title: Burden of emergency conditions and emergency care usage: new estimates from 40 countries.
abstract: OBJECTIVE
  To estimate the global and national burden of emergency conditions, and compare them to emergency care usage rates.
  
  
  METHODS
  We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care usage rates were obtained from a systematic literature review on emergency care facilities in low-income and middle-income countries (LMICs), supplemented by national health system reports.
  
  
  RESULTS
  All 15 leading causes of death and disability-adjusted life years (DALYs) globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency usage. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47 728 per 100 000 population (IQR 45 253-50 085) in low-income, 25 186 (IQR 21 982-40 480) in middle-income and 15 691 (IQR 14 649-16 382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency usage rates were the lowest in low-income countries, with median 8 visits per 1000 population (IQR 6-10), 78 (IQR 25-197) in middle-income and 264 (IQR 177-341) in high-income countries.
  
  
  CONCLUSIONS
  Despite higher burden of emergency conditions, emergency usage rates are substantially lower in LMICs, likely due to limited access to emergency care.
authors.affiliation: Harvard Affiliated Emergency Medicine Residency Program, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Cindy Y
authors.initials: CY
authors.lastname: Chang
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Abujaber
authors.affiliation: Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland.
authors.forename: Teri A
authors.initials: TA
authors.lastname: Reynolds
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.|Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Obermeyer
mesh_terms: D017281:Cost of Illness; D003697:Delphi Technique; D003906:Developing Countries / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data / Q000600:supply & distribution*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D009026:Mortality / Q000639:trends*; D019057:Quality-Adjusted Life Years
keywords: access to care; emergency care systems; emergency department utilisation; global health