Access to urban acute care services in high- vs. middle-income countries: an analysis of seven cities

University of Pittsburgh. The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center. Department of Critical Care Medicine. Pittsburgh, PA, USA.
University of British Columbia. BC Children’s Hospital. Division of Critical Care. Vancouver, BC, Canada.
Columbia University. Department of Anesthesiology. New York, NY, USA / Columbia University. Department of Epidemiology. New York, NY, USA.
Sunnybrook Health Sciences Centre. Department of Critical Care Medicine. Toronto, ON, Canada. / University of Toronto. Toronto, ON, Canada.
University of Pittsburgh. Department of Medicine. Pittsburgh, PA, USA.
Intensive Care National Audit and Research Centre. London, UK.
University of Washington. Department of Medicine, International Respiratory and Severe Illness Center. Division of Allergy and Infectious Diseases. Seattle, WA, USA.
D’OR Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Peking Union Medical College Hospital. Beijing, China.
Peking University People’s Hospital. Beijing, China.
Johns Hopkins Bloomberg School of Public Health. Public Health Computational and Operations Research Group. Baltimore, MD, USA.
Michigan State University. Department of Food Science and Human Nutrition. East Lansing, MI, USA.
Assistance Publique des Hôpitaux de Paris. Cochin Academic Hospital. Surgical ICU. Paris, France / Paris Descartes University. Paris, France / Unités INSERM U738, U707. Paris, France / Pierre and Marie Curie University. Paris, France.
Komfo Anokye Teaching Hospital. Department of Emergency Medicine. Kumasi, Ghana.
Apollo Hospitals. Chennai, India.
Stanley Medical College Hospital. Chennai, India.
Universidad de Cartagena. Intensive Care Gestion Salud. Cartagena, Colombia / Hospital Santa Cruz de Bocagrande. Intensive Care. Cartagena, Colombia / Instituto de Simulación Médica, Bogota, Colombia.
University of Pittsburgh. The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center. Department of Critical Care Medicine. Pittsburgh, PA, USA.

Abstract

Purpose: Cities are expanding rapidly in middle-income countries, but their supply of acute care services is unknown. We measured acute care services supply in seven cities of diverse economic background. Methods: In a crosssectional study, we compared cities from two high-income (Boston, USA and Paris, France), three upper-middle-income (Bogota, Colombia; Recife, Brazil; and Liaocheng, China), and two lower-middleincome (Chennai, India and Kumasi, Ghana) countries. We collected standardized data on hospital beds, intensive care unit beds, and ambulances. Where possible, information was collected from local authorities. We expressed results per population (from United Nations) and per acute illness deaths (from Global Burden of Disease project). Results: Supply of hospital beds where intravenous fluids could be delivered varied fourfold from 72.4/100,000 population in Kumasi to 241.5/100,000 in Boston. Intensive care unit (ICU) bed supply varied more than 45-fold from 0.4/100,000 population in Kumasi to 18.8/100,000 in Boston. Ambulance supply varied more than 70-fold. The variation widened when supply was estimated relative to disease burden (e.g., ICU beds varied more than 65-fold from 0.06/100 deaths due to acute illnesses in Kumasi to 4.11/100 in Bogota; ambulance services varied more than 100-fold). Hospital bed per disease burden was associated with gross domestic product (GDP) (R2 = 0.88, p = 0.01), but ICU supply was not (R2 = 0.33, p = 0.18). No city provided all requested data, and only two had ICU data. Conclusions: Urban acute care services vary substantially across economic regions, only partially due to differences in GDP. Cities were poor sources of information, which may hinder their future planning.

Keywords

Urban population
Acute care services
Global burden of disease
Hospital beds
Intensive care beds
Ambulances

Publisher

Springer

Citation

AUSTIN, Shamly et al. Access to urban acute care services in high- vs. middle-income countries: an analysis of seven cities. Intensive Care Medicine, v. 40, n. 3, p. 342-352, 2014.

DOI

10.1007/s00134-013-3174-7

ISSN

0342-4642

Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/35218

Type

Copyright

Open access

Embargo date

2020-08-30

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