinki, Clinicum, Neurologian yksikkö, HUS Neurocenter, HUS Comprehensive Cancer Center, Helsinki University Hospital Area, GBD 2019 Universal Health Coverage Collaborators, Lozano, Rafael, Fullman, Nancy, Mumford, John Everett, Knight, Megan, Barthelemy, Celine M, Abbafati, Cristiana, Abbastabar, Hedayat, Abd-Allah, Foad, Abdollahi, Mohammad, Abedi, Aidin, Abolhassani, Hassan, Abosetugn, Akine Eshete, Abreu, Lucas Guimarãe, Abrigo, Michael R M, Abu Haimed, Abdulaziz Khalid, Abushouk, Abdelrahman I, Adabi, Maryam, Adebayo, Oladimeji M, Adekanmbi, Victor, Adelson, Jaimie, Adetokunboh, Olatunji O, Adham, Davoud, Advani, Shailesh M, Afshin, Ashkan, Agarwal, Gina, Agasthi, Pradyumna, Aghamir, Seyed Mohammad Kazem, Agrawal, Anurag, Ahmad, Tauseef, Akinyemi, Rufus Olusola, Alahdab, Fare, Al-Aly, Ziyad, Alam, Khurshid, Albertson, Samuel B, Alemu, Yihun Mulugeta, Alhassan, Robert Kaba, Ali, Muhammad, Ali, Saqib, Alipour, Vahid, Aljunid, Syed Mohamed, Alla, Françoi, Almadi, Majid Abdulrahman Hamad, Almasi, Ali, Almasi-Hashiani, Amir, Almasri, Nihad A, Al-Mekhlafi, Hesham M, Almulhim, Abdulaziz M, Alonso, Jordi, Al-Raddadi, Rajaa M, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Alvis-Zakzuk, Nelson J, Amini, Saeed, Amini-Rarani, Mostafa, Amiri, Fatemeh, Amit, Arianna Maever L, Amugsi, Dickson A, Ancuceanu, Robert, Anderlini, Deanna, Andrei, Catalina Liliana, Androudi, Sofia, Ansari, Fereshteh, Ansari-Moghaddam, Alireza, Antonio, Carl Abelardo T, Antony, Catherine M, Antriyandarti, Ernoiz, Anvari, Davood, Anwer, Razique, Arabloo, Jalal, Arab-Zozani, Morteza, Aravkin, Aleksandr Y, Aremu, Olatunde, Ärnlöv, Johan, Asaad, Malke, Asadi-Aliabadi, Mehran, Asadi-Pooya, Ali A, Ashbaugh, Charlie, Athari, Seyyed Shamsadin, Atout, Maha Moh'd Wahbi, Ausloos, Marcel, Avila-Burgos, Leticia, Ayala Quintanilla, Beatriz Paulina, Ayano, Getinet, Ayanore, Martin Amogre, Aynalem, Yared Asmare, Aynalem, Getie Lake, Ayza, Muluken Altaye, Azari, Samad, Azzopardi, Peter S, B, Darshan B, Babaee, Ebrahim, Badiye, Ashish D, Bahrami, Mohammad Amin, Baig, Atif Amin, Bakhshaei, Mohammad Hossein, Bakhtiari, Ahad, Bakkannavar, Shankar M, Balachandran, Arun, Balassyano, Shelly, Banach, Maciej, Banerjee, Srikanta K, Banik, Palash Chandra, Bante, Agegnehu Bante, Bante, Simachew Animen, Barker-Collo, Suzanne Lyn, Bärnighausen, Till Winfried, Barrero, Lope H, Bassat, Quique, Basu, Sanjay, Baune, Bernhard T, Bayati, Mohsen, Baye, Bayisa Abdissa, Bedi, Neeraj, Beghi, Ettore, Behzadifar, Masoud, Bekuma, Tariku Tesfaye Tesfaye, Bell, Michelle L, Bensenor, Isabela M, Berman, Adam E, Bernabe, Eduardo, Bernstein, Robert S, Bhagavathula, Akshaya Srikanth, Bhandari, Dinesh, Bhardwaj, Pankaj, Bhat, Anusha Ganapati, Bhattacharyya, Krittika, Bhattarai, Suraj, Bhutta, Zulfiqar A, Bijani, Ali, Bikbov, Bori, Bilano, Ver, Biondi, Antonio, Birihane, Binyam Minuye, Bockarie, Moses John, Bohlouli, Somayeh, Bojia, Hunduma Amensisa, Bolla, Srinivasa Rao Rao, Boloor, Archith, Brady, Oliver J, Braithwaite, Dejana, Briant, Paul Svitil, Briggs, Andrew M, Briko, Nikolay Ivanovich, Burugina Nagaraja, Sharath, Busse, Reinhard, Butt, Zahid A, Caetano dos Santos, Florentino Luciano, Cahuana-Hurtado, Lucero, Cámera, Luis Alberto, Cárdenas, Rosario, Carreras, Giulia, Carrero, Juan J, Carvalho, Felix, Castaldelli-Maia, Joao Mauricio, Castañeda-Orjuela, Carlos A, Castelpietra, Giulio, Castro, Franz, Catalá-López, Ferrán, Causey, Kate, Cederroth, Christopher R, Cercy, Kelly M, Cerin, Ester, Chandan, Joht Singh, Chang, Angela Y, Charan, Jaykaran, Chattu, Vijay Kumar, Chaturvedi, Sarika, 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Mestrovic, T, Miazgowski, B, Michalek, I, Mirrakhimov, E, Mirzaei, M, Mirzaei-Alavijeh, M, Mitchell, P, Moazen, B, Moghadaszadeh, M, Mohamadi, E, Mohammad, Y, Mohammad, D, Mohammad Gholi Mezerji, N, Mohammadian-Hafshejani, A, Mohammed, S, Mohammed, J, Mokdad, A, Monasta, L, Mondello, S, Moradi, M, Moradi-Lakeh, M, Moradzadeh, R, Moraga, P, Morgado-da-Costa, J, Morrison, S, Mosapour, A, Mosser, J, Mousavi Khaneghah, A, Muriithi, M, Mustafa, G, Nabhan, A, Naderi, M, Nagarajan, A, Naghavi, M, Naghshtabrizi, B, Naimzada, M, Nangia, V, Nansseu, J, Nayak, V, Nazari, J, Ndejjo, R, Negoi, I, Negoi, R, Neupane, S, Ngari, K, Nguefack-Tsague, G, Ngunjiri, J, Nguyen, C, Nguyen, D, Nguyen, H, Nnaji, C, Nomura, S, Norheim, O, Noubiap, J, Nowak, C, Nunez-Samudio, V, Otoiu, A, Ogbo, F, Oghenetega, O, Oh, I, Okunga, E, Oladnabi, M, Olagunju, A, Olusanya, J, Olusanya, B, Oluwasanu, M, Omar Bali, A, Omer, M, Ong, K, Onwujekwe, O, Ortega-Altamirano, D, Ortiz, A, Ostojic, S, Otstavnov, N, Otstavnov, S, Øverland, S, Owolabi, M, Padubidri, J, Pakhale, S, Palladino, R, Pana, A, Panda-Jonas, S, Pangaribuan, H, Pathak, M, Patton, G, Paudel, S, Pazoki Toroudi, H, Pease, S, Peden, A, Pennini, A, Peprah, E, Pereira, J, Pigott, D, Pilgrim, T, Pilz, T, Pinheiro, M, Piradov, M, Pirsaheb, M, Pokhrel, K, Postma, M, Pourjafar, H, Pourmalek, F, Pourmirza Kalhori, R, Pourshams, A, Prada, S, Pribadi, D, Pupillo, E, Quazi Syed, Z, Radfar, A, Rafiee, A, Rafiei, A, Raggi, A, Rahim, F, Rahman, M, Rajabpour-Sanati, A, Rana, S, Ranabhat, C, Rao, S, Rasella, D, Rashedi, V, Rath, G, Rathi, P, Rawaf, S, Rawaf, D, Rawal, L, Rawassizadeh, R, Razo, C, Renjith, V, Renzaho, A, Reshmi, B, Rezaei, N, Riahi, S, Ribeiro, D, Rickard, J, Roberts, N, Roever, L, Romoli, M, Ronfani, L, Roshandel, G, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, M, Sadeghi, E, Safari, Y, Sagar, R, Sahebkar, A, Sahraian, M, Sajadi, S, Salahshoor, M, Salem, M, Salem, H, Salomon, J, Samadi Kafil, H, Samy, A, Sanabria, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suárez, R, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Savic, M, Sawyer, S, Saxena, D, Sbarra, A, Schaeffer, L, Schiavolin, S, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Seedat, S, Sha, F, Shahabi, S, Shaheen, A, Shaikh, M, Shamsizadeh, M, Shannawaz, M, Sharafi, K, Sharara, F, Sharifi, H, Shaw, D, Sheikh, A, Sheikhtaheri, A, Shetty, B, Shibuya, K, Shiferaw, W, Shigematsu, M, Shin, J, Shiri, R, Shirkoohi, R, Shivakumar, K, Shrime, M, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, D, Silva, J, Simonetti, B, Simpson, K, Singh, J, Singh, P, Sinha, D, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soyiri, I, Spurlock, E, Sreeramareddy, C, Stanaway, J, Steel, N, Stein, C, Stokes, M, Sufiyan, M, Suleria, H, Sultan, I, Szumowski, Ł, Tabarés-Seisdedos, R, Tabuchi, T, Tadakamadla, S, Taddele, B, Tadesse, D, Taherkhani, A, Tamiru, A, Tanser, F, Tareque, M, Tarigan, I, Teagle, W, Tediosi, F, Tefera, Y, Tela, F, Tessema, Z, Thakur, B, Titova, M, Tonelli, M, Topor-Madry, R, Topouzis, F, Tovani-Palone, M, Tran, B, Travillian, R, Troeger, C, Tudor Car, L, Uddin, R, Ullah, I, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Uthman, O, Vacante, M, Valdez, P, Varughese, S, Vasankari, T, Vasseghian, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vongpradith, A, Vos, T, Waheed, Y, Walters, M, Wamai, R, Wang, H, Wang, Y, Weintraub, R, Weiss, J, Werdecker, A, Westerman, R, Wilner, L, Woldu, G, Wolfe, C, Wu, A, Wulf Hanson, S, Xie, Y, Xu, R, Yahyazadeh Jabbari, S, Yamagishi, K, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yearwood, J, Yeshitila, Y, Yip, P, Yonemoto, N, Younis, M, Yousefi, Z, Yousefinezhadi, T, Yusefzadeh, H, Zadey, S, Zahirian Moghadam, T, Zaidi, S, Zaki, L, Zaman, S, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zewdie, K, Zhang, Y, Zhao, X, Zhao, Y, Zheng, P, Zhu, C, Ziapour, A, Zlavog, B, Zodpey, S, Murray, C, Tampere University, Health Sciences, 10922180 - Schutte, Aletta Elisabeth, Lozano, R., Fullman, N., Mumford, J. E., Knight, M., Barthelemy, C. M., Abbafati, C., Abbastabar, H., Abd-Allah, F., Abdollahi, M., Abedi, A., Abolhassani, H., Abosetugn, A. E., Abreu, L. G., Abrigo, M. R. M., Abu Haimed, A. K., Abushouk, A. I., Adabi, M., Adebayo, O. M., Adekanmbi, V., Adelson, J., Adetokunboh, O. O., Adham, D., Advani, S. M., Afshin, A., Agarwal, G., Agasthi, P., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Akinyemi, R. O., Alahdab, F., Al-Aly, Z., Alam, K., Albertson, S. B., Alemu, Y. M., Alhassan, R. K., Ali, M., Ali, S., Alipour, V., Aljunid, S. M., Alla, F., Almadi, M. A. H., Almasi, A., Almasi-Hashiani, A., Almasri, N. A., Al-Mekhlafi, H. M., Almulhim, A. M., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amiri, F., Amit, A. M. L., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Andrei, C. L., Androudi, S., Ansari, F., Ansari-Moghaddam, A., Antonio, C. A. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Arabloo, J., Arab-Zozani, M., Aravkin, A. Y., Aremu, O., Arnlov, J., Asaad, M., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Athari, S. S., Atout, M. M. W., Ausloos, M., Avila-Burgos, L., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Aynalem, Y. A., Aynalem, G. L., Ayza, M. A., Azari, S., Azzopardi, P. S., B, D. B., Babaee, E., Badiye, A. D., Bahrami, M. A., Baig, A. A., Bakhshaei, M. H., Bakhtiari, A., Bakkannavar, S. M., Balachandran, A., Banach, M., Banerjee, S. K., Banik, P. C., Bante, A. B., Bante, S. A., Barker-Collo, S. L., Barnighausen, T. W., Barrero, L. H., Bassat, Q., Basu, S., Baune, B. T., Bayati, M., Baye, B. A., Bedi, N., Beghi, E., Behzadifar, M., Bekuma, T. T. T., Bell, M. L., Bensenor, I. M., Berman, A. E., Bernabe, E., Bernstein, R. S., Bhagavathula, A. S., Bhandari, D., Bhardwaj, P., Bhat, A. G., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Bijani, A., Bikbov, B., Bilano, V., Biondi, A., Birihane, B. M., Bockarie, M. J., Bohlouli, S., Bojia, H. A., Bolla, S. R. R., Boloor, A., Brady, O. J., Braithwaite, D., Briggs, A. M., Briko, N. I., Burugina Nagaraja, S., Busse, R., Butt, Z. A., Caetano dos Santos, F. L., Cahuana-Hurtado, L., Camera, L. A., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Catala-Lopez, F., Cederroth, C. R., Cerin, E., Chandan, J. S., Chang, A. Y., Charan, J., Chattu, V. K., Chaturvedi, S., Chin, K. L., Cho, D. Y., Choi, J. -Y. J., Christensen, H., Chu, D. -T., Chung, M. T., Ciobanu, L. G., Cirillo, M., Compton, K., Cortesi, P. A., Costa, V. M., Cousin, E., Dahlawi, S. M. A., Damiani, G., Dandona, L., Dandona, R., Darega Gela, J., Darwesh, A. M., Daryani, A., Dash, A. P., Davey, G., Davila-Cervantes, C. A., Davletov, K., De Neve, J. -W., Denova-Gutierrez, E., Deribe, K., Dervenis, N., Desai, R., Dharmaratne, S. D., Dhungana, G. P., Dianatinasab, M., Dias da Silva, D., Diaz, D., Dippenaar, I. N., Do, H. T., Dorostkar, F., Doshmangir, L., Duncan, B. B., Duraes, A. R., Eagan, A. W., Edvardsson, D., El Sayed, I., El Tantawi, M., Elgendy, I. Y., Elyazar, I. R., Eskandari, K., Eskandarieh, S., Esmaeilnejad, S., Esteghamati, A., Ezekannagha, O., Farag, T., Farahmand, M., Faraon, E. J. A., Farinha, C. S. E. S., Farioli, A., Faris, P. S., Faro, A., Fazlzadeh, M., Feigin, V. L., Fernandes, E., Ferrara, P., Feyissa, G. T., Filip, I., Fischer, F., Fisher, J. L., Flor, L. S., Foigt, N. A., Folayan, M. O., Fomenkov, A. A., Foroutan, M., Francis, J. M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gaidhane, A. M., Gakidou, E., Galles, N. C., Gallus, S., Gardner, W. M., Geberemariyam, B. S., Gebrehiwot, A. M., Gebremeskel, L. G., Gebremeskel, G. G., Gesesew, H. A., Ghadiri, K., Ghafourifard, M., Ghashghaee, A., Ghith, N., Gholamian, A., Gilani, S. A., Gill, P. S., Gill, T. K., Ginindza, T. G., Gitimoghaddam, M., Giussani, G., Glagn, M., Gnedovskaya, E. V., Godinho, M. A., Goharinezhad, S., Gopalani, S. V., Goudarzian, A. H., Goulart, B. N. G., Gubari, M. I. M., Guimaraes, R. A., Guled, R. A., Gultie, T., Guo, Y., Gupta, R., Hafezi-Nejad, N., Hafiz, A., Haile, T. G., Hamadeh, R. R., Hameed, S., Hamidi, S., Han, C., Han, H., Handiso, D. W., Hanif, A., Hankey, G. J., Haro, J. M., Hasaballah, A. I., Hasan, M. M., Hashi, A., Hassan, S., Hassan, A., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Heidari-Soureshjani, R., Hendrie, D., Herteliu, C., Hird, T. R., Ho, H. C., Hole, M. K., Holla, R., Hoogar, P., Hopf, K. P., Horita, N., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsieh, V. C. -R., Hu, G., Huda, T. M., Humayun, A., Hwang, B. -F., Iavicoli, I., Ibitoye, S. E., Ikeda, N., Ilesanmi, O. S., Ilic, M. D., Inbaraj, L. R., Iqbal, U., Irvani, S. S. N., Irvine, C. M. S., Islam, M. M., Islam, S. M. S., Islami, F., Iso, H., Iwu, C. J., Jaafari, J., Jadidi-Niaragh, F., Jafarinia, M., Jahagirdar, D., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Janjani, H., Javaheri, T., Jayatilleke, A. U., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Jia, P., John-Akinola, Y. O., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kabir, Z., Kalankesh, L. R., Kalhor, R., Kamath, A. M., Kanchan, T., Kapoor, N., Karami Matin, B., Karanikolos, M., Karimi, S. M., Kassebaum, N. J., Katikireddi, S. V., Kayode, G. A., Keiyoro, P. N., Khader, Y. S., Khammarnia, M., Khan, M., Khan, E. A., Khang, Y. -H., Khatab, K., Khater, A. M., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khubchandani, J., Kianipour, N., Kim, Y. J., Kimokoti, R. W., Kinfu, Y., Kisa, A., Kissimova-Skarbek, K., Kivimaki, M., Kneib, C. J., Kocarnik, J. M., Kochhar, S., Kohler, S., Kopec, J. A., Korotkova, A. V., Korshunov, V. A., Kosen, S., Kotlo, A., Koul, P. A., Koyanagi, A., Krishan, K., Krohn, K. J., Kugbey, N., Kulkarni, V., Kumar, G. A., Kumar, N., Kumar, M., Kurmi, O. P., Kusuma, D., Kyu, H. H., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Landires, I., Lansingh, V. C., Larsson, A. O., Lasrado, S., Lau, K. M. -M., Lauriola, P., Lazarus, J. V., Ledesma, J. R., Lee, P. H., Lee, S. W. H., Leever, A. T., Legrand, K. E., Leigh, J., Leonardi, M., Li, S., Lim, S. S., Lim, L. -L., Liu, X., Logroscino, G., Lopez, A. D., Lopukhov, P. D., Lotufo, P. A., Lu, A., Ma, J., Madadin, M., Mahasha, P. W., Mahmoudi, M., Majeed, A., Malagon-Rojas, J. N., Maleki, S., Malta, D. C., Mansouri, B., Mansournia, M. A., Martini, S., Martins-Melo, F. R., Martopullo, I., Massenburg, B. B., Mastrogiacomo, C. I., Mathur, M. R., Mcalinden, C., Mckee, M., Medina-Solis, C. E., Meharie, B. G., Mehndiratta, M. M., Mehrabi Nasab, E., Mehri, F., Mehrotra, R., Mekonnen, T., Melese, A., Memiah, P. T. N., Mendoza, W., Menezes, R. G., Mensah, G. A., Meretoja, T. J., Meretoja, A., Mestrovic, T., Miazgowski, B., Michalek, I. M., Mirrakhimov, E. M., Mirzaei, M., Mirzaei-Alavijeh, M., Mitchell, P. B., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, Y., Mohammad, D. K., Mohammad Gholi Mezerji, N., Mohammadian-Hafshejani, A., Mohammed, S., Mohammed, J. A., Mokdad, A. H., Monasta, L., Mondello, S., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morgado-da-Costa, J., Morrison, S. D., Mosapour, A., Mosser, J. F., Mousavi Khaneghah, A., Muriithi, M. K., Mustafa, G., Nabhan, A. F., Naderi, M., Nagarajan, A. J., Naghavi, M., Naghshtabrizi, B., Naimzada, M. D., Nangia, V., Nansseu, J. R., Nayak, V. C., Nazari, J., Ndejjo, R., Negoi, I., Negoi, R. I., Neupane, S., Ngari, K. N., Nguefack-Tsague, G., Ngunjiri, J. W., Nguyen, C. T., Nguyen, D. N., Nguyen, H. L. T., Nnaji, C. A., Nomura, S., Norheim, O. F., Noubiap, J. J., Nowak, C., Nunez-Samudio, V., Otoiu, A., Ogbo, F. A., Oghenetega, O. B., Oh, I. -H., Okunga, E. W., Oladnabi, M., Olagunju, A. T., Olusanya, J. O., Olusanya, B. O., Oluwasanu, M. M., Omar Bali, A., Omer, M. O., Ong, K. L., Onwujekwe, O. E., Ortega-Altamirano, D. V. V., Ortiz, A., Ostojic, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., Padubidri, J. R., Pakhale, S., Palladino, R., Pana, A., Panda-Jonas, S., Pangaribuan, H. U., Pathak, M., Patton, G. C., Paudel, S., Pazoki Toroudi, H., Pease, S. A., Peden, A. E., Pennini, A., Peprah, E. K., Pereira, J., Pigott, D. M., Pilgrim, T., Pilz, T. M., Pinheiro, M., Piradov, M. A., Pirsaheb, M., Pokhrel, K. N., Postma, M. J., Pourjafar, H., Pourmalek, F., Pourmirza Kalhori, R., Pourshams, A., Prada, S. I., Pribadi, D. R. A., Pupillo, E., Quazi Syed, Z., Radfar, A., Rafiee, A., Rafiei, A., Raggi, A., Rahim, F., Rahman, M. A., Rajabpour-Sanati, A., Rana, S. M., Ranabhat, C. L., Rao, S. J., Rasella, D., Rashedi, V., Rath, G. K., Rathi, P., Rawaf, S., Rawaf, D. L., Rawal, L., Rawassizadeh, R., Razo, C., Renjith, V., Renzaho, A. M. N., Reshmi, B., Rezaei, N., Riahi, S. M., Ribeiro, D. C., Rickard, J., Roberts, N. L. S., Roever, L., Romoli, M., Ronfani, L., Roshandel, G., Rubagotti, E., Rwegerera, G. M., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, M., Sadeghi, E., Safari, Y., Sagar, R., Sahebkar, A., Sahraian, M. A., Sajadi, S. M., Salahshoor, M. R., Salem, M. R. R., Salem, H., Salomon, J., Samadi Kafil, H., Samy, A. M., Sanabria, J., Santric-Milicevic, M. M., Saraswathy, S. Y. I., Sarmiento-Suarez, R., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Savic, M., Sawyer, S. M., Saxena, D., Sbarra, A. N., Schaeffer, L. E., Schiavolin, S., Schmidt, M. I., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Seedat, S., Sha, F., Shahabi, S., Shaheen, A. A., Shaikh, M. A., Shamsizadeh, M., Shannawaz, M., Sharafi, K., Sharara, F., Sharifi, H., Shaw, D. H., Sheikh, A., Sheikhtaheri, A., Shetty, B. S. K., Shibuya, K., Shiferaw, W. S., Shigematsu, M., Shin, J. I., Shiri, R., Shirkoohi, R., Shivakumar, K. M., Shrime, M. G., Shuval, K., Siabani, S., Sierpinski, R., Sigfusdottir, I. D., Sigurvinsdottir, R., Silva, D. A. S., Silva, J. P., Simonetti, B., Simpson, K. E., Singh, J. A., Singh, P., Sinha, D. N., Skryabin, V. Y., Smith, E. U. R., Soheili, A., Soltani, S., Soofi, M., Sorensen, R. J. D., Soriano, J. B., Sorrie, M. B., Soyiri, I. N., Spurlock, E. E., Sreeramareddy, C. T., Stanaway, J. D., Steel, N., Stein, C., Stokes, M. A., Sufiyan, M. B., Suleria, H. A. R., Sultan, I., Szumowski, L., Tabares-Seisdedos, R., Tabuchi, T., Tadakamadla, S. K., Taddele, B. W., Tadesse, D. B., Taherkhani, A., Tamiru, A. T., Tanser, F. C., Tareque, M. I., Tarigan, I. U., Teagle, W. L., Tediosi, F., Tefera, Y. G. G., Tela, F. G., Tessema, Z. T., Thakur, B., Titova, M. V., Tonelli, M., Topor-Madry, R., Topouzis, F., Tovani-Palone, M. R. R., Tran, B. X., Travillian, R., Troeger, C. E., Tudor Car, L., Uddin, R., Ullah, I., Umeokonkwo, C. D., Unnikrishnan, B., Upadhyay, E., Uthman, O. A., Vacante, M., Valdez, P. R., Varughese, S., Vasankari, T. J., Vasseghian, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S. E., Vongpradith, A., Vos, T., Waheed, Y., Walters, M. K., Wamai, R. G., Wang, H., Wang, Y. -P., Weintraub, R. G., Weiss, J., Werdecker, A., Westerman, R., Wilner, L. B., Woldu, G., Wolfe, C. D. A., Wu, A. -M., Wulf Hanson, S., Xie, Y., Yahyazadeh Jabbari, S. H., Yamagishi, K., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yearwood, J. A., Yeshitila, Y. G., Yip, P., Yonemoto, N., Younis, M. Z., Yousefi, Z., Yousefinezhadi, T., Yusefzadeh, H., Zadey, S., Zahirian Moghadam, T., Zaidi, S. S., Zaki, L., Zaman, S. B., Zamanian, M., Zandian, H., Zastrozhin, M. S., Zewdie, K. A., Zhang, Y., Zhao, X. -J. G., Zhao, Y., Zheng, P., Zhu, C., Ziapour, A., Zlavog, B. S., Zodpey, S., and Murray, C. J. L.
Subjects: Index (economics), Servicios de Salud, SUSTAINABLE DEVELOPMENT GOALS, 030204 cardiovascular system & hematology, universal health coverage, sustaibale develpment goal, global burden of disease, performance, systematic analysis, Global Burden of Disease, 0302 clinical medicine, Universal Health Insurance, RA0421, 11. Sustainability, Per capita, Medical economics, Disease, 030212 general & internal medicine, 10. No inequality, 11 Medical and Health Sciences, effective coverage of health services, GBD 2019 Universal Health Coverage Collaborators, education.field_of_study, Public health, Medical care, Sjúkdómar, 4. Education, 1. No poverty, Health coverage, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Hälsovetenskaper, 3142 Public health care science, environmental and occupational health, Health services, 3. Good health, Global burden of disease, Health Expenditures, Humans, World Health Organization, Purchasing power parity, Scale (social sciences), Lýðheilsa, universal health coverag, CANCER SURVIVAL, ACCESS, Human, Heilsuhagfræði, medicine.medical_specialty, Health coverage, GBD, GBD, Universal health, GBD 2019, Population, Health expenditures, 3122 Cancers, Population health, 03 medical and health sciences, Health systems, Heilbrigðisvísindi, SDG 3 - Good Health and Well-being, General & Internal Medicine, Development economics, Health Sciences, medicine, Heilbrigðisstefna, Alþjóðaheilbrigðisstofnunin, QUALITY, Global Burden of Disease Study, education, PROGRESS, Disease burden, Health services accessibility, CARE, Heilbrigðisþjónusta, purl.org/pe-repo/ocde/ford#3.02.00 [https], Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, 3121 General medicine, internal medicine and other clinical medicine, Morbility, Administración de los Servicios de Salud, Medical policy, Business, Heilbrigðiskerfi
Abstract: Publisher's version (útgefin grein), Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC., Lucas Guimaraes Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior -Brasil (Capes) -Finance Code 001, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science & Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDSUEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried Barnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (FCT), IP, under the Norma TransitA3ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Ivan Landires is a member of the Sistema Nacional de InvestigaciA3n (SNI), which is supported by the Secretaria Nacional de Ciencia Tecnologia e Innovacion (SENACYT), Panama. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health & Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 -Norma transitA3ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship -Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Suarez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria Ines Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabares-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada., "Peer Reviewed"
Published: 2020

219. Essential core competencies for health policy graduates: a multi-method consensus type study.

Author: Doshmangir L, Alipouri Sakha M, Mostafavi H, Kabiri N, Ghaffarifar S, and Takian A
Subjects: Humans, Iran, Qualitative Research, Administrative Personnel, Curriculum, Health Policy, Consensus, Professional Competence standards
Abstract: Background: In light of the multi-faceted challenges confronting health systems worldwide and the imperative to advance towards development goals, the contribution of health policy graduates is of paramount importance, facilitating the attainment of health and well-being objectives. This paper delineates a set of core skills and competencies that are requisite for health policy graduates, with the objective of preparing these graduates for a spectrum of future roles, including both academic and non-academic positions., Methods: The study was conducted in three phases: a scoping review, qualitative interviews and the validation of identified competencies through brainstorming with experts. In the initial phase, a scoping review was conducted on the databases. The following databases were searched: PubMed, Scopus, Web of Science and Google Scholar search engine. Additionally, the WebPages of universities offering health policy programmes were manually searched. In the second phase, 36 semi-structured interviews were conducted with students, graduates and distinguished academics from Iran and other countries. These interviews were conducted in person or via email. In the third phase, the draft version of the competencies and their associated learning objectives, derived from the preceding stages, was subjected to independent review by an expert panel and subsequently discussed. In light of the expert panel's findings, the authors undertook a subsequent revision of the list, leading to the finalization of the core competencies through a process of consensus., Results: In the scoping review phase, the analysis included six studies and nine university curricula. The results of the scoping review could be classified into five domains: health system understanding, health policy research, knowledge translation, multidisciplinary work and knowledge of public health. In the second phase, six core competencies were extracted from the interviews and combined with the results of the first phase, which were then discussed by the expert panel at the third phase. The final five core competencies, derived from the brainstorming session and presented in no particular order, encompass health policy research, policy analysis, educational competencies, decision-making and multidisciplinary work., Conclusions: It is essential that the curriculum is appropriate and contextually tailored, as this is crucial to foster multi-dimensional competencies that complement the specific disciplines of future health policy scholars. These scholars must possess the ability to genuinely serve their health systems towards achieving health-system goals and sustainable development., (© 2024. The Author(s).)
Published: 2024
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220. Analysis of Iranian health workforce emigration based on a system dynamics approach: a study protocol.

Author: Keyvani H, Majdzadeh R, Khedmati Morasae E, and Doshmangir L
Subjects: Iran, Humans, Developing Countries, Systems Analysis, Emigration and Immigration, Health Workforce, Health Personnel, Health Policy
Abstract: Background: Emigration of health workers has emerged as a significant obstacle in Iran, compelling policymakers to implement a diverse range of interventions and reforms to enhance healthcare services. It is imperative to comprehend the efficacy of emigration control interventions. To explore the intricate dynamics of elite emigration, this study employs a system dynamics modeling approach. The objective is to scrutinize Iranian health workers' emigration, examine the relationships, and evaluate the impact of various factors involved., Objectives: The general purpose of this study is to analyze the policy interventions affecting the emigration of human resources in the field of health in Iran based on the system's dynamic approach., Method: The research consists of four phases including analyzing the emigration status of health workers in developing countries, studying health personnel emigration in Iran, developing a System Dynamics (SD) model, and determining evidence-based policy interventions to address health worker emigration. These phases involve realist review, document analysis, qualitative interviews, data integration, and policy scenario planning. The primary objective is to gain a profound understanding of the underlying causes, mechanisms, and consequences of migration, as well as assess the impact of policies, in order to prioritize effective interventions., Results: It seems that the SD model developed in this study can highlight the interconnectedness of various factors that influence health worker emigration, including demographic changes, economic conditions, and characteristics of healthcare systems., Conclusion: This study uses a systems dynamics approach to analyze health worker emigration from Iran, focusing on policies that promote retention and explore the implications of emigration on the healthcare system. By examining interrelationships and feedback loops within the healthcare system and socioeconomic factors, the study aims to identify effective policy interventions that can mitigate the negative effects of emigration.
Published: 2024
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221. Key factors affecting health promoting behaviors among adolescents: a scoping review.

Author: Tabrizi JS, Doshmangir L, Khoshmaram N, Shakibazadeh E, Abdolahi HM, and Khabiri R
Subjects: Humans, Adolescent, Educational Status, Peer Group, Health Promotion
Abstract: Background: Health-promoting behaviors have been noticed recently as one of the most critical factors in raising life expectancy, which can be formed during adolescence. Thus, the current scoping review aimed to identify the key factors affecting health-promoting behaviors among adolescents., Methods: In this scoping review, we searched multiple English online databases, including PubMed, Web of Science, Science Direct, ProQuest, and Scopus, for articles published between 1977 and 2020. All eligible studies describing health-promoting behaviors in adolescents were included. We followed the JBI guideline for conducting a scoping review and increasing the study's rigor. Extracted data were synthesized through inductive approaches., Results: A total of 3199 articles were identified during the first phase. After the screening process, 20 articles were found eligible for final inclusion. Educational factors (individualized education and school health promotion programs), Economic factors (income, economic incentives and national health insurance), Social factors (support system, responsibility and peers), Spiritual, Psychological and Personal factors (gender, family structure, patterns of living, and medical problems) were found effective in health-promoting behaviors among adolescents., Conclusions: Health-promoting behaviors among adolescents require careful consideration. The current review identified some fundamental factors affecting health-promoting behaviors in adolescents. Based on the findings, it is recommended that policymakers and healthcare providers develop several interventions based on identified factors to increase adolescent's health-promoting behaviors among adolescents., (© 2024. The Author(s).)
Published: 2024
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222. The imperative of good governance and enhanced learning systems for resilient health financing.

Author: Doshmangir L and Majdzadeh R
Subjects: Humans, Healthcare Financing, Delivery of Health Care
Abstract: Competing Interests: We declare no competing interests.
Published: 2023
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223. Factors Affecting Health Policies for Older People in Iran.

Author: Doshmangir L, Doshmangir P, Mobasseri K, Khodayari-Zarnaq R, Ahmadi Teymourlouy A, and Sergeevich Gordeev V
Subjects: Humans, Middle Aged, Aged, Iran, Delivery of Health Care, Health Policy, Policy Making
Abstract: Globally, the number and proportion of people aged 60 years and older is growing fast. As people age, health needs become more complex, and the health system's responsiveness to older people's needs requires evidence-informed policies. Hence, this study explores the factors affecting the health policy development process for older people in Iran. We conducted 32 interviewers with people aged 60 years and older and 21 interviews with key informants involved in policy making related to older people. Qualitative data were analyzed using thematic analysis. Actors and stakeholders, policy structure, selected health policy processes, the health care service delivery system, government financial support, and community and culture building are the most influential factors in health policy making for older people. Government policies and health priority interventions are needed to address these influential factors for older people to ensure healthy aging over the life course.
Published: 2023
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224. Iran's Health after A Hundred Years: Snapshots of the Beginning and End of the Solar Hijri Century.

Author: Doshmangir L and Majdzadeh R
Abstract: Competing Interests: Conflict of Interest The authors declare that there is no conflict of interests.
Published: 2023
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225. Analysis and evolution of health policies in Iran through policy triangle framework during the last thirty years: a systematic review of the historical period from 1994 to 2021.

Author: Doshmangir L, Behzadifar M, Shahverdi A, Martini M, Ehsanzadeh SJ, Azari S, Bakhtiari A, Shahabi S, Bragazzi NL, and Behzadifar M
Subjects: Humans, Iran, Retrospective Studies, Qualitative Research, Health Policy, Policy Making
Abstract: Background: Health policy analysis as a multi-disciplinary approach to public policy illustrates the need for interventions that highlight and address important policy issues, improve the policy formulation and implementation process and lead to better health outcomes. Various theories and frameworks have been contributed as the foundation for the analysis of policy in various studies. This study aimed to analyze health policies during the historical period of the almost last 30 years in Iran using policy triangle framework., Method: To conduct the systematic review international databases (PubMed / Medline, Scopus, Web of Sciences, CINAHL, PsycINFO, Embase, the Cochran Library) and Iranian databases from January 1994 to January 2021 using relevant keywords. A thematic qualitative analysis approach was used for the synthesis and analysis of data. The Critical Appraisal Skills Programme for Qualitative Studies Checklist (CASP) was conducted., Results: Out of 731 articles, 25 articles were selected and analyzed. Studies used health policy triangle framework to analyze policies in the Iranian health sector has been published since 2014. All the included studies were retrospective. The main focus of most of studies for the analysis was on the context and process of polices as the elements of the policy triangle., Conclusion: The main focus of health policy analysis studies in Iran over the last thirty years was on the context and process of polices. Although range of actors within and outside the Iran government influence health policies but in many policy processes the power and the role of all actors or players involved in the policy are not recognized carefully. Also, Iran's health sector suffers from lack of a proper framework for evaluating various implemented policies., Competing Interests: The authors declare that they have no competing interests., (©2023 Pacini Editore SRL, Pisa, Italy.)
Published: 2023
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226. Exploring nationwide policy interventions to control COVID-19 from the perspective of the rapid learning health system approach.

Author: Ahmadi A, Doshmangir L, and Majdzadeh R
Abstract: Introduction: The health systems needed to improve their learning capacities during the COVID-19 pandemic. Iran is one of the countries massively struck by the pandemic. This study aimed to explore whether and how the policy interventions made by Iran's policymakers at the national level to control COVID-19, could improve the rapid learning characteristics of the health system., Methods: A guide to clarify rapid learning health system (RLHS) characteristics was developed. The guide was used by two independent authors to select the policy interventions that could improve RLHS characteristics, then, to analyze the content of the selected policy interventions. In each stage, results were compared and discussed by all three authors. Final results were presented based on different RLHS characteristics and the potential mechanisms of contribution., Results: Five hundred policy interventions were developed during the first 7 months of the outbreak. Thirty-one policy interventions could potentially improve RLHS characteristics (6.2%). Two characteristics, such as the timely production of research evidence and the appropriate decision support were addressed by selected policy interventions. Policies, that could improve learning capacities, focused on decision-maker groups more than user groups or researcher groups., Conclusions: Most of the developed policy interventions during the first months of the epidemic did not address the learning capacities of the health system. To improve health system functions, improving RLHS characteristics of the health system, especially in patient-centered and data linkage characteristics, is recommended., Competing Interests: The authors have no conflicts to disclose., (© 2023 The Authors. Learning Health Systems published by Wiley Periodicals LLC on behalf of University of Michigan.)
Published: 2023
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227. Iranian primary health care network: challenges and ways forward.

Author: Doshmangir L, Shirjang A, Assan A, and Gordeev VS
Subjects: Humans, Iran, Global Health, Primary Health Care, Delivery of Health Care
Abstract: Aim: This study aimed to explore the current challenges of Iran's Iranian Primary Health Care (PHC) network and possible ways forward., Background: PHC network was established in 1985. It remains a core instrument of health care delivery. However, it faces several challenges that can threaten its effective functioning., Methods: We conducted face-to-face semi-structured interviews with 26 key stakeholders. We used the deductive content analysis approach. World Health Organization's health system framework guided our analyses. Data were analysed using MAXQDA software. To enhance data triangulation, we reviewed PHC national related plans, bylaws, and national and international published reports., Findings: PHC network experiences financial challenges and fails to respond fully to the emerging population's needs due to unfair distribution of resources and a lack of community health workers for PHC and a sustainable financing model for PHC. Furthermore, the insurance package is not well integrated into the PHC network system. Policy interests and resource commitments for innovative, preventive, and health promotion initiatives are lacking. Innovative, preventive, and health promotion initiatives should become the highest priority for policymakers. Well-trained community health professionals, active community participation, private sector engagements and active involvement of non-government organisations are fundamental for a well-functioning PHC network in Iran, especially to foster the delivery of evidence-based initiatives.
Published: 2023
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228. Hepatitis B vaccination in Iran: Historical policies and programs.

Author: Behzadifar M, Azari S, Shirkhani S, Gholamrezaei S, Shahabi S, Doshmangir L, Ehsanzadeh SJ, Martini M, Bragazzi NL, and Behzadifar M
Subjects: Infant, Child, Adolescent, Humans, Adult, Iran epidemiology, Hepatitis B Vaccines therapeutic use, Vaccination, Policy, Immunization Programs, Quality of Life, Hepatitis B epidemiology, Hepatitis B prevention & control
Abstract: Hepatitis B virus (HBV) infection is a main challenge of the health system worldwide. Health policymakers in most countries attempt to help HBV patients by implementing support programs in addition to controlling HBV in their community so that the economic burden caused by HBV do not deprive the patients of accessing health services and reducing their quality of life. There are several health interventions for the prevention and control of HBV. Providing the first dose of the HBV vaccine within 24 hours after the infant is born is the most cost-effective way to prevent and control HBV. The purpose of this study is to review the nature of HBV, its epidemiology in Iran and worldwide, and to review the various policies and programs in Iran regarding the prevention and control of HBV, especially the use of vaccination. One of the goals of Sustainable Development Goals (SDGs) is to consider hepatitis as a threat to human health. In this regard, one of the top priorities of WHO is the prevention and control of HBV. In connection with the prevention of HBV, it is claimed that vaccination is the most effective and best intervention. Thus, vaccination in the safe's program of countries is highly recommended. According to the Ministry of Health and Medical Education (MOHME) reports, Iran has the lowest prevalence of HBV among the countries in Eastern Mediterranean Region Organization (EMRO). There is a hepatitis unit in MOHME whose responsibility is to coordinate and implement the hepatitis prevention and control programs. The HBV vaccine has been officially included in the vaccination program for children in Iran since 1993, and three doses of the vaccine are given to all infants. In 2007, during a large-scale program in Iran, 17-year-olds received the HBV vaccine, followed by adolescents born in 1990 and 1991. In recent years, the health system in Iran has made significant progress in preventing and controlling HBV. Over 95% coverage of the HBV vaccination is one of the achievements that have had a great impact on reducing the trend of HBV infection. In order to achieve the 2030 goals, the Iranian government, in addition to paying more attention to HBV elimination programs, should encourage other organizations to cooperate more effectively with MOHME., (©2022 Pacini Editore SRL, Pisa, Italy.)
Published: 2022
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229. Factors affecting hospital services overutilization and reductive strategies in Iran: a qualitative study to explore experts' views.

Author: Doshmangir L, Jabbari H, Arab-Zozani M, Naghavi-Behzad M, Abedi Z, and Mostafavi H
Subjects: Humans, Iran, Qualitative Research, Focus Groups, Hospitals, Delivery of Health Care
Abstract: Objectives: This study aimed to investigate the viewpoints of the main stakeholders of the Iranian healthcare system about the overutilization of hospital services and strategies to eliminate or reduce it in Iran., Methods: This is a qualitative study and thematic data analysis using face-to-face semi-structured interviews and Focus Group Discussions (FGDs). We conducted eight interviewers and two FGDs with hospital stakeholders including faculty members, insurance organizations' authorities, experienced hospital administrative staff, hospital managers, and health-care providers., Results: The factors leading to the overutilization of hospital services were categorized into four main themes including site of service, quality, supplier push, and demand pull. Strategies for eliminating or reducing the overutilization of hospital services are also identified based on the influential factors., Conclusion: Addressing overutilization of hospital services in the health system and adherence to policies for reducing or eliminating overutilization is a way to make preventive strategies to overcome overutilization. Developing a national plan to integrate utilization management into health system programs is a strategy to combat overutilization in various levels of the health system including hospital setting.
Published: 2022
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230. Developing inpatient suicide prevention strategies in medical settings: Integrating literature review with expert testimony.

Author: Fakhari A, Doshmangir L, Farahbakhsh M, Shalchi B, Shafiee-Kandjani AR, Alikhah F, Eslami Z, Esmaeili ED, and Azizi H
Subjects: Humans, Inpatients, Suicidal Ideation, Quality Improvement, Expert Testimony, Suicide Prevention
Abstract: Objective: According to some recent evidence, suicide rate is higher in inpatients than in the general population around the world. However, suicide prevention strategies (SPS) are poorly focused and understood in medical settings. This study aimed to develop effective SPS and interventions in medical settings of Iran and provide evaluation checklists/procedures for them., Methods: The study was performed in two steps, including literature review and expert opinions panel. In the first stage, we conducted a comprehensive literature review to find relevant suicide prevention programs, strategies, interventions, or any efforts to prevent suicide in the medical settings. In the second stage, an expert panel was arranged for developing effective and feasible SPS in medical settings. Data were analyzed through content analysis approach., Results: Overall, 11 records were included in the literature review. SPS varied from staff training, safety plan and quality improvements, and prevention programs to therapy methods. Finally, in the second stage, the following seven major SPS were recommended by the expert panel: 1) Integration and application of obtained suicidal behavior data through evaluating medical records, 2) Screening and suicide risk assessment, 3) Staff training, 4) Quality improvement, 5) Follow-up of inpatients with high-risk behaviors, 6) Reducing stigma and improving public awareness, and 7) Follow-up of discharged high-risk inpatients. Also, 23 interventions within the strategies were presented., Conclusion: Given that SPS are poorly focused in medical settings, the practical framework that emerged in this study could be used to develop or advance SPS in various medical settings., Competing Interests: Conflict of interests Authors have no competing interests to declare., (Copyright © 2022 Elsevier B.V. All rights reserved.)
Published: 2022
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231. Strategies to strengthen non-governmental organizations' participation in the Iranian health system.

Author: Sanadgol A, Doshmangir L, Majdzadeh R, and Gordeev VS
Subjects: Iran, Qualitative Research, Delivery of Health Care, Organizations
Abstract: Background: Non-governmental organizations (NGOs) added a new dimension to intersectoral action for health. Involving the NGOs in health system strengthening could lead to a more efficient, equitable, and better-governed healthcare system. This qualitative study explored effective strategies for NGO participation in the Iranian health system to achieve broader health system goals., Method: We conducted 33 semi-structured interviews with health policymakers and planners, NGO actors at the national and provincial levels, and other key informants. The qualitative data were analyzed through a thematic analysis approach. Trustworthiness in the study was observed at all stages of the study., Result: Four main themes- were identified: empowerment for learning leadership and management skills, creating active participation in policy-making, capacity building for participation, clarifying participation process, falling into 17 sub-themes. Along with the government and health sector policymakers, NGOs may have a significant role in improving health system goals and increasing equity, social responsiveness, financial risk protection, and efficiency., Conclusion: The participation of NGOs in the Iranian health system is a complex process. All elements and dimensions of this process need to be considered when developing a platform for the appropriate participation of NGOs in the health system functions. Evidence-informed strategies for strengthening the participation of NGOs in the health system should be used to utilize NGOs potential to the fullest., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sanadgol, Doshmangir, Majdzadeh and Gordeev.)
Published: 2022
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232. Role of non-governmental organizations in moving toward universal health coverage: A case study in Iran.

Author: Sanadgol A, Doshmangir L, Khodayari-Zarnaq R, and Sergeevich Gordeev V
Subjects: Iran, Qualitative Research, Income, Universal Health Insurance, Health Services
Abstract: Background: Delivering essential health services through non-governmental organizations (NGOs) could facilitate moving toward universal health coverage (UHC), especially in low- and middle-income countries. This study investigates the viewpoints of Iranian health system experts and executive stakeholders on the role of NGOs in moving toward UHC., Method: We conducted 33 semi-structured interviews with health policymakers, NGO representatives at the national and provincial level, and other key informants and analyzed using content analyses methods, using MAXQDA 12. The inductive-deductive approach was used for qualitative data analyses., Result: Based on the thematic analysis of interviews and document reviews, nine main themes and one hundred and five sub-themes were identified. Each theme was categorized based on NGO-, society-, and government-related factors., Conclusion: Recognizing the critical role of NGOs and their contribution in moving toward UHC is essential, particularly in the local context. Collaboration between NGO stakeholders and the government could facilitate moving toward UHC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sanadgol, Doshmangir, Khodayari-Zarnaq and Sergeevich Gordeev.)
Published: 2022
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233. Health policy analysis in Eastern Mediterranean region using a health policy triangle framework: Historical and ethical insights from a systematic review.

Author: Behzadifar M, Ghanbari MK, Ravaghi H, Bakhtiari A, Shahabi S, Doshmangir L, Alidoost S, Azari S, Martini M, Ehsanzadeh SJ, and Bragazzi NL
Subjects: Global Health, Health Promotion, Humans, Morals, Health Policy, Policy Making
Abstract: Background: Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of policy. Policy analysis involves a wide range of methods, techniques, and tools in a way to reach awareness of the impacts of the developed and implemented policies. Whereas policy analysis in developed countries has a long history, in developing countries, it is instead in its first developing stages. Our paper aimed to collect systematically the studies using health policy triangle framework in doing analysis in one of the health policy issues in the Eastern Mediterranean region organization., Methods: To conduct our literature search, ISI/Web of Science, PubMed/MEDLINE, Embase, The Cochrane Library, Global Health Database, Scopus, as well as Google Scholar from 2003 up to June 2020 were systematically mined. To evaluate the methodological quality of the included studies, the Critical Appraisal Skills Program checklist was used., Results: We selected 30 studies, conducted between 2011 and 2020. According to the findings of these studies, in the Eastern Mediterranean region, organization region, and the role of evidence-based research in policy-making has been repeatedly emphasized, but its use in health program decision-making has been limited, and health research systems in Eastern Mediterranean region organization are still under scrutiny. There is still a gap between evidence-based research in health systems and its use in policy-making., Discussion: Based on the present systematic review, studies based on policy analysis should focus on all the elements of health policies and provide evidence to inform decisions that can strengthen health systems, improve health and improve existing inequalities., Competing Interests: Competing interests The authors declare that they have no competing interests., (©2022 Pacini Editore SRL, Pisa, Italy.)
Published: 2022
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234. Interventions to reduce the incidence of medical error and its financial burden in health care systems: A systematic review of systematic reviews.

Author: Ahsani-Estahbanati E, Sergeevich Gordeev V, and Doshmangir L
Abstract: Background and Aim: Improving health care quality and ensuring patient safety is impossible without addressing medical errors that adversely affect patient outcomes. Therefore, it is essential to correctly estimate the incidence rates and implement the most appropriate solutions to control and reduce medical errors. We identified such interventions., Methods: We conducted a systematic review of systematic reviews by searching four databases (PubMed, Scopus, Ovid Medline, and Embase) until January 2021 to elicit interventions that have the potential to decrease medical errors. Two reviewers independently conducted data extraction and analyses., Results: Seventysix systematic review papers were included in the study. We identified eight types of interventions based on medical error type classification: overall medical error, medication error, diagnostic error, patients fall, healthcare-associated infections, transfusion and testing errors, surgical error, and patient suicide. Most studies focused on medication error (66%) and were conducted in hospital settings (74%)., Conclusions: Despite a plethora of suggested interventions, patient safety has not significantly improved. Therefore, policymakers need to focus more on the implementation considerations of selected interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ahsani-Estahbanati, Sergeevich Gordeev and Doshmangir.)
Published: 2022
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235. Strategies for utilisation management of hospital services: a systematic review of interventions.

Author: Doshmangir L, Khabiri R, Jabbari H, Arab-Zozani M, Kakemam E, and Gordeev VS
Subjects: Adult, Child, Hospitalization, Hospitals, Humans, Length of Stay, Aftercare, Patient Discharge
Abstract: Background: To achieve efficiency and high quality in health systems, the appropriate use of hospital services is essential. We identified the initiatives intended to manage adult hospital services and reduce unnecessary hospital use among the general adult population., Methods: We systematically reviewed studies published in English using five databases (PubMed, ProQuest, Scopus, Web of Science, and MEDLINE via Ovid). We only included studies that evaluated interventions aiming to reduce the use of hospital services or emergency department, frequency of hospital admissions, length of hospital stay, or the use of diagnostic tests in a general adult population. Studies reporting no relevant outcomes or focusing on a specific patient population or children were excluded., Results: In total, 64 articles were included in the systematic review. Nine utilisation management methods were identified: care plan, case management, care coordination, utilisation review, clinical information system, physician profiling, consultation, education, and discharge planning. Primary case management was shown to effectively reduce emergency department use. Care coordination reduced 30-day post-discharge hospital readmission or emergency department visit rates. The pre-admission review program decreased elective admissions. The physician profiling, concurrent review, and discharge planning effectively reduced the length of hospital stay. Twenty three studies that evaluated costs, reported cost savings in the hospitals., Conclusions: Utilisation management interventions can decrease hospital use by improving the use of community-based health services and improving the quality of care by providing appropriate care at the right time and at the right level of care., (© 2022. The Author(s).)
Published: 2022
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236. PROTOCOL: Systematic review of methods to reduce risk of bias in knowledge translation interventional studies in health-related issues.

Author: Ahmadi A, Yazdizadeh B, Doshmangir L, Majdzadeh R, and Asghari S
Abstract: Background: Review studies have reported on the low quality of study methodologies and poor reporting of knowledge translation (KT) interventional studies. This flaw cause the result of such studies to become misleading., Objectives: The present review is designed to evaluate the effect of methodological factors on the results of interventional studies that aimed to evaluate KT strategies at the policy level., Search Methods: Bibliographic databases and grey literature databases will be searched. The retrieved studies will be recorded in Covidence. After screening titles and abstracts, the full texts of selected studies will be assessed against the inclusion criteria. Disagreements will be resolved through discussion or by consultation with a third author., Selection Criteria: Primary studies are studies that aimed to estimate the efficacy of KT strategies to improve evidence-informed policymaking. Study participants include policymakers and the intervention is a KT strategy. The main outcome is the desired changes in policy-makers towards evidence-informed decision-making., Data Collection and Analysis: The main effect sizes will be expressed as standard mean difference and its variance for the main efficacy outcome of KT strategies in primary studies. Forest plot meta-analysis will be used to synthesize the effect of each group of KT strategies. The contribution of ROB to the efficacy of KT interventions will be assessed via Meta-epidemiology analysis. The overall estimate will be calculated using inverse-variance random-effects meta-analysis with a 95% confidence interval for the estimate., (© 2022 The Authors. Campbell Systematic Reviews published by John Wiley & Sons Ltd on behalf of The Campbell Collaboration.)
Published: 2022
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237. Setting research priorities to achieve long-term national road safety goals in Iran.

Author: Sadeghi-Bazargani H, Razzaghi A, Atabak A, Bazargani-Hejazi S, Basirat SB, Doshmangir L, Ebrahiminejad S, Farahbakhsh M, Benekohal RF, Ghaffarifar S, Golestani M, Hamidi MH, Heydari ST, Jahani E, Jahangiry L, Imani A, Khabiri MM, Khishdari A, Marouf H, Masoumi G, Mazloumi A, Mehmandar MR, Mortazavi-Tabatabaei SA, Pourebrahim K, Rahmanian NB, Rezapur-Shahkolai F, Rezaei M, Saadati M, Sarbazi E, Samadipour E, Sehat M, Shafieian M, Mohaymany AS, Soori H, Sheikhi S, Tabibi M, Tabrizi JS, Kashani AT, Vahabzadeh I, Veisi S, and Yazdani M
Subjects: Child, Humans, Iran epidemiology, Public Health, Research, Accidents, Traffic prevention & control, Goals
Abstract: Background: Road traffic crashes (RTCs) and its associated injuries are one of the most important public health problems in the world. In Iran, RTCs rank second in terms of mortality. To address this issue, there is a need for research-based interventions. Prioritizing researches using a variety of approaches and frameworks to determine the most effective interventions is a key nodal point in the RTCs' research policy planning cycle. Thus, this study aims to generate and prioritize research questions in the field of RTCs in Iran., Methods: By adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 25 prominent Iranian academic leaders having role in setting Iran's long-term road safety goals, a group of research funders, and policymakers. The experts' proposed research questions were independently scored on a set of criteria: feasibility, impact on health, impact on the economy, capacity building, and equity. Following the prioritization of Research Questions (RQs), they were all classified using the 5 Pillar frameworks., Results: In total, 145 Research Questions were systematically scored by experts against five criteria. Iran's top 20 road traffic safety priorities were established. The RQs related to "road safety management" and "road and infrastructure" achieved a high frequency., Conclusions: The top 20 research questions in the area of RTCs in Iran were determined by experts. The majority of these RQs were related to "road safety management". The results of this study may contribute to the optimal use of resources in achieving long-term goals in the prevention and control of road traffic crashes and its related injuries. Considering these RQs as research investment options will improve the current status of Road Traffic Injuries (RTIs) at a national level and further advance toward compliance with international goals. If these research priorities are addressed, and their findings are implemented, we can anticipate a significant reduction in the number of crashes, injuries, and deaths., Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest Form (available upon request from the corresponding author), and declare no conflicts of interest., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)
Published: 2022
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238. Incidence of symptomatic COVID-19 in close contacts of patients after discharge from hospital.

Author: Ahmadi A, Poopak A, Nazemi S, Mohammadi N, Eslami B, Seyyedsalehi MS, Doshmangir L, Allameh SF, and Zendehdel K
Subjects: Female, Hospitals, Humans, Incidence, Iran epidemiology, Male, COVID-19 epidemiology, Patient Discharge
Abstract: Background: There is a little evidence about the infectiousness of recovered COVID-19 patients. Considering that the circumstance of the isolation of the COVID-19 patients after-discharge is not always optimal, it is not very unlikely that viral transmission still occurs after hospital discharge. This study aims to investigate the incidence of symptomatic COVID-19 in close contacts of recovered patients after discharge from hospital., Methods: Four hundred fifty discharged COVID-19 patients discharged from the largest public treatment center in Tehran, capital city of Iran, were followed up. Demographic and clinical data of participants were collected from medical records. Follow-up data were acquired via telephone call interviews with patients or their main caregivers at home., Results: The study's response rate was 93.77% (422 participated in the study). 60.90% patients were male and 39.10% were female (sex ratio = 1.55 male). The most prevalent comorbidities in these patients were hypertension (29.68%) and diabetes (24.80%). The mean of home isolation after discharge was 25.85. Forty-one (9.71%) patients had at least one new case in their close contacts, up to 3 weeks after they were discharged. There was a significant association between having at least a comorbidity with the odds of getting infected in close contacts [OR (CI) 2.22 (1.05-4.68)]. Density of inhabitant per room in a house' and the quality of isolation had significant associations with observing new cases in the patients' close contacts [high to moderate; OR (CI) 2.44 (1.06-5.61], [bad to good; OR (CI) 2.31 (1.17-4.59)], respectively., Conclusion: After hospital discharge, COVID-19 transmission can still occur, when a large number of people lives together in a single house. Another explanation can be that the less precaution measures are taken by recovered patients' cohabitants. Such conditions are also likely to happen when the recovered patient has other chronic diseases and requires additional care., (© 2022. The Author(s).)
Published: 2022
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239. Individual and institutional capacity-building for evidence-informed health policy-making in Iran: a mix of local and global evidence.

Author: Doshmangir L, Mostafavi H, Behzadifar M, Yazdizadeh B, Sajadi HS, Hasanpoor E, Mahdavi M, and Majdzadeh R
Subjects: Administrative Personnel, Health Policy, Humans, Iran, Capacity Building, Policy Making
Abstract: Background: Providing valid evidence to policy-makers is a key factor in the development of evidence-informed policy-making (EIPM). This study aims to review interventions used to promote researchers' and knowledge-producing organizations' knowledge and skills in the production and translation of evidence to policy-making and explore the interventions at the individual and institutional level in the Iranian health system to strengthen EIPM., Methods: The study was conducted in two main phases: a systematic review and a qualitative study. First, to conduct the systematic review, the PubMed and Scopus databases were searched. Quality appraisal was done using the Joanna Briggs Institute checklists. Second, semi-structured interviews and document review were used to collect local data. Purposive sampling was used and continued until data saturation. A qualitative content analysis approach was used for data analysis., Results: From a total of 11,514 retrieved articles, 18 papers were eligible for the analysis. Based on the global evidence, face-to-face training workshops for researchers was the most widely used intervention for strengthening researchers' capacity regarding EIPM. Target audiences in almost all of the training programmes were researchers. Setting up joint training sessions that helped empower researchers in understanding the needs of health policy-makers had a considerable effect on strengthening EIPM. Based on the local collected evidence, the main interventions for individual and institutional capacity-building were educational and training programmes or courses related to the health system, policy-making and policy analysis, and research cycle management. To implement the individual and institutional interventions, health system planners and authorities and the community were found to have a key role as facilitating factors., Conclusion: The use of evidence-based interventions for strengthening research centres, such as training health researchers on knowledge translation and tackling institutional barriers that can prevent well-trained researchers from translating their knowledge, as well as the use of mechanisms and networks for effective interactions among policy-makers at the macro and meso (organizational) level and the research centre, will be constructive for individual and institutional capacity-building. The health system needs to strengthen its strategic capacity to facilitate an educational and training culture in order to motivate researchers in producing appropriate evidence for policy-makers., (© 2022. The Author(s).)
Published: 2022
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240. Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review.

Author: Sanadgol A, Doshmangir L, Majdzadeh R, and Gordeev VS
Subjects: Financing, Government, Health Services, Humans, Income, Government, Universal Health Insurance
Abstract: Background: Developing essential health services through non-governmental organisations (NGOs) is an important strategy for progressing towards Universal Health Coverage (UHC), especially in low- and middle-income countries. It is crucial to understand NGOs' role in reaching UHC and the best way to engage them., Objective: This study reviewed the role of NGOs and their engagement strategies in progress toward UHC., Method: We systematically reviewed studies from five databases (PubMed, Web of Science (ISI), ProQuest, EMBASE and Scopus) that investigated NGOs interventions in public health-related activities. The quality of the selected studies was assessed using the mixed methods appraisal tool. PRISMA reporting guidelines were followed., Findings: Seventy-eight studies met the eligibility criteria. NGOs main activities related to service and population coverage and used different strategies to progress towards UHC. To ensure services coverage, NGOs provided adequate and competent human resources, necessary health equipment and facilities, and provided public health and health care services strategies. To achieve population coverage, they provided services to vulnerable groups through community participation. Most studies were conducted in middle-income countries. Overall, the quality of the reported evidence was good. The main funding sources of NGOs were self-financing and grants from the government, international organisations, and donors., Conclusion: NGOs can play a significant role in the country's progress towards UHC along with the government and other key health players. The government should use strategies and interventions in supporting NGOs, accelerating their movement toward UHC., (© 2021. The Author(s).)
Published: 2021
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241. Developing a prioritisation framework for patients in need of coronary artery angiography.

Author: Doshmangir L, Pourasghar F, Sharghi R, Rezapour R, and Gordeev VS
Subjects: Angiography, Consensus, Delphi Technique, Humans, Waiting Lists, Coronary Vessels, Myocardial Infarction
Abstract: Background: Effective waiting list management and comprehensive prioritisation can provide timely delivery of appropriate services to ensure that the patient needs are met and increase equity in the provision of health services. We developed a prioritisation framework for patients in need of coronary artery angiography (CAA)., Methods: We used a multi-methods approach to elicit effective factors that affect CAA patient prioritisation. Qualitative data wase collected using semi-structured interviews with 15 experts. The final set of factors was selected using experts' consensus through modifed Delphi technique. The framework was finalised during expert panel meetings., Results: 212 effective factors were identified based on the literature review, interviews, and expert panel discussion of them, 37 factors were selected for modifed Delphi study. Following two rounds of Delphi discussions, seven final factors were selected and weighed by ten experts using pair-wise comparisons. The following weights were given: the severity of pain and symptoms (0.22), stress testing (0.18), background diseases (0.15), number of myocardial infarctions (0.15), waiting time (0.10), reduction of economic and social performance (0.12), and special conditions (0.08)., Conclusion: Clinical effective factors were important for CAA prioritisation framework. Using this framework can potentially lead to improved accountability and justice in the health system., (© 2021. The Author(s).)
Published: 2021
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242. Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis.

Author: Doshmangir L, Hasanpoor E, Abou Jaoude GJ, Eshtiagh B, and Haghparast-Bidgoli H
Subjects: Catastrophic Illness, Humans, Incidence, Quality of Life, Health Expenditures, Neoplasms epidemiology
Abstract: Background: Cancer is the third leading cause of mortality in the world, and cancer patients are more exposed to financial hardship than other diseases. This paper aimed to review studies of catastrophic healthcare expenditure (CHE) in cancer patients, measure their level of exposure to CHE, and identify factors associated with incidence of CHE., Methods: This study is a systematic review and meta-analysis. Several databases were searched until February 2020, including MEDLINE, Web of Science, Scopus, ProQuest, ScienceDirect and EMBASE. The results of selected studies were extracted and analyzed using a random effects model. In addition, determinants of CHE were identified., Results: Among the 19 studies included, an average of 43.3% (95% CI 36.7-50.1) of cancer patients incurred CHE. CHE varied substantially depending on the Human Development Index (HDI) of the country in which a study was conducted. In countries with the highest HDI, 23.4% of cancer patients incurred CHE compared with 67.9% in countries with the lowest HDI. Key factors associated with incidence of CHE at the household level included household income, gender of the household head, and at the patient level included the type of health insurance, education level of the patient, type of cancer and treatment, quality of life, age and sex., Conclusion: The proportion of cancer patients that incur CHE is very high, especially in countries with lower HDI. The results from this review can help inform policy makers to develop fairer and more sustainable health financing mechanisms, addressing the factors associated with CHE in cancer patients., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Published: 2021
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243. Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage.

Author: Doshmangir L, Bazyar M, Rashidian A, and Gordeev VS
Subjects: Health Expenditures, Humans, Iran, Retrospective Studies, Health Equity, Insurance, Health organization & administration, Universal Health Insurance organization & administration
Abstract: Background: Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC., Methods: This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis., Results: Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable., Conclusion: To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.
Published: 2021
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244. Mapping Research Trends of Universal Health Coverage From 1990 to 2019: Bibliometric Analysis.

Author: Ghanbari MK, Behzadifar M, Doshmangir L, Martini M, Bakhtiari A, Alikhani M, and Bragazzi NL
Subjects: Bibliometrics, Humans, Research trends, Universal Health Insurance
Abstract: Background: Universal health coverage (UHC) is one of many ambitious, health-related, sustainable development goals. Sharing various experiences of achieving UHC, in terms of challenges, pitfalls, and future prospects, can help policy and decision-makers reduce the likelihood of committing errors. As such, scholarly articles and technical reports are of paramount importance in shedding light on the determinants that make it possible to achieve UHC., Objective: The purpose of this study is to conduct a comprehensive analysis of UHC-related scientific literature from 1990 to 2019., Methods: We carried out a bibliometric analysis of papers related to UHC published from January 1990 to September 2019 and indexed in Scopus via VOSviewer (version 1.6.13; CWTS). Relevant information was extracted: the number of papers published, the 20 authors with the highest number of publications in the field of UHC, the 20 journals with the highest number of publications related to UHC, the 20 most active funding sources for UHC-related research, the 20 institutes and research centers that have produced the highest number of UHC-related research papers, the 20 countries that contributed the most to the research field of UHC, the 20 most cited papers, and the latest available impact factors of journals in 2018 that included the UHC-related items under investigation., Results: In our analysis, 7224 articles were included. The publication trend was increasing, showing high interest in the scientific community. Most researchers were from the United States, the United Kingdom, and Canada, with Thailand being a notable exception. The Lancet accounted for 3.95% of published UHC-related research. Among the top 20 funding sources, the World Health Organization (WHO), the Bill and Melinda Gates Foundation, and the National Institutes of Health (NIH) accounted for 1.41%, 1.34%, and 1.02% of published UHC-related research, respectively. The highest number of citations was found for articles published in The Lancet, the American Journal of Psychiatry, and the Journal of the American Medical Association (JAMA). The top keywords were "health insurance," "insurance," "healthcare policy," "healthcare delivery," "economics," "priority," "healthcare cost," "organization and management," "health services accessibility," "reform," "public health," and "health policy.", Conclusions: The findings of our study showed an increasing scholarly interest in UHC and related issues. However, most research concentrated in middle- and high-income regions and countries. Therefore, research in low-income countries should be promoted and supported, as this could enable a better understanding of the determinants of the barriers and obstacles to UHC achievement and improve global health., (©Mahboubeh Khaton Ghanbari, Masoud Behzadifar, Leila Doshmangir, Mariano Martini, Ahad Bakhtiari, Mahtab Alikhani, Nicola Luigi Bragazzi. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 11.01.2021.)
Published: 2021
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245. An application of the theory of planned behavior to self-care in patients with hypertension.

Author: Pourmand G, Doshmangir L, Ahmadi A, Noori M, Rezaeifar A, Mashhadi R, Aziminia R, Pourmand A, and Gordeev VS
Subjects: Aged, Cross-Sectional Studies, Female, Humans, Intention, Latent Class Analysis, Life Style, Male, Middle Aged, Hypertension therapy, Psychological Theory, Self Care psychology
Abstract: Background: Self-care behaviors and positive changes in lifestyle are essential for successful hypertension control. We used a behavioral model based on the theory of planned behavior to assess which factors influence self-care behaviors for controlling hypertension., Methods: In this cross-sectional study, five hundred patients with at leastaone-year history of diagnosed hypertension participated in this study. The data collection tool was designed based on the theory of planned behavior. Structural equation modeling was used to estimate the main parameters., Results: For self-care behaviors, ninety-six (19.2%) and forty-five (9.1%) participants had good knowledge and acceptable behavior(≥8 out of 10 points). Having perceived behavioral control regarding quitting smoking and alcohol intake was associated with the patient's intention and behavior [b:1.283 ± .095 and b:1.59 ± .014 (p < .001)]. Having perceived behavioral control over the other self-care behaviors had a positive effect on the intention in female patients [b: .885 ± .442 (p = .045)]. Subjective norms had a positive effect on behavioral intention in younger patients [b:4.52 ± 2.24 (P = .04)]., Conclusions: Group-specific behavioral barriers are important when improving self-care behaviors in patients with hypertension. Perceived control over self-care behaviors is more important in vulnerable patients, such as the elderly and women.
Published: 2020
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246. Setting health care services tariffs in Iran: half a century quest for a window of opportunity.

Author: Doshmangir L, Rashidian A, Kouhi F, and Gordeev VS
Subjects: Commerce, Conflict of Interest, Developing Countries, Government, Government Agencies, Humans, Iran, Physician-Patient Relations, Social Control, Formal, Trust, Delivery of Health Care economics, Fees, Medical trends, Health Policy economics, Health Services economics, Private Sector, Public Sector, Reimbursement Mechanisms
Abstract: Background: The process of medical tariffs setting in Iran remains to be a contentious issue and is heavily criticized by many stakeholders. This paper explores the experience of setting health care services tariffs in the Iranian health care system over the last five decades., Methods: We analyzed data collected through literature review and reviews of the official documents developed at the various levels of the Iranian health system using inductive and deductive content analysis. Twenty-two face-to-face semi-structured interviews supplemented the analysis. Data were analysed and interpreted using 'policy triangle' and 'garbage can' models., Results: Our comprehensive review of changes in the medical tariff setting provides valuable lessons for major stakeholders. Most changes were implemented in a sporadic, inadequate, and a non-evidence-based manner. Disparities in tariffs between public and private sectors continue to exist. Lack of clarity in tariffs setting mechanisms and its process makes negotiations between various stakeholders difficult and can potentially become a source of a corrupt income. Such clarity can be achieved by using fair and technically sound tariffs. Technical aspects of tariff setting should be separated from the political negotiations over the overall payment to the medical professionals. Transparency regarding a conflict of interest and establishing punitive measures against those violating the rules could help improving trust in the doctor-patient relationship., Conclusion: Use of evidence-informed models and methods in medical tariff setting could help to strike the right balance in the process of health care services provision to address health system objectives. A sensitive application of policy models can offer significant insights into the nature of medical tariff setting and highlight existing constraints and opportunities. This study generates lessons learned in tariffs setting, particularly for low- and middle-income countries.
Published: 2020
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247. Determinants of catastrophic health expenditures in Iran: a systematic review and meta-analysis.

Author: Doshmangir L, Yousefi M, Hasanpoor E, Eshtiagh B, and Haghparast-Bidgoli H
Abstract: Background: Catastrophic health expenditures (CHE) are of concern to policy makers and can prevent individuals accessing effective health care services. The exposure of households to CHE is one of the indices used to evaluate and address the level of financial risk protection in health systems, which is a key priority in the global health policy agenda and an indicator of progress toward the UN Sustainable Development Goal for Universal Health Coverage. This study aims to assess the CHE at population and disease levels and its influencing factors in Iran., Methods: This study is a systematic review and meta-analysis. The following keywords and their Persian equivalents were used for the review: Catastrophic Health Expenditures; Health Equity; Health System Equity; Financial Contribution; Health Expenditures; Financial Protection; Financial Catastrophe; and Health Financing Equity. These keywords were searched with no time limit until October 2019 in PubMed, Web of Science, Scopus, ProQuest, ScienceDirect, Embase, and the national databases of Iran. Studies that met a set of inclusion criteria formed part of the meta-analysis and results were analyzed using a random-effects model., Results: The review identified 53 relevant studies, of which 40 are conducted at the population level and 13 are disease specific. At the population level, the rate of CHE is 4.7% (95% CI 4.1% to 5.3%, n = 52). Across diseases, the percentage of CHE is 25.3% (95% CI 11.7% to 46.5%, n = 13), among cancer patients, while people undergoing dialysis face the highest percentage of CHE (54.5%). The most important factors influencing the rate of CHE in these studies are health insurance status, having a household member aged 60-65 years or older, gender of the head of household, and the use of inpatient and outpatient services., Conclusion: The results suggest that catastrophic health spending in Iran has increased from 2001 to 2015 and has reached its highest levels in the last 5 years. It is therefore imperative to review and develop fair health financing policies to protect people against financial hardship. This review and meta-analysis provides evidence to help inform effective health financing strategies and policies to prioritise high-burden disease groups and address the determinants of CHE., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)
Published: 2020
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248. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Author: Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, Marquez N, Abbasalizad-Farhangi M, Abbasi M, Abd-Allah F, Abdoli A, Abdollahi M, Abdollahpour I, Abdulkader RS, Abrigo MRM, Acharya D, Adebayo OM, Adekanmbi V, Adham D, Afshari M, Aghaali M, Ahmadi K, Ahmadi M, Ahmadpour E, Ahmed R, Akal CG, Akinyemi JO, Alahdab F, Alam N, Alamene GM, Alene KA, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Almalki MJ, Al-Mekhlafi HM, Altirkawi K, Alvis-Guzman N, Amegah AK, Amini S, Amit AML, Anbari Z, Androudi S, Anjomshoa M, Ansari F, Antonio CAT, Arabloo J, Arefi Z, Aremu O, Armoon B, Arora A, Artaman A, Asadi A, Asadi-Aliabadi M, Ashraf-Ganjouei A, Assadi R, Ataeinia B, Atre SR, Quintanilla BPA, Ayanore MA, Azari S, Babaee E, Babazadeh A, Badawi A, Bagheri S, Bagherzadeh M, Baheiraei N, Balouchi A, Barac A, Bassat Q, Baune BT, Bayati M, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Belay YB, Bell B, Bell ML, Berbada DA, Bernstein RS, Bhattacharjee NV, Bhattarai S, Bhutta ZA, Bijani A, Bohlouli S, Breitborde NJK, Britton G, Browne AJ, Nagaraja SB, Busse R, Butt ZA, Car J, Cárdenas R, Castañeda-Orjuela CA, Cerin E, Chanie WF, Chatterjee P, Chu DT, Cooper C, Costa VM, Dalal K, Dandona L, Dandona R, Daoud F, Daryani A, Das Gupta R, Davis I, Davis Weaver N, Davitoiu DV, De Neve JW, Demeke FM, Demoz GT, Deribe K, Desai R, Deshpande A, Desyibelew HD, Dey S, Dharmaratne SD, Dhimal M, Diaz D, Doshmangir L, Duraes AR, Dwyer-Lindgren L, Earl L, Ebrahimi R, Ebrahimpour S, Effiong A, Eftekhari A, Ehsani-Chimeh E, El Sayed I, El Sayed Zaki M, El Tantawi M, El-Khatib Z, Emamian MH, Enany S, Eskandarieh S, Eyawo O, Ezalarab M, Faramarzi M, Fareed M, Faridnia R, Faro A, Fazaeli AA, Fazlzadeh M, Fentahun N, Fereshtehnejad SM, Fernandes JC, Filip I, Fischer F, Foigt NA, Foroutan M, Francis JM, Fukumoto T, Fullman N, Gallus S, Gebre DG, Gebrehiwot TT, Gebremeskel GG, Gessner BD, Geta B, Gething PW, Ghadimi R, Ghadiri K, Ghajarzadeh M, Ghashghaee A, Gill PS, Gill TK, Golding N, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goulart BNG, Graetz N, Greaves F, Green MS, Guo Y, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Hamidi S, Haririan H, Haro JM, Hasankhani M, Hasanpoor E, Hasanzadeh A, Hassankhani H, Hassen HY, Hegazy MI, Hendrie D, Heydarpour F, Hird TR, Hoang CL, Hollerich G, Rad EH, Hoseini-Ghahfarokhi M, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsairi M, Ilesanmi OS, Imani-Nasab MH, Iqbal U, Irvani SSN, Islam N, Islam SMS, Jürisson M, Balalami NJ, Jalali A, Javidnia J, Jayatilleke AU, Jenabi E, Ji JS, Jobanputra YB, Johnson K, Jonas JB, Shushtari ZJ, Jozwiak JJ, Kabir A, Kahsay A, Kalani H, Kalhor R, Karami M, Karki S, Kasaeian A, Kassebaum NJ, Keiyoro PN, Kemp GR, Khabiri R, Khader YS, Khafaie MA, Khan EA, Khan J, Khan MS, Khang YH, Khatab K, Khater A, Khater MM, Khatony A, Khazaei M, Khazaei S, Khazaei-Pool M, Khubchandani J, Kianipour N, Kim YJ, Kimokoti RW, Kinyoki DK, Kisa A, Kisa S, Kolola T, Kosen S, Koul PA, Koyanagi A, Kraemer MUG, Krishan K, Krohn KJ, Kugbey N, Kumar GA, Kumar M, Kumar P, Kuupiel D, Lacey B, Lad SD, Lami FH, Larsson AO, Lee PH, Leili M, Levine AJ, Li S, Lim LL, Listl S, Longbottom J, Lopez JCF, Lorkowski S, Magdeldin S, Abd El Razek HM, Abd El Razek MM, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Manafi N, Manda AL, Mansourian M, Martins-Melo FR, Masaka A, Massenburg BB, Maulik PK, Mayala BK, Mazidi M, McKee M, Mehrotra R, Mehta KM, Meles GG, Mendoza W, Menezes RG, Meretoja A, Meretoja TJ, Mestrovic T, Miller TR, Miller-Petrie MK, Mills EJ, Milne GJ, Mini GK, Mir SM, Mirjalali H, Mirrakhimov EM, Mohamadi E, Mohammad DK, Darwesh AM, Mezerji NMG, Mohammed AS, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi M, Moradi Y, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Mosapour A, Mousavi SM, Mueller UO, Muluneh AG, Mustafa G, Nabavizadeh B, Naderi M, Nagarajan AJ, Nahvijou A, Najafi F, Nangia V, Ndwandwe DE, Neamati N, Negoi I, Negoi RI, Ngunjiri JW, Thi Nguyen HL, Nguyen LH, Nguyen SH, Nielsen KR, Ningrum DNA, Nirayo YL, Nixon MR, Nnaji CA, Nojomi M, Noroozi M, Nosratnejad S, Noubiap JJ, Motlagh SN, Ofori-Asenso R, Ogbo FA, Oladimeji KE, Olagunju AT, Olfatifar M, Olum S, Olusanya BO, Oluwasanu MM, Onwujekwe OE, Oren E, Ortega-Altamirano DDV, Ortiz A, Osarenotor O, Osei FB, Osgood-Zimmerman AE, Otstavnov SS, Owolabi MO, P A M, Pagheh AS, Pakhale S, Panda-Jonas S, Pandey A, Park EK, Parsian H, Pashaei T, Patel SK, Pepito VCF, Pereira A, Perkins S, Pickering BV, Pilgrim T, Pirestani M, Piroozi B, Pirsaheb M, Plana-Ripoll O, Pourjafar H, Puri P, Qorbani M, Quintana H, Rabiee M, Rabiee N, Radfar A, Rafiei A, Rahim F, Rahimi Z, Rahimi-Movaghar V, Rahimzadeh S, Rajati F, Raju SB, Ramezankhani A, Ranabhat CL, Rasella D, Rashedi V, Rawal L, Reiner RC Jr, Renzaho AMN, Rezaei S, Rezapour A, Riahi SM, Ribeiro AI, Roever L, Roro EM, Roser M, Roshandel G, Roshani D, Rostami A, Rubagotti E, Rubino S, Sabour S, Sadat N, Sadeghi E, Saeedi R, Safari Y, Safari-Faramani R, Safdarian M, Sahebkar A, Salahshoor MR, Salam N, Salamati P, Salehi F, Zahabi SS, Salimi Y, Salimzadeh H, Salomon JA, Sambala EZ, Samy AM, Santric Milicevic MM, Jose BPS, Saraswathy SYI, Sarmiento-Suárez R, Sartorius B, Sathian B, Saxena S, Sbarra AN, Schaeffer LE, Schwebel DC, Sepanlou SG, Seyedmousavi S, Shaahmadi F, Shaikh MA, Shams-Beyranvand M, Shamshirian A, Shamsizadeh M, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharifi H, Sharma J, Sharma R, Sheikh A, Shields C, Shigematsu M, Shiri R, Shiue I, Shuval K, Siddiqi TJ, Silva JP, Singh JA, Sinha DN, Sisay MM, Sisay S, Sliwa K, Smith DL, Somayaji R, Soofi M, Soriano JB, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Sykes BL, Sylaja PN, Tabarés-Seisdedos R, Tabb KM, Tabuchi T, Taveira N, Temsah MH, Terkawi AS, Tessema ZT, Thankappan KR, Thirunavukkarasu S, To QG, Tovani-Palone MR, Tran BX, Tran KB, Ullah I, Usman MS, Uthman OA, Vahedian-Azimi A, Valdez PR, van Boven JFM, Vasankari TJ, Vasseghian Y, Veisani Y, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov V, Vos T, Vu GT, Vujcic IS, Waheed Y, Wakefield J, Wang H, Wang Y, Wang YP, Ward JL, Weintraub RG, Weldegwergs KG, Weldesamuel GT, Westerman R, Wiysonge CS, Wondafrash DZ, Woyczynski L, Wu AM, Xu G, Yadegar A, Yamada T, Yazdi-Feyzabadi V, Yilgwan CS, Yip P, Yonemoto N, Lebni JY, Younis MZ, Yousefifard M, Yousof HSA, Yu C, Yusefzadeh H, Zabeh E, Moghadam TZ, Bin Zaman S, Zamani M, Zandian H, Zangeneh A, Zerfu TA, Zhang Y, Ziapour A, Zodpey S, Murray CJL, and Hay SI
Subjects: Child, Geography, Global Health, Humans, Infant, Infant, Newborn, Organizational Objectives, Public Health, Socioeconomic Factors, United Nations, Child Mortality trends, Infant Mortality trends
Abstract: Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
Published: 2019
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249. Stewardship as a Fundamental Challenge in Strategic Purchasing of Health Services: A Case Study of Iran.

Author: Ghoddoosi-Nejad D, Jannati A, Doshmangir L, Arab-Zozani M, and Imani A
Subjects: Delivery of Health Care standards, Delivery of Health Care trends, Focus Groups methods, Group Purchasing standards, Health Policy trends, Humans, Interviews as Topic methods, Iran, Qualitative Research, Delivery of Health Care economics, Group Purchasing methods, Strategic Planning
Abstract: Objective: To understand the stewardship challenges in strategic purchasing of health care in Iran's health system from the viewpoints of experts, policy makers, and decision makers., Study Design: This was a qualitative study., Methods: Researchers used interviews and FGDs for collecting and framework analysis for analyzing data., Results: Stewardship challenges were classified into three themes and nine subthemes. A lack of management information systems, a lack of enforcement for rules and laws, a lack of stewardship units, and the conflict of interest between the Ministry of Health and insurers as care purchasers in the health system are among the main challenges identified in the implementation of the strategic purchasing of health care in Iran., Conclusion: A strong stewardship is needed for implementing strategic purchasing of health care, which requires participation of all stakeholders., (Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)
Published: 2019
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250. The Status of Health Promoting Lifestyle among Students of Tabriz, Northwestern Iran.

Author: Tabrizi JS, Khoshmaram N, Doshmangir L, and Shakibazadeh E
Abstract: Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.
Published: 2018

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