Population Health Metrics最新文献

Background: Evidence indicating persistent geographic inequalities in health outcomes signifies a need for routine subnational monitoring of health-related Sustainable Development Goal targets in sub-Saharan Africa. Health facilities may be an appropriate subnational unit for monitoring purposes, but a lack of suitable demographic data complicates the production of baseline facility-level population denominators against which progress can be reliably measured. This scoping review aimed to map the methods and data sources used to estimate health facility catchment areas and translate them to population denominators for child health indicators in the region.

Methods: Peer-reviewed research publications and grey literature reports were identified by searching bibliographic databases and relevant organisational websites. The inclusion criteria required that studies were conducted in sub-Saharan Africa since January 2000, described quantitative method(s) for estimating health facility catchment areas and/or population denominators, and focussed on children as the population of interest. Following title/abstract then full text screening of search results, relevant data were extracted using a standard form. Thematic analysis was undertaken to extract themes and present a narrative synthesis.

Results: Overall, 33 research publications and 3 grey literature reports were included. Of these, only 7 research studies and 1 technical guidance document outlined aims explicitly framed around methods development and/or evaluation. Studies increasingly estimated catchment areas using complex geostatistical or travel time-based modelling approaches rather than simpler proximity metrics, and produced denominators by intersecting catchment boundaries with gridded population surfaces rather than aggregating area-based administrative counts. Few studies used data produced by or describing health facilities to link estimation methods to service utilisation patterns, inter-facility competition or facility characteristics.

Conclusion: There is a need for catchment population estimation methods that can be scaled to national-level facility networks and replicated across the region. This could be achieved by leveraging routinely collected health data and other readily available and nationally consistent data sources. Future methodological development should emphasise modern geostatistical approaches drawing upon the relative strengths of multiple data sources and capturing the range of spatial, supply-side, individual-level and environmental factors with potential to influence catchments' extent, shape and demographic composition.

Background: Civilians bear a significant burden of morbidity and mortality in modern armed conflicts, particularly when explosive weapons are used in densely populated areas. Many civilian facilities were attacked in the war in Tigray since the beginning of hostilities in November 2020. This study assessed the impact of airstrikes on civilians from June 2021 until the signing of the Agreement for Lasting Peace through a Permanent Cessation of Hostilities between the Ethiopian Government and the Tigray People's Liberation Front in November 2022.

Methods: A retrospective review was conducted of all injury data reported between June 2021-October 2022 from each district health facility in six zones of Tigray, Ethiopia. Descriptive analysis was conducted for variables of interest (e.g., age, sex, location, injury outcomes).

Results: A total of 1,143 casualties from airstrikes were reported from six zones and 24 districts of Tigray, Ethiopia. From the total of 80 instances of drone and aerial bombardments incidents, one third of the airstrikes resulted in death (33.7%, n = 385). The mean age of the victims was 28.9 years (SD = 17.9) with a range of less than 1 year to 87 years. Almost a third of the victims (28.3%, n = 323) were children aged < 18 years. Approximately 5% of casualties were age > 60 years (5.3%, n = 61). Almost half (45.1%, n = 516) of the causalities were female including pregnant and lactating women. The Southern and Northwest zones suffered the most casualties, followed by the Southeast zones and Mekelle. The airstrikes took place predominantly in civilian areas, including marketplaces, internally displaced persons (IDP) camps, residential areas, public transportation, villages, children's playgrounds, churches, mills and hospitals, resulting in numerous casualties that disproportionately affected civilians, especially children, the elderly and women.

Conclusions: Civilians suffered significant death and injury from airstrikes during hostilities in the war in Tigray, including a high proportion of women and children. The most common targets were civilian facilities including IDP camps, which the United Nations has determined to be a crime against humanity. Enhanced collaboration between health and protection stakeholders can improve support to victims from immediate post-injury care as well as rehabilitation so that they can live as healthy, dignified, and productive citizens.

Background: Italy implemented various measures, including lockdowns and a mass vaccination campaign, to address the COVID-19 pandemic. This study aims to describe the temporal and regional differences in mortality trends between March 2020 and December 2021, along with associated socioeconomic, policy, and behavioral factors.

Methods: We used National Ministry of Health data on COVID-19 mortality, excess mortality (EM), and vaccine uptake, along with data from the Italian arm of a European survey of preventive behaviors and attitudes, such as trust in institutions. The analysis was conducted across four macro regions and five study periods. Avertable mortality was calculated as observed EM minus the lowest EM at the macro-regional level for each study period.

Results: In 2020-21, the estimated total EM was 180,169 deaths, with 76.4% officially attributed to COVID-19. This proportion ranged from 13.5% in the South and Islands (June-October 2020) to 140.0% in the Northeast (March-July 2021). Excess and avertable mortality peaked in the North during the first two periods (March 2020 - February 2021) and in the South and Islands thereafter (March-December 2021). Survey data revealed reduced adherence to stay-at-home orders in the North and lower trust in hospitals and reduced vaccine uptake, especially among the elderly, in the South and Islands. After the initial period, 33,587 deaths (18.6%) could have been averted if each macro-region had matched the lowest rates observed in that period. An estimated 40.7% of avertable deaths occurred in Southern and Insular Italy, which constitutes 33.7% of the national population.

Conclusions: Due to differential misreporting, EM estimates offer a more accurate view of regional and temporal patterns in COVID-19 mortality than official rates. The higher EM in northern Italy during the first year of the pandemic might be linked to lesser adherence to control policies, possibly associated with higher private-sector employment. The higher EM in the South and Islands post-March 2021, contributing to 40.7% of avertable EM, could be partly explained by the lower vaccination rates in the population aged 80 and older, who experienced the highest age-specific mortality rates and lower trust in the healthcare system in this macro-region.

Background: Following Hamas's 7 October attack, Israel launched extensive aerial bombardments in the Gaza Strip, followed by a large-scale ground invasion. During the first 3 months of the conflict, up to December 31, 2023, the Palestinian Ministry of Health reported that 21,822 Palestinians were killed in Israeli strikes. This study estimates the number of excess deaths in children due to the war in the Gaza Strip in 2023 and assesses how the conflict has impacted the experience of parental loss among children.

Methods: We reconstructed background life tables for the Gaza Strip based on under-five mortality estimates from sample surveys and accounted for casualties due to the 2023 conflict, using the age distribution of deaths from an individual list of 13,101 fatalities reported by the Palestinian Ministry of Health. We employed a kinship matrix model to estimate the number of new orphans in 2023 and the prevalence of maternal and paternal orphanhood.

Results: From October 8 to December 31, 2023, our estimates indicate that 8120 children under 18 years of age were killed due to the conflict (with a range of 7099 to 9196 excess deaths). Additionally, 15,127 children (14,716-15,553) lost a father, and 9886 children (9564-10,216) lost a mother due to the conflict. Between 2022 and 2023, the probability of dying in childhood (ages 0-17) increased nearly sixfold for both males and females. The war increased the risk of losing a mother and a father by nine-fold and six-fold, respectively. Compared to the situation in 2022, the proportion of paternal orphans among children aged 0-17 rose by 1.5 times, while the proportion of maternal orphans doubled.

Conclusions: The dramatic number of excess deaths among children and the sharp increases in orphanhood underscores the urgent need to prioritize the well-being and rights of children caught up in the war in Gaza.

Commonly used measures of socioeconomic inequalities in mortality, such as the slope and the relative index of inequality, are based on summary measures of the group-specific age-at-death distributions (e.g. standardized mortality rate or life expectancy). While this approach is informative, it ignores valuable information contained in the group-specific distributions. A recent approach applied a measure of distributional dissimilarity (the non-overlap index) to measure lifespan stratification. In this paper, we rigorously evaluate and further implement the multi-group extension of the non-overlap index ( $S^P$ ) to measure socioeconomic inequalities in mortality across a number of groups, and assess whether differences across countries and over time are driven by mortality or compositional changes in two applications with different data availability: educational groups (Sweden and Denmark) and groups defined by an area-level deprivation measure (England). Our findings suggest that the multi-group $S^P$ is sensitive not only to changes in the means or variances, but also to broader mortality changes that affect distributional shapes. The method can be employed to any context where mortality rates by age are available by sub-groups. Furthermore, levels and trends in mortality inequalities computed with the multigroup $S^P$ often differ compared to other conventional summary-based measures. Moreover, we find that the contribution of mortality changes to changes in inequalities is generally greater than that of the changes in the population composition. Whereas levels and trends of inequalities may depend on whether life expectancy- or lifespan variation-based measures are employed, the multi-group $S^P$ provides a holistic perspective by capturing both dimensions simultaneously.

Background: China now faces multiple challenging demographic and public policy problems that have emerged from four decades of sex-selective induced abortions. The sex-selective induced abortion of female fetuses has been under-examined quantitatively in China.

Methods: Using annual data on the officially registered number of births, induced abortions, and SRB data, we estimate the annual number of sex-selective abortions and then estimated two related proportions over the past decades.

Results: The annual proportions and number of selective abortions rose in the 1980s with the strict family planning policy and the diffusion of sex identification technology, remained at a high level between 1990 and 2010, and then declined, totaling 30.04 million. The abortion of second-order female fetuses was the largest proportion of all sex-selective abortions but declined after 2000 partly due to the change in birth composition by order. Children's composition affected sex-selective practice. Village selective abortions accounted for the majority of all selective abortions but decreased markedly in 2010 with changes in birth composition by residence. The rural-urban comparison by order indicated that urban couples were not less likely to abort female fetuses than their rural counterparts. Sex-selective abortions still exhibit provincial differences.

Conclusions: In China, the long-standing preference for sons, easy access to sex-selective technologies, and the spontaneous fertility decline have led to the continued practice of selectively aborting female fetuses, despite its prohibition. As a result, the imbalanced sex ratio may take years to normalize.

Background: Quality-Adjusted Life Expectancy (QALE) is a well-established approach for evaluating health expectancy, combining health-related quality of life (HRQoL) with life expectancy (LE) to produce a cohesive summary score. This study offers QALE estimates for the Iranian population, categorized by age group and sex.

Methods: To establish QALE population norms, we integrated age- and sex-specific EQ-5D-3 L utility scores with the national life tables of the Iranian population, sourced from the World Health Organization. The utility scores were derived from data gathered through the EQ-5D questionnaire survey, collected from 27,704 participants during the eighth round of the nationwide Stepwise approach to surveillance (STEPS) conducted in 2021. EQ-5D health status was converted into utility scores using the existing value set provided through a face-to-face time trade-off method for the Iranian general population.

Results: The utility score for men decreased from 0.95 in the 18-19 age group to 0.76 in the 85 + age group, while for women, it declined from 0.91 to 0.66 over the same age range. Although women have a higher life expectancy than men, the reverse is true for QALE. QALE at birth is 68.29 QALYs for men and 66.69 QALYs for women.

Conclusions: This study presents Quality-Adjusted Life Expectancy (QALE) population norms for Iran. These norms can be used in economic assessments of health interventions and population health studies.

Background: Yemen is the poorest and war-torn country in the North Africa and Middle East region and lacks a comprehensive assessment of temporal trends in the overall disease burden, injuries, and disabilities at the country level; these insights are required to guide healthcare interventions and improve overall population health. We estimated the burden and temporal trends of diseases and their risk factors in Yemen between 1990 and 2021 using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021.

Methods: In this systematic analysis, we presented all-causes and cause-specific mortality rates, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), as well as the life expectancy at birth and health-adjusted life expectancy (HALE) using the standardized GBD methodology. Moreover, we compared the disease burden of Yemen with the top five war-torn countries based on the Global Peace Index (GPI) 2021, including Afghanistan, Syria, South Sudan, and Iraq.

Results: In Yemen, the life expectancy at birth increased from 59.0 years (95% UI 56.4-61.8) in 1990 to 65.3 years (95% UI 62.2-67.9) in 2021. Between 1990 and 2021, the all-causes age-standardized mortality rate in Yemen decreased from 1471.7 deaths (95% UI 1268.4-1696.3) to 1347.2 deaths (95% UI 1097.5-1659.5). However, the age-standardized mortality rate caused by conflict and terrorism substantially increased from 1.9 deaths (95% UI 1.7-2.1) to 50.0 deaths (95% UI 45.5-55.0) between 2010 and 2021. In 2021, ischemic heart disease, COVID-19, stroke, hypertensive heart disease, conflict and terrorism, and neonatal disorders were leading causes of age-standardized mortality and YLLs rate. Dietary iron deficiency, low back pain, depressive disorders, headache disorders, anxiety disorders, and gynecological diseases were the leading causes of age-standardized YLDs rate in 2021. High blood pressure, high levels of low-density lipoprotein, smoking, low birth weight, and short gestations were the leading risk factors for age-standardized mortality in 2021. Yemen ranked 3rd in terms of high age-standardized all-causes deaths, YLLs, and lowest HALE at birth and lowest life expectancy at birth among the top five war-torn countries in 2021.

Conclusion: Yemen must proportionately address the burden caused by non-communicable diseases, communicable, maternal, neonatal, and nutritional diseases, and conflict and terrorism. Prioritizing these areas will improve the overall population health and prevent premature mortality and disabilities.

Background: The multiple imputation by chained equations (MICE) is a widely used approach for handling missing data. However, its robustness, especially for high missing proportions in health indicators, is under-researched. The study aimed to provide a preliminary guideline for the choice of the extent of missing proportion to impute longitudinal health-related data using the MICE method.

Methods: The study obtained complete data on five mortality-related health indicators of 100 countries (2015-2019) from the Global Health Observatory. Nine incomplete datasets with missing rates from 10 to 90% were generated and imputed using MICE. The robustness of MICE was assessed through three approaches: comparison of means using the Repeated Measures- Analysis of variance, estimation of evaluation metrics (Root mean square error, mean absolute deviation, Bias, and proportionate variance), and visual inspection of box plots of imputed and non-imputed data.

Results: The Repeated Measures- Analysis of variance revealed significant differences between complete and imputed data, primarily in imputed data with over 50% missing proportions. Evaluation metrics exhibited 'high performance' for the dataset with a 50% missing proportion for various health indicators However, with missing proportions exceeding 70%, the majority of indicators demonstrated a 'low' performance level in terms of most evaluation metrics. The visual inspection of the box plot revealed severe variance shrinkage in imputed datasets with missing proportions beyond 70%, corroborating the findings from the evaluation metrics.

Conclusion: It demonstrates high robustness up to 50% missing values, with marginal deviations from complete datasets. Caution is warranted for missing proportions between 50 and 70%, as moderate alterations are observed. Proportions beyond 70% lead to significant variance shrinkage and compromised data reliability, emphasizing the importance of acknowledging imputation limitations for practical decision-making.