Journal of global health · 2026
Quality of care index for acute lymphoblastic leukaemia at global, regional, and national levels: a systematic analysis of the global burden of disease from 1990 to 2021.
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Wei Fei, Dai Lu, Tan Qiuxiang, Zhou Xuan, Huang Qingxiang
Аннотация
BACKGROUND: Acute lymphoblastic leukaemia (ALL) is a highly heterogeneous hematologic malignancy. Despite continuous optimisation of treatment strategies, significant disparities in care quality persist globally. This study systematically analysed trends in global ALL care quality from 1990 to 2021, focusing on variations in distinct countries, regions, age groups, and genders.
METHODS: Acute lymphoblastic leukaemia burden data (1990-2021) were from the Global Burden of Diseases Study (GBD) 2021. Care quality was measured utilising the quality-of-care index (QCI), which integrated incidence rate, prevalence rate, mortality, and disease burden ratio through principal component analysis. Gender disparities in QCI were assessed via the gender disparity ratio (GDR). Estimated annual percentage change (EAPC) was applied to analyse temporal trends in QCI and GDR.
RESULTS: The QCI of global ALL increased from 31.35 (95% uncertainty intervals (UI) = 31.21, 31.45) in 1990 to 58.46 (95% UI = 58.36, 58.58) in 2021, with an EAPC of 2.27 (95% confidence intervals (CI) = 2.16, 2.38). GDR increased from 0.96 in 1990 to 1.00 in 2021 (EAPC = 0.18; 95% CI = 0.15, 0.22). In 2021, the high sociodemographic index (SDI) region achieved a QCI of 90.75 (95% UI = 90.72, 90.85), whereas the low-SDI region lagged at 14.10 (95% UI = 13.97, 14.16). Gender disparities were minimal in regions with high SDI but persisted in those with low SDI, where females received inferior care quality and disparities widened. Among children aged 0-5 years, QCI was the highest, while among elderly populations, it scored lower.
CONCLUSIONS: Global ALL care quality improved from 1990 to 2021, with reduced gender disparities. However, inequities across regions, ages, and genders remain. Future interventions should target low-SDI regions and elderly patients through optimised resource allocation to promote equitable global ALL care development.
METHODS: Acute lymphoblastic leukaemia burden data (1990-2021) were from the Global Burden of Diseases Study (GBD) 2021. Care quality was measured utilising the quality-of-care index (QCI), which integrated incidence rate, prevalence rate, mortality, and disease burden ratio through principal component analysis. Gender disparities in QCI were assessed via the gender disparity ratio (GDR). Estimated annual percentage change (EAPC) was applied to analyse temporal trends in QCI and GDR.
RESULTS: The QCI of global ALL increased from 31.35 (95% uncertainty intervals (UI) = 31.21, 31.45) in 1990 to 58.46 (95% UI = 58.36, 58.58) in 2021, with an EAPC of 2.27 (95% confidence intervals (CI) = 2.16, 2.38). GDR increased from 0.96 in 1990 to 1.00 in 2021 (EAPC = 0.18; 95% CI = 0.15, 0.22). In 2021, the high sociodemographic index (SDI) region achieved a QCI of 90.75 (95% UI = 90.72, 90.85), whereas the low-SDI region lagged at 14.10 (95% UI = 13.97, 14.16). Gender disparities were minimal in regions with high SDI but persisted in those with low SDI, where females received inferior care quality and disparities widened. Among children aged 0-5 years, QCI was the highest, while among elderly populations, it scored lower.
CONCLUSIONS: Global ALL care quality improved from 1990 to 2021, with reduced gender disparities. However, inequities across regions, ages, and genders remain. Future interventions should target low-SDI regions and elderly patients through optimised resource allocation to promote equitable global ALL care development.