Relative importance of demographic, socioeconomic and health factors on life expectancy in low- and lower-middle-income countries

ICT penetration and life expectancy in emerging market economies: panel evidence from asymmetric causality analysis

BACKGROUND

Life expectancy is a significant result indicator of public health and sustainable development. Therefore, one of the final objectives of all economic and social policies is to increase the life expectancy. In this context, a limited number of researchers have investigated the relationship between ICT penetration and life expectancy. However, multiple interaction channels exist between ICT penetration and life expectancy. Furthermore, the studies have usually focused on the effect of ICT penetration on life expectancy through regression and ignored the effect of life expectancy on ICT penetration to a large extent. Therefore, this study aims to contribute to the empirical literature by investigating the causal relationship between ICT indicators and life expectancy.

METHODS

This study uses symmetric and asymmetric causality approaches to investigate the two-way interaction between ICT indicators and life expectancy in emerging market economies over the 1997-2020 period. Employment of the asymmetric causality test enables us to analyze the hidden relationships between ICT indicators and life expectancy, unlike the traditional causality test.

RESULTS

The results of the symmetric causality test uncover a bidirectional causal interaction between mobile subscriptions and life expectancy but a one-way causal relationship from life expectancy to internet usage. However, the asymmetric causality test results uncover a unidirectional causal relationship between mobile subscriptions and life expectancy in China, Colombia, Czechia, Egypt, Greece, India, Kuwait and Turkiye due to positive shocks from mobile subscriptions. On the other hand, a bidirectional causal interaction exists between internet usage and life expectancy in all countries due to negative shocks from internet usage and life expectancy. Last, a unidirectional causal relationship exists between internet usage and life expectancy in all countries due to positive shocks from internet usage.

CONCLUSION

ICT indicators significantly influence life expectancy health in a sample of emerging market economies. Therefore, internet usage and mobile devices are significant tools to improve life expectancy.

Inequalities in regional excess mortality and life expectancy during the COVID-19 pandemic in Europe

Using data for 201 regions (NUTS 2) in Europe, we examine the mortality burden of the COVID-19 pandemic and how the mortality inequalities between regions changed between 2020 and 2022. We show that over the three years of the pandemic, not only did the level of excess mortality rate change considerably, but also its geographical distribution. Focusing on life expectancy as a summary measure of mortality conditions, we find that the variance of regional life expectancy increased sharply in 2021 but returned to the pre-pandemic level in 2022. The 2021 increase was due to a much higher-than-average excess mortality in regions with lower pre-pandemic life expectancy. While the life expectancy inequality has returned to its pre-pandemic level in 2022, the observed life expectancy in almost all regions is far below that expected without the pandemic.

Spatiotemporal evolution and characteristics of worldwide life expectancy

Exploring global differences in life expectancy can facilitate the development of strategies to narrow regional disparities. However, few researchers have systematically examined patterns in the evolution of worldwide life expectancy over a long time period. Spatial differences among 181 countries in 4 types of worldwide life expectancy patterns from 1990 to 2019 were investigated via geographic information system (GIS) analysis. The aggregation characteristics of the spatiotemporal evolution of life expectancy were revealed by local indicators of spatial association. The analysis employed spatiotemporal sequence-based kernel density estimation and explored the differences in life expectancy among regions with the Theil index. We found that the global life expectancy progress rate shows upward then downward patterns over the last 30 years. Female have higher rates of spatiotemporal progression in life expectancy than male, with less internal variation and a wider spatial aggregation. The global spatial and temporal autocorrelation of life expectancy shows a weakening trend. The difference in life expectancy between male and female is reflected in both intrinsic causes of biological differences and extrinsic causes such as environment and lifestyle habits. Investment in education pulls apart differences in life expectancy over long time series. These results provide scientific guidelines for obtaining the highest possible level of health in countries around the world.

Comparing Life Expectancy Determinants between Saudi Arabia and United Arab Emirates from 1980-2020

Despite marked advancements, life expectancy (LE) growth in Saudi Arabia and the United Arab Emirates (UAE) has remained stagnant compared to other developed nations. This study aims to investigate the significant correlation between macroeconomic (ME), sociodemographic (SD), and health status and resources (HSR) factors and LE to formulate an explanatory model for Saudi Arabia and the UAE-a previously unexplored area. Utilizing an ecological, retrospective, time-series study design, we delved into secondary data on SD, ME, and HSR factors and LE of the populations of the UAE and Saudi Arabia spanning three decades (1980-2020). We employed partial least squares-structural equation modeling for statistical analysis. Our analysis revealed significant direct impacts of HSR factors on LE for Saudi Arabia (β = 0.958, p < 0.001) and the UAE (β = 0.716, p < 0.001). Furthermore, we discerned a notable indirect influence of ME factors on LE, mediated through SD and HSR factors for Saudi Arabia (β = 0.507, p < 0.001) and the UAE (β = 0.509, p < 0.001), along with a considerable indirect effect of SD factors on LE through HSR (Saudi: β = 0.529, p < 0.001; UAE: β = 0.711, p < 0.001). This study underscores the mediating role of a nexus of ME-SD-HSR factors on LE in Saudi Arabia and the UAE. Consequently, these findings signal an imperative need for holistic policy interventions addressing ME, SD, and HSR factors, aiming to alter health behaviors and improve LE projections for Saudi Arabia and the UAE in the long run.

Unlocking the Secrets of Longevity: Exploring the Impact of Socioeconomic Factors and Health Resources on Life Expectancy in Oman and Qatar

In an era marked by a sweeping pandemic and the encroaching shadow of an energy crisis, the well-being and lifespan of global populations have become pressing concerns for every nation. This research zeroes in on life expectancy (LE), a powerful indicator of societal health in Oman and Qatar. Our study juxtaposes 3 key factors affecting LE: health status and resources (HSR), macroeconomics (ME), and sociodemographic (SD) factors. To achieve this, we tapped into a comprehensive data set from the World Bank, encompassing a transformative 3-decade span from 1990 to 2020. The intricate interplay between these factors and LE was deciphered through robust Structural Equation Modeling (SEM). Our findings construct a compelling narrative: ME has an indirect yet considerable influence on LE-manifesting with an effect of 0.602 for Oman and 0.676 for Qatar. This influence is mediated by SD and HSR components. Similarly, SD elements impact LE indirectly-with an effect of 0.653 for Oman and 0.759 for Qatar- this effect is mediated by HSR. In contrast, HSR themselves wield a robust and direct influence on LE, indicated by an effect of 0.839 for Oman and 0.904 for Qatar. All these aforementioned effects were statistically substantial (P < .001). Our research magnifies the robust direct influence of HSR on LE in both Oman and Qatar, simultaneously highlighting the noteworthy indirect role of ME and SD factors. This emphasizes the significance of adopting an integrated policy approach that considers all the SD, ME, and HSR factors to improve the population health in both countries, which are also crucial for promoting LE growth in the Gulf Cooperation Council region.

Patterns in age and cause of death contribution to the sex gap in life expectancy: a comparison among ten countries

Women live longer than men and the absolute difference between male and female mortality risk reaches its maximum at old ages. We decomposed the sex gap in life expectancy and investigated the changes over time of the profile of the age–cause specific contributions with indicators of location, magnitude and dispersion in ten countries. Data were retrieved from the Human Cause-of-Death Database. The decomposition analyses revealed that neoplasm, heart diseases and external causes were the main drivers of the gender gap. We also find two main patterns in the development of age-specific contributions. With mortality delay, regarding neoplasm-related mortality and heart disease-related mortality, the shift (i.e., movement of the modal age at contribution towards older ages) and compression (i.e., dispersion concentrated on a shorter age interval) of the survival advantage of women over a narrower age range reveal that men are gradually improving their survival. This might be linked to improvements in survival, diagnosis and access to treatment, at least to those ages no longer affected by the most significant differences.

Measurement and identification of relative poverty level of pastoral areas: an analysis based on spatial layout

Pastoral areas are the key difficulty in China's pursuit of common prosperity and a key region for China to build the northern ecological safety barrier and to realize the Two Centenary Goals. It is of great significance to scientifically evaluate the quality of rural life (QRL), measure the relative poverty level (RPL), and identify the relatively poor areas, making it possible to dock poverty elimination with rural revitalization. Based on the socio-economic data of 18 pastoral areas in Inner Mongolia, this paper draws on spatial layout theory to evaluate QRL and measures RPL by the natural breakpoint method and then identifies the relatively poor areas in Inner Mongolia. The results show that (1) the QRLs of pastoral areas in Inner Mongolia were unbalanced and highly polarized. The mean score of QRLs was 0.2598. Eleven (61.11%) of the counties/banners had a QRL smaller than the mean score. On the spatial layout of QRLs, the western areas were stronger than the central areas. High QRL counties/banners are mainly concentrated in the western region. In the central region, the QRLs were very fragmented, falling onto all five levels. (2) The pastoral areas in Inner Mongolia differed significantly in RPL. The mean score of RPL stood at 0.3788. Nine counties/banners (50%) had an RPL greater than the mean. Contrary to the spatial layout features of QRLs, the central pastoral areas in Inner Mongolia had stronger RPLs than the eastern ones. High RPL counties/banners are mostly clustered in the central region. The spatial layout of RPLs is relatively reasonable in the central region: the RPLs decreased gradually from Dorbod Banner. (3) Nearly 45% of the pastoral areas in central and western Inner Mongolia face serious relative poverty and a high risk of returning to poverty. Eight counties/banners (45%) were identified as high composite relative poverty areas. From spatial layout, the composite relatively poor counties/banners clustered clearly, mainly in the western region. Finally, this paper establishes a warning mechanism against large-scale returning to poverty, aiming to lower composite RPL. The research results provide empirical reference and implementation path for consolidating the results of poverty eradication and facilitating rural revitalization.

Healthy Aging: Comparative Analysis of Local Perception and Diet in Two Health Districts of Côte d’Ivoire and Japan

Context: Good health and longevity depend on dynamic interactions between biological, social, psychological, and environmental factors. Aging is globally a big challenge, particularly with the demographic transition, including population growth, and an emerging burden to society. Knowledge, behavior, diet, and consumption of animal source food were related to aging and emerged as the key factors modulating healthy aging.

Objective: The study was designed to understand the main healthy aging factors, such as knowledge, social network, and diet of elders, and to derive mutual learning from it for healthy aging.

Methods: A qualitative approach has been applied to explore health-related knowledge, attitude, and diet of elders from Ebetsu (Japan) and Tiassalé (Côte d’Ivoire) health districts, using focus group discussions and comparative context analysis between high- and low-income countries.

Results: The study shows that living longer is a common feature of people in Japan compared to Côte d’Ivoire, where the life expectancy is still low. Both groups of elders have social networks that support them, and both offer their gained experience to society. While Japanese elders depend on pension and insurance for income and medical treatments, Ivorians depend mostly on their children and social network in old age. The worries of elders differ between the two regions. In Ebetsu, elder members of the community are concerned about the future burden they pose for the younger generation if they develop ill-health, making them more resilient to aging. In Taabo, elders are considered to be culturally and socially useful to the society. Elders in Ebetsu pointed out that for healthy aging, education on diet at a younger age, physical activities, and access to basic social services are the key aspects. This was not observed in Taabo’s context. Being inactive and dependent on others were described as the most worrying situations for elders in Ebetsu, as it is perceived to increase the risk of non-communicable diseases and anxiety. Elders in Ebetsu have good knowledge on what constitutes a healthy diet, and they believe that diversifying their diet, reducing portions, and substituting red meat with good animal and vegetable proteins are best eating practices to maintain good health. In Côte d’Ivoire, the diet is imbalanced and the whole family consumes the same meal made mainly with high-energy staples and little protein. However, it is observed in both societies that adopting a good diet is very expensive.

Conclusion: The consciousness of aging is universal, but healthy aging varies according to the social systems, education, and knowledge on diet transition. Physical activities, protein–energy balance in diet, and social networks are the key for healthy aging in both contexts. The challenge is to find ways to increase knowledge regarding healthy aging and to strengthen the support system so that healthy aging becomes affordable.

Gender equality and the gender gap in life expectancy in the European Union

Introduction

Life expectancy (LE) depends on the wider determinants of health, which have different impact in women and men. Therefore, this study aimed to investigate whether gender equality was correlated with LE in women and men.

Methods

Gender equality in the 27 European Union (EU) member states between 2010 and 2019 was estimated using a modified Gender Equality Index (mGEI), based on the index developed by the European Institute for Gender Equality. The correlation between this mGEI and LE and the gender gap in LE was calculated using the Spearman correlation coefficient.

Results

Between 2010 and 2019, LE increased more for men than women, which resulted in a narrowing of the gender gap in LE in the EU. During the same period, there was an increase in gender equality, as measured by the mGEI, although with substantial heterogeneity between countries. There was a strong correlation between the mGEI and the gender gap in LE (−0.880), which was explained by a stronger correlation between the mGEI and longer LE in men than in women (0.655 vs 0.629, respectively). The domains of the mGEI most strongly associated with a narrowing of the gender gap in LE were health, money and knowledge, while power was the domain with the weakest association.

Conclusions

Gender equality appears to be at least as beneficial to men as women with regard to LE, thus reinforcing the key role gender equality plays in improving population health and longevity.

A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

Background: The core Universal Health Coverage (UHC) objectives are to ensure universal access to healthcare services by reducing all forms of inequalities. However, financial constraints are major barriers to accessing healthcare, especially in countries such as Nigeria and South Africa. The findings of this study may aid in informing and communicating health policy to increase financial access to healthcare and its utilization in South Africa and Nigeria. Nigeria-South Africa bilateral relations in terms of politics, economics and trade are demonstrated in the justification of the study setting selection. The objectives were to estimate the prevalence of health insurance coverage, and to explore the socio-demographic factors associated with health insurance in South Africa and Nigeria. Methods: This was a cross-sectional study using the 2018 Nigeria Demographic Health Survey and the 2016 South Africa Demographic Health Survey. The 2018 Nigeria Demographic Health Survey data on 55,132 individuals and the 2016 South Africa Demographic Health Survey on 12,142 individuals were used to investigate the prevalence of health insurance associated with socio-demographic factors. Percentages, frequencies, Chi-square and multivariate logistic regression were e mployed, with a significance level of p < 0.05. Results: About 2.8% of the Nigerian population and 13.3% of the South African population were insured (Nigeria: males-3.4%, females-2.7% vs. South Africa: males-13.9%, females-12.8%). The multivariate logistic regression analyses showed that higher education was significantly more likely to be associated with health insurance, independent of other socio-demographic factors in Nigeria (Model I: OR: 1.43; 95% CI: 0.34-1.54, p < 0.05; Model II: OR: 1.34; 95% CI: 0.28-1.42, p < 0.05) and in South Africa (Model I: OR: 1.33; 95% CI: 0.16-1.66, p < 0.05; Model II: OR: 1.76; 95% CI: 0.34-1.82, p < 0.05). Respondents with a higher wealth index and who were employed were independently associated with health insurance uptake in Nigeria and South Africa (p < 0.001). Females were more likely to be insured (p < 0.001) than males in both countries, and education had a significant impact on the likelihood of health insurance uptake in high wealth index households among both male and females in Nigeria and South Africa. Conclusion: Health insurance coverage was low in both countries and independently associated with socio-demographic factors such as education, wealth and employment. There is a need for continuous sensitization, educational health interventions and employment opportunities for citizens of both countries to participate in the uptake of wide health insurance coverage.

A structural equation model to explore sociodemographic, macroeconomic, and health factors affecting life expectancy in Oman

Introduction

the factors determining life expectancy (LE) are crucial for policymakers to study in implementing an effective and accurate intervention in society. In Oman, the available data over the past four decades were not extracted to develop a statistical model to understand how the sociodemographic (SD), macroeconomic (ME), and health-status and resources (HSR) factors affecting LE. The study was aimed at creating a representative model to explain the factors affecting LE in Oman and examine the direct and indirect effects of SD, ME, and HSR in LE in Oman.

Methods

the research was a retrospective, ecological, time-series study design to collect the annual published data on SD, ME, and HSR in Oman from all available resources from 1978 to 2018. The data were then analyzed with structural equation modeling (SEM) method using IBM® SPSS® Amos 24 for the study of their impacts in LE.

Results

in Oman, using SEM, the SD, ME, and HSR significantly and directly affected LE by the estimate of -0.92 (p < 0.001), -0.15 (p < 0.001), and 0.23 (p < 0.001) respectively.

Conclusion

the study was the first attempt to analyze all the different aspects of LE comprehensively in Oman. In the case of Oman, the health resource is an important factor that need to be addressed to increase or to maintain the current LE. Hence, during social hardship or economic recession, health-related support by the government should be continued or even improved because of its positive effect on LE.

Demand- and supply-side factors associated with the use of contraceptive methods in Pakistan: a comparative study of demographic and health surveys, 1990-2018

Background

A remarkable decline in fertility rates has been observed in many countries, with a primary determinant being an increase in the use of contraceptives. However, the birth rate in Pakistan is still higher compared to the other countries of the region. Therefore, this study aims to assess the effect of demand- and supply-side factors associated with the use of contraceptive measures in Pakistan.

Methods

Secondary data analysis of four data series of the Pakistan Demographic and Health Surveys (PDHS 1990–1991, 2006–2007, 2012–2013 and 2017–2018) were used. The data includes ever-married women aged 15–49 years who had given birth in the previous five years and participated in the family planning module of the PDHS. A total of 25,318 women were included in the analysis. Data were analysed by investigating the associations between independent variables (demand- and supply-side factors) and the use of contraceptive measures through unadjusted odds ratios (OR) and adjusted OR (AOR).

Results

The results among demand-side factors indicated that in 2012–2013, women without media exposure were less likely to use contraceptives and the trend remains almost constant for 2017–2018 (AOR = 0.664, 95% CI 0.562–0.784) in 2012–2013 and (AOR = 0.654, 95% CI 0.483–0.885) in 2017–2018. However, they still show a lower likelihood of using contraceptives without media exposure. The results among supply-side factors indicated that absence of transport (2012–2013) and limited visits by family planning workers over the previous 12 months (2006–2007, 2012–2013 and 2017–2018) remained significant factors for not using contraceptive methods.

Conclusions

The results of the study indicate that certain demand- and supply-side factors are associated with the use of contraceptive measures in Pakistan. It highlights the need for the provision of family planning resources and further structural factors, particularly in remote areas.

The Power of Multidimensional Poverty in Explaining Life Expectancy: Empirical Evidence from Cross-Sectional Data of 62 Developing Countries

BACKGROUND

We examined whether multidimensional poverty index (MPI) explained variations in life expectancy (LE) better than income poverty; and assessed the relative importance of MPI indicators in influencing LE.

METHODS

Cross-sectional data from 62 developing countries were used to run several multivariate linear regressions. R2 was used to compare the powers of MPI with income-poverties (income poverty gaps [IPG] at 1.9 and 3.1 USD) in explaining LE.

RESULTS

Adjusting for controls, both MPI (β =-0.245, P<0.001) and IPG at 3.1 USD (β=-0.135, P=0.044) significantly correlates with LE, but not IPG at 1.9 USD (β=-0.147, P=0.135). MPI explains 12.1% of the variation in LE compared to only 3.2% explained by IPG at 3.1 USD. The effect of MPI on LE is higher on female (β=-0.210, P<0.001) than male (β=-0.177, P<0.001). The relative influence of the deprivation indictors on LE ranks as follows (most to least): Asset ownership, drinking water, cooking fuel, flooring, child school attendance, years of schooling, nutrition, mortality, improved sanitation, and electricity.

CONCLUSION

Interventions to reduce poverty and improve LE should be guided by MPI, not income poverty indices. Such policies should be female-oriented and prioritized based on the relative influence of the various poverty deprivation indicators on LE.

Poverty, Income, and Unemployment as Determinants of Life Expectancy: Empirical Evidence from Panel Data of Thirteen Malaysian States

BACKGROUND

The primary indicator of public health, which all nations aim to prolong, is life expectancy at birth. Uncovering its socioeconomic determinants is key to extending life expectancy. This study examined the determinants of life expectancy in Malaysia.

METHODS

This observational study employs secondary data from various official sources of 12 states and one federal territory in Malaysia (2002-2014). Panel data of 78 observations (13 cross-sections at six points in time) were used in multivariate, fixed-effect, regressions to estimate the effects of socioeconomic variables on life expectancy at birth for male, female and both-gender.

RESULTS

Poverty and income significantly determine female, male, and total life expectancies. Unemployment significantly determines female and total life expectancies, but not male. Income inequality and public spending on health (as a percentage of total health spending) do not significantly determine life expectancy. The coefficients of the multivariate regressions suggest that a 1% reduction in poverty, 1% reduction in unemployment, and around USD 23.20 increase in household monthly income prolong total life expectancy at birth by 17.9, 72.0, and 16.3 d, respectively. The magnitudes of the effects of the socioeconomic variables on life expectancy vary somewhat by gender.

CONCLUSION

Life expectancy in Malaysia is higher than the world average and higher than that in some developing countries in the region. However, it is far lower than the advanced world. Reducing poverty and unemployment and increasing income are three effective channels to enhance longevity.

Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries

Background

A key component of ‘obesogenic environments’ is the ready availability of convenient, calorie-dense foods, in the form of hyper-palatable and relatively inexpensive ultra-processed products. Compelling evidence indicates that the regular consumption of soft drinks, specifically carbonated and non-carbonated sugar-sweetened beverages (SSBs), has a significant impact on the prevalence of overweight and obesity. However, to implement country-level effective prevention programmes we need to supplement this evidence with quantitative knowledge of the relationships between overweight/obesity and the main determinants of SSB consumption, notably SSB prices and consumers’ disposable income.

Method

Affordability considers the simultaneous effects of both price and disposable income on the buying decision. The purpose of this study was to investigate the effect of SSB affordability on the consumers’ purchasing behaviour and weight-related health outcomes. Our study was divided into three parts. First, we computed SSB consumption and affordability for approximately 150 countries worldwide. Second, we estimated a demand function for SSBs to assess the impact of affordability on consumption at the country level. Third, we used a multivariate regression model and country data on the prevalence of overweight and obesity to test the role of SSB affordability in the current obesity epidemic.

Results

The analysis reveals that SSB affordability: 1) showed both a large variability across countries and a clear tendency to increase substantially with the level of economic development; 2) played a key role in determining cross-country differences in the amount of soft drink consumed per capita; and 3) was significantly associated with the prevalence rates of both overweight and obesity. Specifically, we show that a 10 % increase in SSB affordability was associated, on average, with approximately 0.4 more overweight/obese adults per 100 inhabitants.

Conclusions

By controlling for the main possible confounding factors, our results clearly indicate that affordability is a major driver of purchasing behaviours and is significantly associated with the prevalence rates of both overweight and obesity. We thus suggest a fiscal approach to curb SSB consumption based on the effectiveness of ‘soda taxes’ to affect the long-term dynamic of SSB affordability.

Electronic supplementary material

The online version of this article (10.1186/s12992-019-0474-x) contains supplementary material, which is available to authorized users.

Trends in Life Expectancy and Its Association with Economic Factors in the Belt and Road Countries-Evidence from 2000⁻2014

In 2013, China launched the Belt and Road (B&amp;R) Initiative in an effort to promote trade and economic collaboration. This study examined the change in life expectancy (LE) among countries along B&amp;R and studied the impact of economic development on LE. Data from 65 B&amp;R countries from 2000 to 2014 were compiled and analyzed. Trend of LE was examined by sex and country. Linear quantile mixed model was used to study the associations between LE and economic factors. In 2014, the average LE in all B&amp;R countries was 69.7 years for men and 73.7 years for women. Across countries in 2014, LE for men ranged from 58.6 years in Afghanistan to 80.2 years in Israel. LE for women ranged from 61.3 years in Afghanistan to 85.9 in Singapore. GDP per capita was positively associated with longevity across B&amp;R countries. The unemployment rate was positively associated with LE only for countries in the top LE quantiles. GDP growth rate and Inflation were negatively associated with LE for the countries in the bottom LE quantiles for men, not for women. LE increased substantially among B&amp;R countries during 2000⁻2014. The influence of macroeconomic factors on LE was related to the distribution of LE.

The Influence of Universal Health Coverage on Life Expectancy at Birth (LEAB) and Healthy Life Expectancy (HALE): A Multi-Country Cross-Sectional Study

Background: There are substantial differences in long term health outcomes across countries, particularly in terms of both life expectancy at birth (LEAB) and healthy life expectancy (HALE). Socio-economic status, disease prevention approaches, life style and health financing systems all influence long-term health goals such as life expectancy. Within this context, universal health coverage (UHC) is expected to influence life expectancy as a comprehensive health policy. The aim of the study is to investigate this relationship between Universal Health Coverage (UHC) and life expectancy. Method: A multi-country cross-sectional study was performed drawing on different sources of data (World Health Organization, UNDP-Education and World Bank) from 193 UN member countries, applying administrative record linkage theory. Descriptive statistics, t-tests, Pearson correlations, hierarchical linear regressions were utilized as appropriate. Result: Global average healthy life years was shown to be 61.34 ± 8.40 and life expectancy at birth was 70.00 ± 9.3. Standardized coefficients from regression analysis found UHC (0.34), child vaccination (Diphtheria Pertussis Tetanus-3: 0.17) and sanitation coverage (0.31) were associated with significantly increased life expectancy at birth. In contrast, population growth was associated with a decrease (0.29). Likewise, unit increases in child vaccination (DPT 3), sanitation and UHC would increase healthy life expectancy considerably (0.18, 0.31, and 0.40 respectively), whereas the same for population growth reduces healthy life expectancy by 0.28. Conclusion: Universal Health Coverage (UHC) is a comprehensive health system approach that facilitates a wide range of health services and significantly improves the life expectancy at birth and healthy life expectancy. This study suggests that specific programs to achieve UHC should be considered for countries that have not seen sufficient gains in life expectancy as part of the wider push to achieve the Sustainable Development Goal (SDG).

Decomposition of age- and cause-specific adult mortality contributions to the gender gap in life expectancy from census and survey data in Zambia

In the context of high adult mortality and an immense impact on the health burden of Zambia, a decomposition analysis of age- and cause-specific mortality in age group 15–59 was performed to determine the contributions to the gap in life expectancy at birth between males and females. Previous studies on decomposition have examined income groups, ethnicity, and regional differences’ contributions to gaps in life expectancy, but not the adult mortality age group 15–59. These studies focus on developed countries and few on developing countries. Arriaga’s decomposition method was applied to 2010 census and 2010–2012 sample vital registration with verbal autopsy survey (SAVVY) data to decompose contributions of age- and cause-specific adult mortality to the gap in life expectancy at birth between males and females. The decomposition analysis revealed that mortality was higher among males than females and concentrated in age groups 20–49. Age- and cause-specific adult mortality contributed positively, 50% of the years to the gap in life expectancy at birth between males and females. Major cause-specific mortality contributors to the gap in life expectancy were infectious and parasitic diseases (1.17 years, 26.3%), accidents and injuries (0.54 years, 12.2%), suicide and violence (0.30 years, 6.8%). Female HIV mortality offset male mortality. Neoplasms deaths among females contributed negatively to the gap in life expectancy (-0.22 years, -5.4%). Accidents, injuries, suicide, and violence are emerging major causes of death in age group 20–49 in Zambia which health policy and programmes should target.

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Adult mortality contributed half of the years to the gender gap in life expectancy at birth.

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Male mortality in age group 20–49 years contributed most to the gender difference in life expectancy at birth.

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Accidents and injuries, and suicide and violence among males were major positive contributors to the gender gap in life expectancy at birth.

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Female HIV mortality offset male mortality and contributed negatively to the gender life expectancy gap.

Correlates of healthy life expectancy in low- and lower-middle-income countries

Background

Healthy life expectancy (HALE) at birth is an important indicator of health status and quality of life of a country’s population. However, little is known about the determinants of HALE as yet globally or even country-specific level. Thus, we examined the factors that are associated with HALE at birth in low- and lower-middle-income countries.

Methods

In accordance with the World Bank (WB) classification seventy-nine low- and lower-middle-income countries were selected for the study. Data on HALE, demographic, socioeconomic, social structural, health, and environmental factors from several reliable sources, such as the World Health Organization, the United Nations Development Program, Population Reference Bureau, WB, Heritage Foundation, Transparency International, Freedom House, and International Center for Prison Studies were obtained as selected countries. Descriptive statistics, correlation analysis, and regression analysis were performed to reach the research objectives.

Results

The lowest and highest HALE were observed in Sierra Leone (44.40 years) and in Sri Lanka (67.00 years), respectively. The mean years of schooling, total fertility rate (TFR), physician density, gross national income per capita, health expenditure, economic freedom, carbon dioxide emission rate, freedom of the press, corruption perceptions index, prison population rate, and achieving a level of health-related millennium development goals (MDGs) were revealed as the correlates of HALE. Among all the correlates, the mean years of schooling, TFR, freedom of the press, and achieving a level of health-related MDGs were found to be the most influential factors.

Conclusion

To increase the HALE in low- and lower-middle-income countries, we suggest that TFR is to be reduced as well as to increase the mean years of schooling, freedom of the press, and the achievement of a level of health-related MDGs.

Sociodemographic Factors on Contraceptive Use among Ever-Married Women of Reproductive Age: Evidence from Three Demographic and Health Surveys in Bangladesh

Contraceptive use among married women of reproductive age has showed a substantial progress over the last few decades in Bangladesh. This study explores the sociodemographic factors associated with contraceptive use among ever-married women of reproductive age in Bangladesh by utilizing the information extracted from three of the Bangladesh Demographic and Health Surveys (BDHSs) in 1993–1994, 2004 and 2014. Bivariate analysis was conducted by performing chi-squared test of independence to explore the relationship between selected sociodemographic factors and dependent variables. To know the adjusted effects of covariates, a popular binary logistic regression model was considered. Respondents’ current age, place residence, division religion, education, age at first marriage, family planning (FP) media exposure, ideal number of children and fertility preferences are the significant determinants according to the most recent survey, BDHS 2014. However, wealth index and a respondent’s current working status were found to be significant factors only in BDHS 2004. The results of the study strongly recommend efforts to increase the education level among poor people, particularly among women in Bangladesh. Program interventions, including health behavior education and family planning services and counselling, are especially needed for some categories of the population, including those living in rural areas, Sylhet, Chittagong and Dhaka divisions, as well as illiterate and Muslim ever-married women.

Reduced costs of reproduction in females mediate a shift from a male-biased to a female-biased lifespan in humans

The causes underlying sex differences in lifespan are strongly debated. While females commonly outlive males in humans, this is generally less pronounced in societies before the demographic transition to low mortality and fertility rates. Life-history theory suggests that reduced reproduction should benefit female lifespan when females pay higher costs of reproduction than males. Using unique longitudinal demographic records on 140,600 reproducing individuals from the Utah Population Database, we demonstrate a shift from male-biased to female-biased adult lifespans in individuals born before versus during the demographic transition. Only women paid a cost of reproduction in terms of shortened post-reproductive lifespan at high parities. Therefore, as fertility decreased over time, female lifespan increased, while male lifespan remained largely stable, supporting the theory that differential costs of reproduction in the two sexes result in the shifting patterns of sex differences in lifespan across human populations. Further, our results have important implications for demographic forecasts in human populations and advance our understanding of lifespan evolution.

Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes

BACKGROUND

Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking.

OBJECTIVE

To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health.

DESIGN

The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems' responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection.

RESULTS

Health determinants' indicators - access to improved drinking sources, accountability, and average years of schooling - were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child mortality; education mattered more for inequalities in births attended by skilled personnel.

CONCLUSIONS

This paper adds to the literature on comparative health systems research. National and international health monitoring frameworks need to incorporate indicators on trends in and impacts of other policy sectors on health. This will empower the health sector to carry out public health practices that promote health and health equity.

Prevalence and Determinants of Contraceptive use among Employed and Unemployed Women in Bangladesh

BACKGROUND

Contraceptive use plays a significant role in controlling fertility, particularly in reaching the replacement level of fertility. The association between women's employment status and contraceptive use is poorly studied and understood in Bangladesh. The aim of this study was to determine the factors that influence contraceptive use among employed and unemployed women in Bangladesh.

METHODS

Data and necessary information of 16,616 married women were extracted from the Bangladesh Demographic and Health Survey (BDHS) 2011. The cross sectional data has been used for univariate analysis, to carry out the description of the variables; bivariate analysis, to find the associations among the variables; and binary logistic regression analysis, to evaluate the effects of selected sociodemographic factors on contraceptive use.

RESULTS

The results revealed that the contraceptive use was found higher among employed women (67%) than that of unemployed women. Women's age, education, region, number of living children, and child preference were found to be significantly associated with current use of contraception among employed women. On the other hand, women's age, education, husband's education, region, residence, religion, number of living children, ever heard about family planning, and child preference were identified as the significant predictors of contraceptive use among unemployed women.

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

A gap in using contraceptives among employed and unemployed women is identified. By creating employment opportunities for women to be enhanced the contraceptive use. Moreover, the sociodemographic factors need to be taken into consideration in formulating policies and implementing programs to increase the contraceptive prevalence rate among women.

Determinant factors of tobacco use among ever-married men in Bangladesh

Background

The burden of tobacco use is shifting from developed to developing countries. This study aimed to explore the different types of tobacco use, and to identify the determinant factors associated with the tobacco use among ever-married men in Bangladesh.

Data and methods

Data of 3,771 ever-married men, 15–54 years of age were extracted from the Bangladesh Demographic and Health Survey 2007. Prevalence rate, chi-square (χ²) test, and binary logistic regression analysis were used as the statistical tools to analyze the data.

Results

Tobacco use through smoking (58.68%) was found to be higher than that of chewing (21.63%) among men, which was significantly more prevalent among the poorest, less educated, and businessmen. In bivariate analysis, all the socioeconomic factors were found significantly associated with tobacco use; while in multivariate analysis, age, education, wealth index, and occupation were identified as the significant predictors.

Conclusion

Tobacco use was found to be remarkably common among males in Bangladesh. The high prevalence of tobacco use suggests that there is an urgent need for developing intervention plans to address this major public health problem in Bangladesh.

Mapping chemical structure-activity information of HAART-drug cocktails over complex networks of AIDS epidemiology and socioeconomic data of U.S. counties

Using computational algorithms to design tailored drug cocktails for highly active antiretroviral therapy (HAART) on specific populations is a goal of major importance for both pharmaceutical industry and public health policy institutions. New combinations of compounds need to be predicted in order to design HAART cocktails. On the one hand, there are the biomolecular factors related to the drugs in the cocktail (experimental measure, chemical structure, drug target, assay organisms, etc.); on the other hand, there are the socioeconomic factors of the specific population (income inequalities, employment levels, fiscal pressure, education, migration, population structure, etc.) to study the relationship between the socioeconomic status and the disease. In this context, machine learning algorithms, able to seek models for problems with multi-source data, have to be used. In this work, the first artificial neural network (ANN) model is proposed for the prediction of HAART cocktails, to halt AIDS on epidemic networks of U.S. counties using information indices that codify both biomolecular and several socioeconomic factors. The data was obtained from at least three major sources. The first dataset included assays of anti-HIV chemical compounds released to ChEMBL. The second dataset is the AIDSVu database of Emory University. AIDSVu compiled AIDS prevalence for >2300 U.S. counties. The third data set included socioeconomic data from the U.S. Census Bureau. Three scales or levels were employed to group the counties according to the location or population structure codes: state, rural urban continuum code (RUCC) and urban influence code (UIC). An analysis of >130,000 pairs (network links) was performed, corresponding to AIDS prevalence in 2310 counties in U.S. vs. drug cocktails made up of combinations of ChEMBL results for 21,582 unique drugs, 9 viral or human protein targets, 4856 protocols, and 10 possible experimental measures. The best model found with the original data was a linear neural network (LNN) with AUROC>0.80 and accuracy, specificity, and sensitivity≈77% in training and external validation series. The change of the spatial and population structure scale (State, UIC, or RUCC codes) does not affect the quality of the model. Unbalance was detected in all the models found comparing positive/negative cases and linear/non-linear model accuracy ratios. Using synthetic minority over-sampling technique (SMOTE), data pre-processing and machine-learning algorithms implemented into the WEKA software, more balanced models were found. In particular, a multilayer perceptron (MLP) with AUROC=97.4% and precision, recall, and F-measure >90% was found.

Socioeconomic and Demographic Disparities in Knowledge of Reproductive Healthcare among Female University Students in Bangladesh

BACKGROUND

Reproductive health (RH) is a critical component of women's health and overall well-being around the world, especially in developing countries. We examine the factors that determine knowledge of RH care among female university students in Bangladesh.

METHODS

Data on 300 female students were collected from Rajshahi University, Bangladesh through a structured questionnaire using purposive sampling technique. The data were used for univariate analysis, to carry out the description of the variables; bivariate analysis was used to examine the associations between the variables; and finally, multivariate analysis (binary logistic regression model) was used to examine and fit the model and interpret the parameter estimates, especially in terms of odds ratios.

RESULTS

The results revealed that more than one-third (34.3%) respondents do not have sufficient knowledge of RH care. The χ (2)-test identified the significant (p < 0.05) associations between respondents' knowledge of RH care with respondents' age, education, family type, watching television; and knowledge about pregnancy, family planning, and contraceptive use. Finally, the binary logistic regression model identified respondents' age, education, family type; and knowledge about family planning, and contraceptive use as the significant (p < 0.05) predictors of RH care.

CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS

Knowledge of RH care among female university students was found unsatisfactory. Government and concerned organizations should promote and strengthen various health education programs to focus on RH care especially for the female university students in Bangladesh.

Socio-demographic factors affecting knowledge level of Tuberculosis patients in Rajshahi City, Bangladesh

BACKGROUND

The Tuberculosis (TB) control program in Bangladesh is still unsatisfactory due to insufficient knowledge and stigma about TB. Patients with low knowledge may be at higher risk of experiencing delays in diagnosis and appropriate treatment.

OBJECTIVES

The aims of this study were to identify the knowledge levels of TB and investigate the factors associated with knowledge level among the TB patients in Bangladesh.

METHODS

A cross-sectional study was conducted at Rajshahi City, Bangladesh. A total of 384 TB patients were interviewed through a pretested, structured questionnaire using purposive sampling techniques. Logistic regression analysis was used to evaluate the effects of selected socio-demographic factors on TB knowledge level.

RESULTS

The results revealed that pulmonary TB patients had greater knowledge than that of extra-pulmonary patients, and that sex, age, educational status and TB type were significantly associated with knowledge level.

CONCLUSIONS

In general, males and young adults, ages 21-35, had greater awareness about transmission and prevention of TB than females and adults over 35. Individuals with higher education and urban area patients were comparatively better informed about TB infection. Patients with greater knowledge about TB were also less likely to experience delays in seeking treatment.

Impact of Socio-Health Factors on Life Expectancy in the Low and Lower Middle Income Countries

BACKGROUND

This study is concerned with understanding the impact of demographic changes, socioeconomic inequalities, and the availability of health factors on life expectancy (LE) in the low and lower middle income countries.

METHODS

The cross-country data were collected from 91 countries from the United Nations agencies in 2012. LE is the response variable with demographics (total fertility rate, and adolescent fertility rate), socioeconomic status (mean year of schooling, and gross national income per capita), and health factors (physician density, and HIV prevalence rate) are as the three main predictors. Stepwise multiple regression analysis is used to extract the main factors.

RESULTS

The necessity of more healthcare resources and higher levels of socioeconomic advantages are more likely to increase LE. On the other hand, demographic changes and health factors are more likely to increase LE by way of de-cease fertility rates and disease prevalence.

CONCLUSION

These findings suggest that international efforts should aim at increasing LE, especially in the low income countries through the elimination of HIV prevalence, adolescent fertility, and illiteracy.