Deconstructable steel–fibre reinforced concrete deck slabs with a transverse confining system
In: Materials and design, Band 89, S. 1007-1019
ISSN: 1873-4197
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In: Materials and design, Band 89, S. 1007-1019
ISSN: 1873-4197
The present study explored the quality of PM10, over a four-year period in the western part of Iran. A total of 1334 samples were collected from air pollution measurement stations in Kermanshah. Statistical analysis was carried out using the SPSS ver.14. The results showed that the total percent change in PM10 over a period of 4 years was 10.04, 59.2, 26.4, 0.7 and 3.3. The highest and the lowest frequencies of PM10 occurred in February with 37.7, June and July with 0; winter and summer months with 21.96 and 4.81, respectively. The results are depicted that the air quality in July, the summer months and 2008 was worst in terms of PM10 concentration, which was mainly due to the fluctuations and acute entrance of dust particles into western Iran. Hence, the reduction in such emissions is indispensable and requires extensive and considerable cooperation between the government of Iran and the neighbouring countries. © School of Engineering, Taylor�s University.
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In: Estonian journal of ecology, Band 63, Heft 3, S. 130
In: Yaghoubi, M. and Nojomi, M. and Vaezi, A. and Erfani, V. and Mahmoudi, S. and Ezoji, K. and Zahraei, S.M. and Chaudhri, I. and Moradi-Lakeh, M. (2018) Cost-Effectiveness Analysis of the Introduction of HPV Vaccination of 9-Year-Old-Girls in Iran. Value in Health Regional Issues, 15. pp. 112-119.
Objectives: To estimate the cost effectiveness of introducing the quadrivalent human papillomavirus (HPV) vaccine into the national immunization program of Iran. Methods: The CERVIVAC cost-effectiveness model was used to calculate incremental cost per averted disability-adjusted life-year by vaccination compared with no vaccination from both governmental and societal perspectives. Calculations were based on epidemiologic parameters from the Iran National Cancer Registry and other national data sources as well as from literature review. We estimated all direct and indirect costs of cervical cancer treatment and vaccination program. All future costs and benefits were discounted at 3 per year and deterministic sensitivity analysis was used. Results: During a 10-year period, HPV vaccination was estimated to avert 182 cervical cancer cases and 20 deaths at a total vaccination cost of US 23,459,897; total health service cost prevented because of HPV vaccination was estimated to be US 378,646 and US 691,741 from the governmental and societal perspective, respectively. Incremental cost per disability-adjusted life-year averted within 10 years was estimated to be US 15,205 and US 14,999 from the governmental and societal perspective, respectively, and both are higher than 3 times the gross domestic product per capita of Iran (US 14,289). Sensitivity analysis showed variation in vaccine price, and the number of doses has the greatest volatility on the incremental cost-effectiveness ratio. Using a two-dose vaccination program could be cost-effective from the societal perspective (incremental cost-effectiveness ratio = US 11,849). Conclusions: Introducing a three-dose HPV vaccination program is currently not cost-effective in Iran. Because vaccine supplies cost is the most important parameter in this evaluation, considering a two-dose schedule or reducing vaccine prices has an impact on final conclusions. © 2018
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In: Yaghoubi, M. and Nojomi, M. and Vaezi, A. and Erfani, V. and Mahmoudi, S. and Ezoji, K. and Zahraei, S.M. and Chaudhri, I. and Moradi-Lakeh, M. (2018) Cost-Effectiveness Analysis of the Introduction of HPV Vaccination of 9-Year-Old-Girls in Iran. Value in Health Regional Issues, 15. pp. 112-119.
Objectives: To estimate the cost effectiveness of introducing the quadrivalent human papillomavirus (HPV) vaccine into the national immunization program of Iran. Methods: The CERVIVAC cost-effectiveness model was used to calculate incremental cost per averted disability-adjusted life-year by vaccination compared with no vaccination from both governmental and societal perspectives. Calculations were based on epidemiologic parameters from the Iran National Cancer Registry and other national data sources as well as from literature review. We estimated all direct and indirect costs of cervical cancer treatment and vaccination program. All future costs and benefits were discounted at 3 per year and deterministic sensitivity analysis was used. Results: During a 10-year period, HPV vaccination was estimated to avert 182 cervical cancer cases and 20 deaths at a total vaccination cost of US 23,459,897; total health service cost prevented because of HPV vaccination was estimated to be US 378,646 and US 691,741 from the governmental and societal perspective, respectively. Incremental cost per disability-adjusted life-year averted within 10 years was estimated to be US 15,205 and US 14,999 from the governmental and societal perspective, respectively, and both are higher than 3 times the gross domestic product per capita of Iran (US 14,289). Sensitivity analysis showed variation in vaccine price, and the number of doses has the greatest volatility on the incremental cost-effectiveness ratio. Using a two-dose vaccination program could be cost-effective from the societal perspective (incremental cost-effectiveness ratio = US 11,849). Conclusions: Introducing a three-dose HPV vaccination program is currently not cost-effective in Iran. Because vaccine supplies cost is the most important parameter in this evaluation, considering a two-dose schedule or reducing vaccine prices has an impact on final conclusions. © 2018
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Background: Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq® (RV5)) in Iran, from the viewpoints of Iran's health system and society. Methods: The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3 was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results. Results: Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US 499.91 million. Also, US 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario. Conclusion: Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran. © 2014 Elsevier Ltd.
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BACKGROUND AND PURPOSE: The Eastern Mediterranean Region (EMR) is experiencing a demographic shift towards rapid ageing at a time of political unrest. We aimed to estimate the burden of neurodegenerative disorders, and its relationship with sociodemographic indicators (SDI) in the EMR countries from 1990 to 2016. METHODS: Using data from the Global Burden of Disease (GBD) 2016 study, we calculated country-specific trends for prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for Alzheimer's disease/other dementias and Parkinson's disease in the EMR during 1990-2016. RESULTS: In EMR, age-standardized prevalence rate of Alzheimer's disease/other dementias and Parkinson's disease was estimated at 759.8 (642.9-899.9) and 87.1 (69.8-108.2) /100,000 in 2016, demonstrating 0.01% and 42.3% change from 1990, respectively. Neurodegenerative disorders contributed to 5.4% of total DALYs and 4.6% of total YLDs among the older EMR population aged 70 years or older in 2016. Age-standardized DALYs due to Parkinson's disease was strongly correlated with the SDI level (r=0.823, p-value<0.001). The YLD/DALY ratio of neurodegenerative diseases declined during this period in the low income EMR countries but not in high income ones. CONCLUSIONS: Our findings demonstrated an increasing trend in the burden of dementias and Parkinson's disease in most EMR countries between 1990 and 2016. With aging of the EMR populations, countries should target the modifiable risk factors of neurodegenerative diseases to control their increasing burden. This article is protected by copyright. All rights reserved.
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In: Asadi-Lari, M. and Vaez-Mahdavi, M.R. and Faghihzadeh, S. and Cherghian, B. and Esteghamati, A. and Farshad, A.A. and Golmakani, M. and Haeri-Mehrizi, A.-A. and Hesari, H. and Kalantari, N. and Kamali, M. and Kordi, R. and Malek-Afzali, H. and Montazeri, A. and Moradi-Lakeh, M. and Motevallian, A. and Noorbala, A. and Raghfar, H. and Razzaghi, E. (2013) Response-oriented measuring inequalities in Tehran: Second round of Urban health equity assessment and response tool (Urban HEART-2), concepts and framework. Medical Journal of the Islamic Republic of Iran, 27 (4). pp. 236-248.
Background: Current evidence consistently confirm inequalities in health status among socioeconomic groups, gender, ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health of the population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural, educational, political or environmental problems. Measuring inequalities, improving daily living conditions, and tackling inequitable distribution of resources are highly recommended by international SDH commissioners in recent years to 'close the gaps within a generation'. To measure inequalities in socio-economic determinants and core health indicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2) was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre). Method: For 'assessment' part of the project, 65 indicators in six policy domains namely 'physical and infrastructure', 'human and social', 'economic', 'governance', 'health and nutrition', and also 'cultural' domain were targeted either through a population based survey or using routine system. Survey was conducted in a multistage random sampling, disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households (118000 individuals) were collected. For 'response' part of the project, widespread community based development (CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013. Conclusion: Following the first round of Urban HEART project in 2008, the second round was conducted to track changes over time, to institutionalize inequality assessment within the local government, to build up community participation in 'assessment' and 'response' parts of the project, and to implement appropriate and evidence-based actions to reduce health inequalities within all neighborhoods of Tehran.
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In: Fereshtehnejad, S.-M. and Vosoughi, K. and Heydarpour, P. and Sepanlou, S.G. and Farzadfar, F. and Tehrani-Banihashemi, A. and Malekzadeh, R. and Sahraian, M.A. and Vollset, S.E. and Naghavi, M. and Vos, T. and Feigin, V. and Murray, C. and Mokdad, A.H. and Moradi-Lakeh, M. and of Disease Study 2016 Eastern Mediterranean Region Collaborators, Global Burden (2019) Burden of neurodegenerative diseases in the Eastern Mediterranean Region, 1990�2016: findings from the Global Burden of Disease Study 2016. European Journal of Neurology.
Background and purpose: The Eastern Mediterranean Region (EMR) is experiencing a demographic shift towards rapid aging at a time of political unrest. We aimed to estimate the burden of neurodegenerative disorders and its relationship with sociodemographic index in the EMR countries from 1990 to 2016. Methods: Using data from the Global Burden of Disease Study 2016, we calculated country-specific trends for prevalence, mortality, disability-adjusted life-years (DALY), years of life lost and years lived with disability (YLD) for Alzheimer's disease/other dementias and Parkinson's disease in the EMR during 1990�2016. Results: In the EMR, the age-standardized prevalence rate of Alzheimer's disease/other dementias and Parkinson's disease was estimated at 759.8/100 000 (95 uncertainty intervals, 642.9�899.9) and 87.1/100 000 (95 uncertainty intervals, 69.8�108.2) people in 2016, demonstrating 0.01 and 42.3 change from 1990, respectively. Neurodegenerative disorders contributed to 5.4 of total DALY and 4.6 of total YLD among the older EMR population (70 years of age or older in 2016). Age-standardized DALY due to Parkinson's disease were strongly correlated with the sociodemographic index level (r = 0.823, P < 0.001). The YLD:DALY ratio of neurodegenerative diseases declined during this period in the low-income but not the high-income EMR countries. Conclusions: Our findings demonstrated an increasing trend in the burden of dementias and Parkinson's disease in most EMR countries between 1990 and 2016. With aging of the EMR populations, countries should target the modifiable risk factors of neurodegenerative diseases to control their increasing burden. © 2019 EAN
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The Lancet Countdown tracks progress on health and climate change and provides an independent assessment of the health effects of climate change, the implementation of the Paris Agreement,1 and the health implications of these actions. It follows on from the work of the 2015 Lancet Commission on Health and Climate Change,2 which concluded that anthropogenic climate change threatens to undermine the past 50 years of gains in public health, and conversely, that a comprehensive response to climate change could be "the greatest global health opportunity of the 21st century". The Lancet Countdown is a collaboration between 24 academic institutions and intergovernmental organisations based in every continent and with representation from a wide range of disciplines. The collaboration includes climate scientists, ecologists, economists, engineers, experts in energy, food, and transport systems, geographers, mathematicians, social and political scientists, public health professionals, and doctors. It reports annual indicators across five sections: climate change impacts, exposures, and vulnerability; adaptation planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement.
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The Lancet Countdown is an international collaboration established to provide an independent, global monitoring system dedicated to tracking the emerging health profile of the changing climate. The 2020 report presents 43 indicators across five sections: climate change impacts, exposures, and vulnerabilities; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. This report represents the findings and consensus of the 35 leading academic institutions and UN agencies that make up The Lancet Countdown, and draws on the expertise of climate scientists, geographers, engineers, experts in energy, food, and transport, economists, social, and political scientists, data scientists, public health professionals, and doctors.
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Background Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used causespecific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings In 2016, there were 27.08 million (95% uncertainty interval [UI] 24.30-30.30 million) new cases of TBI and 0.93 million (0.78-1.16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55.50 million (53.40-57.62 million) and of SCI was 27.04 million (24.98-30.15 million). From 1990 to 2016, the agestandardised prevalence of TBI increased by 8.4% (95% UI 7.7 to 9.2), whereas that of SCI did not change significantly (-0.2% [-2.1 to 2.7]). Age-standardised incidence rates increased by 3.6% (1.8 to 5.5) for TBI, but did not change significantly for SCI (-3.6% [-7.4 to 4.0]). TBI caused 8.1 million (95% UI 6.0-10.4 million) YLDs and SCI caused 9.5 million (6.7-12.4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. ; Published version ; We acknowledge the funding and support of the Bill & Melinda Gates Foundation. AK was supported by the Miguel Servet contract, which was financed by the CP13/00150 and PI15/00862 projects integrated into the National Research, Development, and Implementation, and funded by the Instituto de Salud Carlos III General Branch Evaluation and Promotion of Health Research and the European Regional Development Fund (ERDF-FEDER). AMS is supported by the Egyptian Fulbright Mission Program. AF acknowledges the Federal University of Sergipe (Sergipe, Brazil). AA received financial assistance from the Indian Department of Science and Technology (New Delhi, India) through the INSPIRE faculty programme. AS is supported by Health Data Research UK. DJS is supported by the South African Medical Research Council. AB is supported by the Public Health Agency of Canada. SMSI received a senior research fellowship from the Institute for Physical Activity and Nutrition, Deakin University (Waurn Ponds, VIC, Australia), and a career transition grant from the High Blood Pressure Research Council of Australia. FP and CF acknowledge support from the European Union (FEDER funds POCI/01/0145/FEDER/007728 and POCI/01/0145/FEDER/007265) and National Funds (FCT/MEC, Fundação para a Ciência e a Tecnologia, and Ministério da Educação e Ciência) under the Partnership Agreements PT2020 UID/MULTI/04378/2013 and PT2020 UID/QUI/50006/2013. TB acknowledges financial support from the Institute of Medical Research and Medicinal Plant Studies, Yaoundé, Cameroon. AM of Imperial College London is grateful for support from the Northwest London National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care and the Imperial NIHR Biomedical Research Centre. KD is funded by a Wellcome Trust Intermediate Fellowship in Public Health and Tropical Medicine (grant number 201900). PSA is supported by an Australian National Health and Medical Research Council Early Career Fellowship. RT-S was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI17/00719 from ISCIII-FEDER. The Serbian part of this contribution (by MJ) has been co-financed with grant OI175014 from the Serbian Ministry of Education, Science and Technological Development; publication of results was not contingent upon the Ministry's approval. MMMSM acknowledges support from the Serbian Ministry of Education, Science and Technological Development (contract 175087). MM's research was supported by the NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust (London, UK) and King's College London. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health. TWB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt professor award, which was funded by the German Federal Ministry of Education and Research.
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Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.
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IMPORTANCE: The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. OBJECTIVE: To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged < 5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. EVIDENCE REVIEW: Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14 244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35 620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIVinfection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. FINDINGS: Of the 7.7 (95 uncertainty interval UI, 7.4-8.1) million deaths among children and adolescents globally in 2013,6.28 million occurred amongyounger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections amongyounger children (905 059 deaths; 95% UI, 810 304-998125), diarrheal diseases among older children (38 325 deaths; 95% UI, 30 365-47 678), and road injuries among adolescents (115186 deaths; 95% UI, 105185-124 870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred injust 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. CONCLUSIONS AND RELEVANCE: Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed. Copyright 2016 American Medical Association. All rights reserved.
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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.
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