Indexing Healthcare Access and Quality for Surgically Amenable Causes of Death: A Global Analysis of 204 Countries and Territories in 2019.

BACKGROUND: We analyzed the healthcare access and quality (HAQ) index for surgically amenable causes, its progress since 1990, and the gap compared to non-surgical HAQ across 204 countries and territories in 2019 for children (up to 14 years) and overall populations. METHODS: The Global Burden of Disease 2019 study provided mortality-to-incidence ratios and risk-standardized death rates for 32 causes with preventable mortality. Of these, 14 (18) and 9 (17) causes were considered surgical (non-surgical) for the overall population and children, respectively. We constructed composite indices ranging from 0 (worst) to 100 (best) using the adjusted Mazziotta Pareto index methodology. The ratio of surgical HAQ in 2019 to that in 1990 noted a change over time. Surgical-to-non-surgical HAQ ratio gave the relative gap in 2019. Ratios > 1 depicted improvement over time or better-performing surgical care systems. RESULTS: In 2019, the overall surgical HAQ varied from 18.00 for the Central African Republic to 98.25 for Canada. The child surgical HAQ index varied from 39.87 for Chad to 99.41 for San Marino. For both surgical HAQ indices, 202 countries noted progress from 1990 to 2019. Only 31 countries (15.2%) had greater surgical HAQ index values than their non-surgical counterparts. The child surgical HAQ index lagged non-surgical for 61.28% of countries. CONCLUSIONS: Low-income countries had limited progress in surgical HAQ indices since 1990 and lagged behind the non-surgical HAQ index in 2019 the most. These findings are valuable for global evaluations, policymaking, and advocacy for investing in surgical care.

Duke Scholars

Author Tamara Noel Fitzgerald Surgery, Pediatric General Surgery

Author Emily R Smith Emergency Medicine

Author Catherine Ann Staton Emergency Medicine