title: Frequency of surgery and hospital admissions for communicable diseases in a high- and middle-income setting.
abstract: BACKGROUND
  In high-income countries, non-communicable diseases drive the demand for surgical healthcare. Middle-income countries face a double disease burden, of both communicable and non-communicable disease. The aim of this study was to describe the role of surgery for the in-hospital care of infectious conditions in the high-income country Sweden and the middle-income country South Africa.
  
  
  METHODS
  A retrospective cohort study was performed of 1.4 million infectious disease admissions. The study populations were the entire population of Sweden, and a cohort of 3.5 million South Africans with private healthcare insurance, during a 7-year interval. The outcome measures were frequency of surgical procedures across a spectrum of diseases, and sex and age during the medical care event.
  
  
  RESULTS
  Some 8.1 per cent of Swedish and 15.7 per cent of South African hospital admissions were because of infectious disease. The proportion of infectious disease admissions that were associated with surgery was constant over time: 8.0 (95 per cent c.i. 7.9 to 8.1) per cent in Sweden and 21.1 (21.0 to 21.2) per cent in South Africa. The frequency of surgery was 2.6 (2.6 to 2.7) times greater in South Africa, and 2.2 (2.2 to 2.3) times higher after standardization for age, sex and disease category.
  
  
  CONCLUSIONS
  The study suggests that surgical care is required to manage patients with communicable diseases, even in high-income settings with efficient prevention and functional primary care. These results further stress the importance of scaling up functional surgical health systems in low- and middle-income countries, where the disease burden is distinguished by infectious disease.
authors.affiliation: Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Jarnheimer
authors.affiliation: Discovery Health, Sandton, and Department of Anaesthesiology, University of Cape Town, Cape Town, South Africa.|Department of Anesthesiology and Perioperative Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors.forename: G
authors.initials: G
authors.lastname: Kantor
authors.affiliation: Division of Paediatric Surgery, Rady Children's Hospital-University of California, San Diego, California, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bickler
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Division of Global Health Equity, Brigham and Women's Hospital, and Partners In Health, Boston, Massachusetts, USA.
authors.forename: P
authors.initials: P
authors.lastname: Farmer
authors.affiliation: Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Hagander
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003141:Communicable Diseases / Q000601:surgery*; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D012189:Retrospective Studies; D017678:Sex Distribution; D013019:South Africa; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D013548:Sweden; D055815:Young Adult