Burden of emergency conditions and emergency care usage: new estimates from 40 countries

Abstract

Objective To estimate the global and national burden of emergency conditions, and compare them to emergency care utilization rates. Methods We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care utilization rates were obtained from a systematic literature review on emergency care facilities in low- and middle-income countries (LMICs), supplemented by national health system reports. Findings All 15 leading causes of death and DALYs globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency utilization. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47,728 per 100,000 population (IQR 45,253-50,085) in low-income, 25,186 (IQR 21,982-40,480) in middle-income, and 15,691 (IQR 14,649-16,382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency utilization rates were the lowest in low-income countries, with median 8 visits per 1,000 population (IQR 6-10), 78 (IQR 25-197) in middle-income, and 264 (IQR 177-341) in high-income countries. Conclusion Despite higher burden of emergency conditions, emergency utilization rates are substantially lower in LMICs, likely due to limited access to emergency care.

World Health Assembly Resolution 72.16: What are the implications for the Australasian College for Emergency Medicine and emergency care development in the Indo‐Pacific?

“…EC systems are poorly developed in a majority of low‐ and middle‐income countries (LMICs), and there is a significant unmet need for acute care. These challenges are compounded by structural barriers to healthcare access and a limited health workforce …”

“…These challenges are compounded by structural barriers to healthcare access and a limited health workforce. [3][4][5][6] In May 2019, the World Health Assembly (WHA) acknowledged the value of global EC by adopting Resolution 72. 16 ('Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured').…”

Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa

“…The burden of deaths due to TCC is much greater in low and middle-income countries (LMICs) than in high-income countries, the difference being around threefold. 3 Despite the urgent need to respond to this burden, health system provision for acute care has not historically received attention in funding or research, with focus instead on care for specific diseases. 4 5 Knowledge of the burden of TCC is inadequate due to a lack of systematic health surveillance of between two-thirds to three-quarters of the key questions What is already known?…”

Emergency care research ethics in low-income and middle-income countries

“…A large proportion of the total global burden of disease is caused by emergency medical conditions, including asthma, severe diarrhoea, maternal haemorrhage, myocardial infarction, sepsis, stroke, and trauma 1. The majority of this burden is in low- and middle-income countries (LMICs) 2. Emergency care research—defined as research conducted on diseases, syndromes and systems of care for patients with acute, potentially life-threatening or disabling illness or injury—is essential to improving emergency medicine.…”