title: The association between health system development and the burden of cardiovascular disease: an analysis of WHO country profiles.
abstract: BACKGROUND
  Several risk factors for cardiovascular disease (CVD) have been identified in recent decades. However, the association between the health system and the burden of CVD has not yet been sufficiently researched. The objective of this study was to analyse the association between health system development and the burden of CVD, in particular CVD-related disability-adjusted life-years (DALYs).
  
  
  METHODS
  Univariate and multivariate generalized linear mixed models were applied to country-level data collected by the World Bank and World Health Organization. Response variables were the age-standardized CVD mortality and age-standardized CVD DALY rates.
  
  
  RESULTS
  The amount of available health system resources, indicated by total health expenditures per capita, physician density, nurse density, dentistry density, pharmaceutical density and the density of hospital beds, was associated with reduced CVD DALY rates and CVD mortality. However, in the multivariate models, the density of nurses and midwives was positively associated with CVD. High out-of-pocket costs were associated with increased CVD mortality in both univariate and multivariate analyses.
  
  
  CONCLUSIONS
  A highly developed health system with a low level of out-of-pocket costs seems to be the most appropriate to reduce the burden of CVD. Furthermore, an efficient balance between human health resources and health technologies is essential.
authors: Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße, Neuherberg, Germany.
authors: Yanmei
authors: Y
authors: Liu
authors: Koustuv
authors: K
authors: Dalal
authors: Björn
authors: B
authors: Stollenwerk
mesh_terms: D002318:Cardiovascular Diseases / Q000191:economics* / Q000401:mortality*; D017281:Cost of Illness; D003906:Developing Countries / Q000191:economics; D005260:Female; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics*; D006280:Health Workforce / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D014944:World Health Organization
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