Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 225
Filter
Add filters

Document Type
Year range
1.
Eur J Neurol ; 28(10): 3375-3383, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1604393

ABSTRACT

BACKGROUND AND PURPOSE: In multiple sclerosis (MS), disease-related factors and dysfunctional coping might favor the development of mental distress induced by COVID-19 containment measures. Aim of this study was exploring the relationship between disability, coping strategies, daily life reorganization and neuropsychiatric symptoms in an Italian MS population during the COVID-19 lockdown, in order to identify potentially modifiable factors that could inform clinical management of mental distress in people with MS. METHODS: We explored the relationship between mental distress, disability and coping strategies in the Italian MS population under lockdown. Structural equation modeling was applied to information collected via web survey to identify modifiable factors that could account for mental distress. RESULTS: A total of 845 participants (497 with MS and 348 controls) were included in the study. The MS group had higher scores than the control group for depression (p = 0.005), but not for anxiety, emotional dyscontrol or sleep disturbances. The structural equation modeling explained 74% of the variance observed in depression score. Within the model, three latent factors were characterized from measured variables: motor disability and cognitive dysfunction contributed to disability (ß = 0.509 and ß = 0.836; p < 0.001); positive attitude and exercise contributed to active attitude (ß = 0.386 and ß = 0.297; p < 0.001); and avoidance, social support and watching television contributed to passive attitude (ß = 0.301, ß = 0.243 and ß = 0.212; p < 0.001). With regard to the relationship between latent factors and their influence on depression, disability contributed to passive attitude (ß = 0.855; p < 0.001), while both passive and active attitude significantly influenced depression (ß = 0.729 and ß = -0.456; p < 0.001). CONCLUSION: As a practical implication of our model, favoring exercise would enhance active attitude and its positive impact on mental well-being while, at the same time, reducing the negative impact of disability on depression, representing a valuable tool in facing COVID-19-related mental distress.


Subject(s)
COVID-19 , Disabled Persons , Motor Disorders , Multiple Sclerosis , Anxiety , Communicable Disease Control , Depression/epidemiology , Humans , Multiple Sclerosis/epidemiology , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
2.
Front Public Health ; 9: 782793, 2021.
Article in English | MEDLINE | ID: covidwho-1595898

ABSTRACT

This cross-sectional analysis estimated differences, based on disability status, in college students' (n = 777) experiences during the COVID-19 pandemic. Data were modeled using t-tests and logistic regression. Most participants were white (86.2%), and women (66.4%). The mode age was 23. A third (35.6%) had at least one disability. Students reported high rates of psychosocial distress, like fear of contracting (59.7%) and spreading (74.3%) COVID-19, worry about friends and family (83.7%), and increased anxiety (72.5%), depression (59.9%), and substance use (24.7%). Forty-two percent (42.2%) were scared they would miss out on their education through virtual classes. About a third feared forgetting assignments (34.1%) and making mistakes (33.9%). Fewer students expressed apprehension about (27.9%) and intimidation by (26.3%) virtual learning. Only 17.2% would continue taking virtual classes after the pandemic. Students with disabilities (M = 12.4, SD = 4.1) experienced more psychosocial stressors compared to students without disabilities (M = 9.9, SD = 4.2), [t (775) = 7.86, p < 0.001]. In adjusted models, disabled students were more than twice as likely to experience worry about medical bills (OR = 2.29), loneliness (OR = 2.09), and increased anxiety (OR = 2.31). They were also more than three times as likely to report increased depression (OR = 3.51) and changes in sexual activity (OR = 3.12). However, students with disabilities (M = 1.5, SD = 1.1) also reported receiving more support compared to their non-disabled classmates (M = 1.1, SD = 1.1), [t (775) = 6.06, p < 0.001]. Disabled students were more likely to feel a sense of contributing to society by following precautions (OR = 1.80) and receive support from family and others (emotional support: OR = 2.01, financial support: OR = 2.04). Interestingly, no significant differences were found in students' feelings associated with online or virtual learning [t (526.08) = 0.42, p = 0.68]. Students with disabilities, though, trended toward reporting negative experiences with virtual learning. In conclusion, students with disabilities were disproportionately affected by COVID-19 stressors, but also expressed more support and a sense of contributing to the common good.


Subject(s)
COVID-19 , Disabled Persons , Education, Distance , Cross-Sectional Studies , Female , Humans , Pandemics , SARS-CoV-2 , Students
3.
Fam Syst Health ; 39(4): 663-664, 2021 12.
Article in English | MEDLINE | ID: covidwho-1574960

ABSTRACT

The author works at a nonprofit art studio for people with disabilities in Austin, Texas. The studio is having its first drawing class since the studio closed due to COVID-19 last spring. The author describes the struggles with accessibility of Susan, her first student to attend the studio in person since the pandemic. The author's initial thrill about in-person classes dulled, dissipated after hearing Susan's story and seeing her distress. She concludes that in the rush and excitement of this (hopefully) postpandemic world, we must take the opportunity to rethink what "back to normal" means. Perhaps we can replace our idea of normal with something more inclusive. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19 , Disabled Persons , Female , Humans , Pandemics , SARS-CoV-2 , Texas
4.
Disabil Health J ; 15(1): 101230, 2022 01.
Article in English | MEDLINE | ID: covidwho-1560479
5.
Soc Sci Med ; 292: 114637, 2022 01.
Article in English | MEDLINE | ID: covidwho-1556987

ABSTRACT

The economic impact of COVID-19 has exacerbated inequalities in society, but disability has been neglected. This paper contributes to this knowledge gap by providing a comprehensive analysis of the differential labour market impact of COVID-19 by disability in the UK. Using data from the Labour Force Survey before and during the pandemic it estimates disability gaps in pre-pandemic risk factors, as well as changes in labour market inequality nearly one year on. Disabled workers are found to face higher COVID-19-related economic and health risks, including being more likely to work in 'shutdown' industries, and in occupations with greater proximity to others and exposure to disease. However, established measures of inequality, including the disability employment and pay gap suggest limited impact of COVID-19 in 2020. Nevertheless, the increase in the probability of being temporarily away from work, even among otherwise comparable workers, is 40% higher for disabled workers and consistent with disproportionate use of the government's job retention scheme. While the reasons for this are likely to be complex, there is a risk that it will contribute to future disability-related labour market inequality.


Subject(s)
COVID-19 , Disabled Persons , Humans , Occupations , SARS-CoV-2 , United Kingdom/epidemiology
6.
J Med Internet Res ; 23(11): e25745, 2021 11 04.
Article in English | MEDLINE | ID: covidwho-1547110

ABSTRACT

BACKGROUND: In the last decade, there has been a rapid increase in research on the use of artificial intelligence (AI) to improve child and youth participation in daily life activities, which is a key rehabilitation outcome. However, existing reviews place variable focus on participation, are narrow in scope, and are restricted to select diagnoses, hindering interpretability regarding the existing scope of AI applications that target the participation of children and youth in a pediatric rehabilitation setting. OBJECTIVE: The aim of this scoping review is to examine how AI is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with disabilities or other diagnosed health conditions in valued activities. METHODS: We conducted a comprehensive literature search using established Applied Health Sciences and Computer Science databases. Two independent researchers screened and selected the studies based on a systematic procedure. Inclusion criteria were as follows: participation was an explicit study aim or outcome or the targeted focus of the AI application; AI was applied as part of the provided and tested intervention; children or youth with a disability or other diagnosed health conditions were the focus of either the study or AI application or both; and the study was published in English. Data were mapped according to the types of AI, the mode of delivery, the type of personalization, and whether the intervention addressed individual goal-setting. RESULTS: The literature search identified 3029 documents, of which 94 met the inclusion criteria. Most of the included studies used multiple applications of AI with the highest prevalence of robotics (72/94, 77%) and human-machine interaction (51/94, 54%). Regarding mode of delivery, most of the included studies described an intervention delivered in-person (84/94, 89%), and only 11% (10/94) were delivered remotely. Most interventions were tailored to groups of individuals (93/94, 99%). Only 1% (1/94) of interventions was tailored to patients' individually reported participation needs, and only one intervention (1/94, 1%) described individual goal-setting as part of their therapy process or intervention planning. CONCLUSIONS: There is an increasing amount of research on interventions using AI to target the participation of children and youth with disabilities or other diagnosed health conditions, supporting the potential of using AI in pediatric rehabilitation. On the basis of our results, 3 major gaps for further research and development were identified: a lack of remotely delivered participation-focused interventions using AI; a lack of individual goal-setting integrated in interventions; and a lack of interventions tailored to individually reported participation needs of children, youth, or families.


Subject(s)
Artificial Intelligence , Disabled Persons , Adolescent , Child , Delivery of Health Care , Humans
7.
Front Public Health ; 9: 744706, 2021.
Article in English | MEDLINE | ID: covidwho-1528872

ABSTRACT

The special vulnerability of people with disability (PWD) in the COIVD-19 pandemic has been confirmed by many studies, but data shows that the infection rate of PWD in China is lower than for non-disabled people. We believe that this difference can be attributed to the Chinese government's targeted safeguards for the disabled community during the pandemic, including support for disability empowerment, the establishment of a remote interactive decision-making system, fair vaccine distribution and economic protection for PWD. The professionalism of decision-makers and the maintenance of channels of interaction with PWD are also important. All of these changes have benefitted China's public health policy and legal framework. This system, which has six components (governance, prevention, response, knowledge, coordination, and people), enables the country to quickly formulate a series of safeguards for PWD that have a sufficient legal basis. We believe that China's rapidly improving public health policy and legal framework will make a hugely significant impact by alleviating the impact of the COVID-19 pandemic on the PWD community. Countries should pay more attention to discovering the special needs and obstacles of PWD in the COIVD-19 pandemic: in referring to China's experience, they should explore the protection framework for persons with disabilities and adjust it to their own needs on the basis of national conditions.


Subject(s)
COVID-19 , Disabled Persons , China/epidemiology , Humans , Pandemics/prevention & control , SARS-CoV-2
8.
Intellect Dev Disabil ; 59(6): 441-445, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1528706

ABSTRACT

In the COVID-19 pandemic, concerns exist that ventilator triage policies may lead to discrimination against people with disabilities. This study evaluates whether preclinical medical students demonstrate bias towards people with disabilities during an educational ventilator-allocation exercise. Written student responses to a triage simulation activity were analyzed to describe ventilator priority rankings and to identify themes regarding disability. Disability status was not cited as a reason to withhold a ventilator. Key themes observed in ventilator triage decisions included life expectancy, comorbidities, and social worth. Although disability discrimination has historically been perpetuated by health care professionals, it is encouraging that preclinical medical students did not demonstrate explicit bias against people with disabilities in ventilator triage scenarios.


Subject(s)
COVID-19 , Disabled Persons , Intellectual Disability , Students, Medical , Humans , Pandemics , SARS-CoV-2 , Ventilators, Mechanical
9.
J Coll Physicians Surg Pak ; 31(12): 1391-1393, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1527130
10.
Curr Psychiatry Rep ; 23(12): 80, 2021 10 13.
Article in English | MEDLINE | ID: covidwho-1525618

ABSTRACT

PURPOSE OF REVIEW: This paper reviews the empirical literature on exposures to disaster or terrorism and their impacts on the health and well-being of children with disabilities and their families since the last published update in 2017. We also review the literature on studies examining the mental health and functioning of children with disabilities during the COVID-19 pandemic. RECENT FINDINGS: Few studies have examined the effects of disaster or terrorism on children with disabilities. Research shows that children with disabilities and their families have higher levels of disaster exposure, lower levels of disaster preparedness, and less recovery support due to longstanding discriminatory practices. Similarly, many reports of the COVID-19 pandemic have documented its negative and disproportionate impacts on children with disabilities and their families. In the setting of climate change, environmental disasters are expected to increase in frequency and severity. Future studies identifying mitigating factors to disasters, including COVID-19; increasing preparedness on an individual, community, and global level; and evaluating post-disaster trauma-informed treatment practices are imperative to support the health and well-being of children with disabilities and their families.


Subject(s)
COVID-19 , Disabled Persons , Disaster Planning , Disasters , Terrorism , Adolescent , Child , Humans , Pandemics , SARS-CoV-2
11.
Lancet Public Health ; 6(11): e817-e825, 2021 11.
Article in English | MEDLINE | ID: covidwho-1514342

ABSTRACT

BACKGROUND: People with learning disabilities are at substantially increased risk of COVID-19 mortality, but evidence on risks of COVID-19 mortality for disabled people more generally is limited. We aimed to use population-level data to estimate the association between self-reported disability and death involving COVID-19 during the first two waves of the COVID-19 pandemic in England. METHODS: We conducted a retrospective, population-based cohort study of adults aged 30-100 years living in private households or communal establishments in England, using data from the Office for National Statistics Public Health Data Asset. Participants were present at the 2011 Census and alive on Jan 24, 2020. Participants reported being limited a lot in their daily activities, limited a little, or not limited at all, in response to a question from the 2011 Census. The outcome was death involving COVID-19, occurring between Jan 24, 2020, and Feb 28, 2021. We used Cox proportional hazards regression to calculate hazard ratios (HRs) for the association between disability and death involving COVID-19, sequentially adjusting for age, residence type (private household, care home, or other communal establishment), geographical characteristics (local authority district and population density), sociodemographic characteristics (ethnicity, highest qualification, Index of Multiple Deprivation decile, household characteristics [National Statistics Socio-economic Classification of the household reference person, tenure of household, household size, family status, household composition, and key worker in household], key worker type, individual and household exposure to disease, and individual and household proximity to others), and health status (pre-existing health conditions, body-mass index, and number of admissions to hospital and days spent in hospital over the previous 3 years). FINDINGS: 29 293 845 adults were included in the study (13 806 623 [47%] men, 15 487 222 [53%] women), of whom 3 038 772 (10%) reported being limited a little and 2 011 576 (7%) reported being limited a lot. During follow-up, 105 213 people died from causes involving COVID-19 in England, 61 416 (58%) of whom were disabled. Age-adjusted analyses showed higher mortality involving COVID-19 among disabled people who were limited a lot (HR 3·05 [95% CI 2·98-3·11] for men; 3·48 [3·41-3·56] for women) and disabled people who were limited a little (HR 1·88 [1·84-1·92] for men; 2·03 [1·98-2·08] for women) than among non-disabled people. Adjustment for residence type, geography, sociodemographics, and health conditions reduced but did not eliminate the associations between disability and death involving COVID-19 (HR 1·35 [1·32-1·38] for men who were limited a lot; 1·21 [1·18-1·23] for men who were limited a little; 1·55 [1·51-1·59] for women who were limited a lot; and 1·28 [1·25-1·31] for women who were limited a little). INTERPRETATION: Given the association between disability and mortality involving COVID-19, verification of these findings and consideration of recommendations for protective measures are now required. FUNDING: None.


Subject(s)
COVID-19/mortality , Disabled Persons/statistics & numerical data , Pandemics , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , England/epidemiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Self Report
14.
Am J Bioeth ; 21(11): 82-84, 2021 11.
Article in English | MEDLINE | ID: covidwho-1506104
15.
Crit Care ; 25(1): 382, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1506095

ABSTRACT

BACKGROUND: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. METHODS: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. RESULTS: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. CONCLUSIONS: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.


Subject(s)
COVID-19/epidemiology , Critical Illness/epidemiology , Disabled Persons , Recovery of Function/physiology , Return to Work/trends , Aged , Aged, 80 and over , Australia/epidemiology , COVID-19/diagnosis , COVID-19/therapy , Cohort Studies , Critical Illness/therapy , Female , Follow-Up Studies , Health Status , Humans , Male , Middle Aged , Mortality/trends , Prospective Studies , Time Factors , Treatment Outcome
16.
Int J Equity Health ; 20(1): 166, 2021 07 16.
Article in English | MEDLINE | ID: covidwho-1496176

ABSTRACT

BACKGROUND: The COVID-19 pandemic has uncovered the ways in which disabled people are made more vulnerable due to structural inequalities. These vulnerabilities are the result of the interaction between individual and structural factors that shape how risk is experienced by disabled people. In Australia, these vulnerabilities are influenced by the way disability services and care for disabled people are delivered through a consumer-directed approach. We analysed the policies and documentation made by the Australian Government and state and territory governments during the pandemic to explore whether these were disability-inclusive. We aimed to unpack how these policies shaped disabled people as vulnerable citizens. METHODS: Guided by documentary research, we used framework analysis to examine the policies of the Australian Government and state and territory governments. We analysed legislation that was given royal assent by the federal, state and territory governments, and documents (reports, fact sheets, guidance documents, etc.) published by the federal government and the state of Victoria (given that this state experienced the brunt of the epidemic in Australia) between February 2020 to August of 2020. RESULTS: We found that most of the resources were not aimed at disabled people, but at carers and workers within disability services. In addition, most policies formulated by the Australian Government were related to the expansion of welfare services and the creation of economic stimulus schemes. However, while the stimulus included unemployed people, the expansion of benefits explicitly excluded disabled people who were not employed. Most of the legislation and documents offered accessibility options, though most of these options were only available in English. Disability oriented agencies offered more extensive accessibility options. CONCLUSIONS: The findings indicate a large number of documents addressing the needs of disabled people. However, disability-inclusiveness appeared to be inconsistent and not fully considered, leaving disabled people exposed to greater risk of COVID-19. Neoliberal policies in the health and welfare sector in Australia have led to an individualisation of the responsibility to remain healthy and a reliance on people as independent consumers. Governments need to take a clear stance towards the emergence of such a discourse that actively disvalues disabled people.


Subject(s)
COVID-19/epidemiology , Disabled Persons , Government , Pandemics , Policy , Australia/epidemiology , Guidelines as Topic , Humans , Risk Assessment , Vulnerable Populations
17.
Int J Environ Res Public Health ; 18(21)2021 10 27.
Article in English | MEDLINE | ID: covidwho-1488552

ABSTRACT

The SARS COVID-19 pandemic emerged in 2019 and has impacted people everywhere. Disparities in impact and outcomes are becoming apparent for individuals and communities which go beyond the trajectory of the disease itself, influenced by the strength and weaknesses of systems of universal health care, and the actions of civil society and government. This article is one of a series exploring COVID-19-related experiences of assistive technology (AT) users across the globe and implications for AT systems strengthening. AT such as mobility products, braille devices, and information communication technologies are key enablers of functioning, necessary to the achievement of the UN Sustainable Development Goals and enshrined in the Convention on the Rights of Persons with Disabilities. Reporting on a survey of 73 AT users across six global regions, we demonstrate that minority groups already living with health inequities are unduly impacted. An AT ecosystem analysis was conducted using the WHO GATE 5P framework, that is, people, products, personnel, provision and policy. AT users and families call for inclusive pandemic responses which encompass their needs across the lifespan, from very young to very old. We offer specific recommendations for future action to strengthen access to AT across public policy and civil society in pandemic preparedness and response.


Subject(s)
COVID-19 , Disabled Persons , Self-Help Devices , Ecosystem , Humans , Pandemics , SARS-CoV-2
18.
Public Health ; 200: 106-108, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1482900

ABSTRACT

OBJECTIVES: To estimate levels of COVID-19 vaccine hesitancy among working-age adults with disabilities in the United Kingdom. STUDY DESIGN: Cross-sectional survey. METHODS: Secondary analysis of data collected on a nationally representative sample of 10,114 respondents aged 16-64 years. RESULTS: The adjusted relative risk for hesitancy among respondents with a disability was 0.92 (95% CI 0.67-1.27). There were stronger associations between gender and hesitancy and ethnic status and hesitancy among participants with a disability. The most common reasons cited by people with disabilities who were hesitant were: concern about the future effects of the vaccine, not trusting vaccines and concern about the side effects of vaccination. CONCLUSIONS: The higher rates of vaccine hesitancy among women with disabilities and among people from minority ethnic groups with disabilities are concerning.


Subject(s)
COVID-19 , Disabled Persons , Vaccines , Adult , COVID-19 Vaccines , Cross-Sectional Studies , Female , Humans , SARS-CoV-2 , United Kingdom/epidemiology , Vaccination
19.
Int J Equity Health ; 20(1): 214, 2021 09 26.
Article in English | MEDLINE | ID: covidwho-1477425

ABSTRACT

BACKGROUND: COVID-19 has caused almost unprecedented change across health, education, the economy and social interaction. It is widely understood that the existing mechanisms which shape health inequalities have resulted in COVID-19 outcomes following this same, familiar, pattern. Our aim was to estimate inequalities in the population health impact of COVID-19 in Scotland, measured by disability-adjusted life years (DALYs) in 2020. Our secondary aim was to scale overall, and inequalities in, COVID-19 DALYs against the level of pre-pandemic inequalities in all-cause DALYs, derived from the Scottish Burden of Disease (SBoD) study. METHODS: National deaths and daily case data were input into the European Burden of Disease Network consensus model to estimate DALYs. Total Years of Life Lost (YLL) were estimated for each area-based deprivation quintile of the Scottish population. Years Lived with Disability were proportionately distributed to deprivation quintiles, based on YLL estimates. Inequalities were measured by: the range, Relative Index of Inequality (RII), Slope Index of Inequality (SII), and attributable DALYs were estimated by using the least deprived quintile as a reference. RESULTS: Marked inequalities were observed across several measures. The SII range was 2048 to 2289 COVID-19 DALYs per 100,000 population. The rate in the most deprived areas was around 58% higher than the mean population rate (RII = 1.16), with 40% of COVID-19 DALYs attributed to differences in area-based deprivation. Overall DALYs due to COVID-19 ranged from 7 to 20% of the annual pre-pandemic impact of inequalities in health loss combined across all causes. CONCLUSION: The substantial population health impact of COVID-19 in Scotland was not shared equally across areas experiencing different levels of deprivation. The extent of inequality due to COVID-19 was similar to averting all annual DALYs due to diabetes. In the wider context of population health loss, overall ill-health and mortality due to COVID-19 was, at most, a fifth of the annual population health loss due to inequalities in multiple deprivation. Implementing effective policy interventions to reduce health inequalities must be at the forefront of plans to recover and improve population health.


Subject(s)
COVID-19 , Health Status Disparities , Pandemics , Population Health , COVID-19/epidemiology , Disabled Persons/statistics & numerical data , Humans , Quality-Adjusted Life Years , Scotland/epidemiology
20.
BMJ Glob Health ; 6(6)2021 06.
Article in English | MEDLINE | ID: covidwho-1476484

ABSTRACT

INTRODUCTION: Cost-effectiveness analysis (CEA) is critical for identifying high-value interventions that address significant unmet need. This study examines whether CEA study volume is proportionate to the burden associated with 21 major disease categories. METHODS: We searched the Tufts Medical Center CEA and Global Health CEA Registries for studies published between 2010 and 2019 that measured cost per quality-adjusted life-year or cost per disability-adjusted life-year (DALY). Stratified by geographical region and country income level, the relationship between literature volume and disease burden (as measured by 2019 Global Burden of Disease estimates of population DALYs) was analysed using ordinary least squares linear regression. Additionally, the number of CEAs per intervention deemed 'essential' for universal health coverage by the Disease Control Priorities Network was assessed to evaluate how many interventions are supported by cost-effectiveness evidence. RESULTS: The results located below the regression line but with relatively high burden suggested disease areas that were 'understudied' compared with expected study volume. Understudied disease areas varied by region. Higher-income and upper-middle-income country (HUMIC) CEA volume for non-communicable diseases (eg, mental/behavioural disorders) was 100-fold higher than that in low-income and lower-middle-income countries (LLMICs). LLMIC study volume remained concentrated in HIV/AIDS as well as other communicable and neglected tropical diseases. Across 60 essential interventions, only 33 had any supporting CEA evidence, and only 21 had a decision context involving a low-income or middle-income country. With the exception of one intervention, available CEA evidence revealed the 21 interventions to be cost-effective, with base-case findings less than three times the GDP per capita. CONCLUSION: Our analysis highlights disease areas that require significant policy attention. Research gaps for highly prevalent, lethal or disabling diseases, as well as essential interventions may be stifling potential efficiency gains. Large research disparities between HUMICs and LLMICs suggest funding opportunities for improving allocative efficiency in LLMIC health systems.


Subject(s)
Cost of Illness , Disabled Persons , Global Health , Humans , Quality-Adjusted Life Years , Universal Health Insurance
SELECTION OF CITATIONS
SEARCH DETAIL
...