title: Access to urban acute care services in high- vs. middle-income countries: an analysis of seven cities.
abstract: OBJECTIVE
  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 cross-sectional 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-middle-income (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) (R (2) = 0.88, p = 0.01), but ICU supply was not (R (2) = 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.
authors: Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, 3550 Terrace Street, 614 Scaife Hall, Pittsburgh, PA, 15261, USA.
authors: Shamly
authors: S
authors: Austin
authors: Srinivas
authors: S
authors: Murthy
authors: Hannah
authors: H
authors: Wunsch
authors: Neill K J
authors: NK
authors: Adhikari
authors: Veena
authors: V
authors: Karir
authors: Kathryn
authors: K
authors: Rowan
authors: Shevin T
authors: ST
authors: Jacob
authors: Jorge
authors: J
authors: Salluh
authors: Fernando A
authors: FA
authors: Bozza
authors: Bin
authors: B
authors: Du
authors: Youzhong
authors: Y
authors: An
authors: Bruce
authors: B
authors: Lee
authors: Felicia
authors: F
authors: Wu
authors: Yen-Lan
authors: YL
authors: Nguyen
authors: Chris
authors: C
authors: Oppong
authors: Ramesh
authors: R
authors: Venkataraman
authors: Vimalraj
authors: V
authors: Velayutham
authors: Carmelo
authors: C
authors: Dueñas
authors: Derek C
authors: DC
authors: Angus
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data; D001900:Boston / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D002947:Cities / Q000706:statistics & numerical data*; D003105:Colombia / Q000453:epidemiology; D016638:Critical Illness / Q000401:mortality; D003430:Cross-Sectional Studies; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005869:Ghana / Q000453:epidemiology; D014943:Global Health / Q000592:standards; D006297:Health Services Accessibility / Q000592:standards; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D010297:Paris / Q000453:epidemiology; D014504:Urban Health / Q000592:standards*