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Global Disparity: Death by Medical Emergency

By Junaid Razzak, M.B.B.S, Ph.D.

Medical emergencies — injuries, strokes, heart attacks and lung infections — caused about half of the world’s 28 million human deaths in 2015, with poorer nations bearing the bulk of the burden.

This may surprise some readers because global health research traditionally focuses on primary care and disease prevention, leaving emergency care as a lower-priority topic of inquiry.

I collaborated with Mohammad Farooq Usmani (Johns Hopkins University School of Medicine) and Zulfiqar Bhutta (Hospital for Sick Children in Canada and Aga Khan University in Pakistan) on what we believe to be a first-of-its-kind look at the international impact of medical emergencies.

The journal BMJ Global Health recently published our statistical analysis of how emergency medical conditions affect health worldwide — literally. I emphasize literally, because we included morbidity and mortality data on more than 30 emergency medical conditions in each of the world’s 195 countries.

We used data from the 1990 and 2015 studies by the Global Burden of Disease, an international database of hundreds of medical condition statistics housed at the University of Washington’s Institute for Health Metrics and Evaluation. The database generally defines an emergency condition as one that requires intervention within minutes to hours to reduce the chance of disability and death and improve health outcomes.

Our study showed that injuries from accidents, falls and burns (22%), heart attacks (17%), lung infections (11%) and strokes (7%) made up the top emergency conditions and diseases around the world in 2015. Other conditions such as diarrheal diseases and malaria had a lower overall global burden, but were more prevalent in low-income countries. Our analysis also showed that emergency diseases affect men nearly twice as much as women, and half of all emergency disease burden was among people younger than 45.

We saw a 6% increase in deaths of adults and children due to emergency conditions between 1990 and 2015. China, India and the United States — the three most populous countries — ranked globally at 64th, 144th and 47th out of 195, respectively, in terms of the lowest burden of emergency diseases.

Over the 25-year period, we found the most significant decrease in upper-middle-income countries, and the lowest level of decrease in poorer nations. Countries with the lowest mortality and morbidity burden of medical emergencies included Bahrain, Israel and Kuwait, while Chad, Niger and Mali had the highest burdens. Overall, our research showed that a person in a low-income country was more than four times more likely to die from a medical emergency, compared with someone in a high-income country.

This level of disparity between richer and poorer nations is significant and should not be acceptable to the global community. We encourage policymakers to consider these data as validation for enhancing investments in emergency care, whether in ambulance systems or in emergency departments themselves. We hope our research will lead to conversations that spur future public health strategies to redirect resources and ultimately save lives.

Junaid Razzak, M.B.B.S., M.D., Ph.D., is a professor in the Department of Emergency Medicine at the Johns Hopkins University School of Medicine. His research focuses on implementing and measuring health system innovations to enhance access to emergency and nonemergency health care for vulnerable populations, especially in low- and middle-income countries.


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