Global access to surgical care: a modelling study.
Global access to surgical care: a modelling study.
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DOI：
10.1016/s2214-109x(15)70115-4
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发表时间：
2015-06
期刊：
影响因子：
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通讯作者：
Farmer PE
中科院分区：
文献类型：
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作者：
Alkire BC;Raykar NP;Shrime MG;Weiser TG;Bickler SW;Rose JA;Nutt CT;Greenberg SL;Kotagal M;Riesel JN;Esquivel M;Uribe-Leitz T;Molina G;Roy N;Meara JG;Farmer PE
仅根据手术室的密度，就有20多亿人无法接受手术治疗。柳叶刀全球外科委员会的愿景是在需要时普遍获得安全、负担得起的手术和麻醉护理。我们的目标是估计全世界无法获得委员会远景所界定的外科服务的人数。我们根据四个维度对196个国家的手术服务可获得性进行了建模：及时性、手术能力、安全性和可负担性。我们为每个国家建立了一棵机会树，根据每个维度对获得手术的概率进行建模，并由此构建了一个统计模型，以估计每个国家无法获得手术服务的人口比例。我们用单向敏感度分析、缺失数据的多重归因和概率敏感度分析来解释不确定性。世界上至少有48亿人(95%的后验可信区间4·6-5·0[67%，-70岁])无法接受手术。按流行病区分层，无法获得医疗服务的人口比例差别很大：在南亚和撒哈拉以南非洲中部、东部和西部，超过95%的人口无法获得医疗服务，而在澳大拉西亚、高收入的北美和西欧，只有不到5%的人口无法获得医疗服务。世界上大多数人口无法获得外科护理，而且获得外科护理的机会分布不均。许多低收入和中等收入国家几乎无法获得医疗服务，这是一场危机，随着全球卫生界继续支持推进全民医疗覆盖，增加获得外科服务的机会将在确保所有人获得医疗保健方面发挥核心作用。没有。
More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission’s vision. We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with one-way sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis. At least 4·8 billion people (95% posterior credible interval 4·6–5·0 [67%, 64–70]) of the world’s population do not have access to surgery. The proportion of the population without access varied widely when stratified by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access. Most of the world’s population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all. None.