Crossing the Global Quality Chasm Improving Health Care Worldwide (2018) / Chapter Skim
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Appendix D: Methods for Chapter 4
Appendix D: Methods for Chapter 4
Pages 309-374
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From page 309... ...
, 319 3 Noncommunicable Diseases 321 Lung Cancer Mortality, 321 Acute Myocardial Infarction (AMI) Inpatient Mortality, 322 Congestive Heart Failure (CHF)
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From page 310... ...
We used the same mortality rates, disability weights, distribution of short-/long-term disability, and duration of disability as those used by Jha et al. We calculated disability-adjusted life years (DALYs)
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From page 311... ...
In addition, we did not update the literature search for urinary tract infections but used the studies that were included in Jha et al., excluding those that were exclusively in the ICU. Falsified and Substandard Medications Assumption 1.
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From page 312... ...
Variable Definitions Variable Definition Source Prevalence Number of diagnosed and IHME undiagnosed HIV/AIDS cases Known status Of all HIV/AIDS patients, UNAIDS, AIDSInfo share that know their status Treated Of all HIV/AIDS UNAIDS, AIDSInfo patients, share that are on antiretroviral therapy (ART) Deaths Deaths from untreated IHME HIV/AIDS Age of death Mean age of death from IHME untreated HIV/AIDS Disability weights Disability attributable to Global Burden of Disease HIV/AIDS (GBD)
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From page 313... ...
The average age of death was weighted for the number of HIV deaths by country. A half-cycle correction was applied by adding 0.5 years to the mean age of death (equivalently, we can subtract 0.5 years from the remaining life expectancy)
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From page 314... ...
disability weights To incorporate falsified drugs we adjust our treatment variable by subtracting the share of falsified drugs from the treatment rate to come up with a falsified-adjusted treatment rate. To incorporate nonadherence into this estimate, we multiply the adherence rate (conditional on treatment)
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From page 315... ...
We obtained a range of estimates of mortality rates by smear positive and HIV status from the literature and from a WHO publication. The absence of data on the untreated in the WHO database is why we look to alternative sources for an untreated mortality rate.
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The first mortality rate (46.6 percent) is a weighted average of four mortality rates, that are in turn weighted for the distribution of smearpositive (SM +)
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The population accounted for in the data represented 99 percent of the LMIC population, meaning that extrapolation had little effect on our estimates. Between HIV status, we calculated a weighted average disability weights using the HIV infected-patient share of untreated patients.
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From page 318... ...
, National Universities Commission Surveys (NUCS) , and other data sources Mortality rate, LMIC Inpatient PN mortality rate Literature search in LMICs Mortality rate, HIC Inpatient PN mortality rate National Inpatient Sample in HICs Hospitalizations Proxied by care-seeking UNICEF aggregation of variable DHS, MICS, NUCS, and other data sources Age of death Mean age of death from N/A inpatient PN among children under 5 assumed to be 2.5 years For this indicator, we are not focused on treatment status but rather quality of treatment.
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From page 319... ...
We do so by first obtaining PN mortality rates (for the under 5) and PN hospitalizations from the National Inpatient Sample, 2014.
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From page 320... ...
, zinc, or ORS + zinc among those care seeking Age of death Mean age of death from N/A diarrhea among children under 5 assumed to be 2.5 years The percent of children under 5 with diarrhea taken to a health care facility was identified using data on care seeking for diarrhea from a UNICEF aggregation of survey data. A total of 103 LMICs (74 percent)
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From page 321... ...
Our analytic dataset accounts for 91 percent of the LMIC population. Our method relies on the following linear specification: Lung Cancer Deaths per 100,000 = b0 + Pcontrols + γregion+ aincome + e Where controls is a vector that includes air pollution, smoking rates, and lung cancer incidence; region is an indicator for geographic region;
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From page 322... ...
Variable Definitions Variable Definition Source Mortality rate, LMIC Inpatient AMI mortality in Literature search LMICs Mortality rate, HIC Inpatient AMI mortality in OECD Stat, National HICs Inpatient Sample Hospitalizations Hospitalization rates per OECD Stat, literature 100,000 people for AMI in search LMICs Age of death Mean age of death from Literature search inpatient AMI A literature search was conducted for mortality rates and average age of death in LMICs. After applying exclusion criteria, a total of 28 studycountry observations, which contained both mortality rates and either average or median ages, were included.
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From page 323... ...
Assuming that YLL in HICs is the expected burden conditional on provision of high-quality medical care, we use the difference in mortality rates between HICs and LMICs to calculate excess burden. We do so by first obtaining AMI mortality rates (for the 45+ population)
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To account for uncertainty in our estimates, we used a Monte Carlo model to simulate variation in mortality rates and ages of death. For mortality, we used the study population weighted average mortality rate (14.353804 percent)
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From page 325... ...
Variable Definitions Variable Definition Source Mortality rate, LMIC Inpatient stroke mortality Literature search rate in LMICs Mortality rate, HIC Inpatient stroke mortality OECD Stat, National rate in HICs Inpatient Sample Hospitalizations Hospitalization rates per Literature search 100,000 people for stroke in LMICs
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For mortality, we used the study population weighted mortality rate (10.72 percent) and standard deviation (6.66)
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For mortality, we used the study population weighted mortality rate (23.63 percent) and standard deviation (14.37)
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From page 328... ...
Variable Definitions Variable Definition Source Mortality rate, LMIC Inpatient COPD mortality Literature search in LMICs Mortality rate, HIC Inpatient COPD mortality National Inpatient Sample, in HICs literature search Hospitalizations Hospitalization rates per OECD Stat, literature 100,000 people for COPD search in LMICs Age of death Mean age of death from Literature search inpatient COPD in LMICs A literature search was conducted for mortality rates and average age of death in LMICs. After applying exclusion criteria, a total of 15 studycountry observations, which contained both mortality rates and either average or median ages, were included.
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The range of mean mortality rates defines the range of Monte Carlo–based YLL estimates we report. Similarly, for age, we used the study population weighted average age of death (75.18683)
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From page 330... ...
Variable Definitions Variable Definition Source Prevalence of diabetes The number of adults 18+ International Diabetes years old with diagnosed Federation diabetes mellitus Untreated The percent of diagnosed WHO STEPS persons with diabetes who are on not on any medication (oral or insulin) Average disability weights Disability attributable to GBD, 2016 diabetes The number of adults 18+ years old with diagnosed diabetes mellitus was identified using data from the International Diabetes Federation, 2017.
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From page 331... ...
Variable Definitions Variable Definition Source Deaths attributable to Number of deaths IHME injury attributable to injuries Prevalence of injuries Prevalence of injuries IHME Years of life lost IHME attributable to injuries Remaining life expectancy Remaining life expectancy IHME/calculated among those dying from trauma; calculated as YLL divided by number of deaths Mortality rate Deaths attributable Calculated to injuries divided by prevalence of injuries To calculate excess deaths attributable to injuries, we obtained data on deaths, incidence, and prevalence of injuries, excluding those attributable to adverse effects of medical care, war, natural disasters, and terrorism. We calculated a mortality rate for LMICs as well as high-income countries by dividing the number of deaths by prevalence.
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The rate for schizophrenia (0.33 percent) was taken from a literature review and is a global estimate, not limited to LMICs, owing to limited data Care seeking Care seeking is currently Literature search taken from the WHO (2004)
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%untreated * average disability weights Using data from the World Mental Health Survey (WMHS)
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We exclude moderate severity for anxiety, depression, and alcohol use disorder because of variance in the recommended standard of care. All estimates are applied to the adult LMIC population.
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Disability Weights Common Major depressive 1.89–12.0% Moderate: 48.7% 46.1% 90.3–81.4% Moderate: .396 mental health disorder Severe: 28.4% 85.4–76.3% Severe: .658 Anxiety 2.66–9.0% Moderate: 34.6% 42.5% 90.3–81.4% Moderate: .133 Severe: 29.5% 85.4–76.3% Severe: .523 Serious Bipolar disorder 0.45–0.46% Moderate: 17.1% 49.8% 90.3–81.4% Residual: .032 mental health Severe: 82.9% 85.4–76.3% Manic: .492 Schizophrenia 0.27–0.33% Residual: 63% 68.9% 90.3–81.4% Residual: .588 (and nonaffective psychoses) Acute: 37% 85.4–76.3% Acute: .778 Addictive Alcohol use 1.27–4.1% Moderate: 10.9% 21.9% 90.3–81.4% Moderate: .373 disorders disorder Severe: 27.5% 85.4–76.3% Severe: .570 NOTE: See "variable definitions" table above for sources.
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From page 336... ...
TABLE D-2 Distribution of Severity as a Percent of Total National Prevalence 336 United States Lebanon South Africa Japan Metropolitan China Anxiety Mild: 43.5 Mild: 43.6 Mild: 35.1 Mild: 35.3 Mild: 41.3 Mod: 33.7 Mod: 36.7 Mod: 34.4 Mod: 46.4 Mod: 44.6 Sev: 22.8 Sev: 19.7 Sev: 30.5 Sev: 18.3 Sev: 14.1 Depression Mild: 19.5 Mild: 8.2 Mild: 20.3 Mild: 26.6 Mild: 32.4 Mod: 50.1 Mod: 49.3 Mod: 45.4 Mod: 53.4 Mod: 51.1 Sev: 30.4 Sev: 42.5 Sev: 34.3 Sev: 20.0 Sev: 16.5 Bipolar disorder Mild: 0.00 Mild: 0.00 Mild: no data Mild: 57.4 Mild: 0.00 Mod: 17.1 Mod: 0.00 Mod: no data Mod: 30.9 Mod: 0.00 Sev: 82.9 Sev: 100 Sev: no data Sev: 11.7 Sev: 100 Alcohol use disorder Mild: 31.5 Mild: 63.3 Mild: 61.5 Mild: 63.5 Mild: 59.9 Mod: 39.7 Mod: 4.2 Mod: 11.6 Mod: 8.0 Mod: 18.1 Sev: 28.9 Sev: 32.6 Sev: 26.9 Sev: 28.5 Sev: 22 Source Kessler et al., 2005 Karam et al., 2006 Herman et al., 2009 Ishikawa et al., Shen et al., 2006 2016 SOURCE: Kessler et al., 2005.
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TABLE D-3 Distribution of Severity for Schizophrenia as a Percent of Total National Prevalence United States Tanzania China Russia Germany Pooled Schizophrenia Residual: 38 Residual: 40 Residual: 49 Residual: 50 Residual: 25 Residual: 37 Acute: 62 Acute: 60 Acute: 51 Acute: 50 Acute: 75 Acute: 63 Residual: 31 Acute: 69 NOTE: Source for schizophrenia is not limited to LMICs, but uses a pooled estimate from Ferrari et al., 2012.
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From page 338... ...
After using the Markov chain model to generate maternal mortality rates, we multiply these estimates to the total number of live births by country to generate an estimate of total maternal deaths: Maternal Deaths = MMR * Live Births We also multiply the share of attended births by the number of live births to generate a total number of attended births.
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From page 339... ...
The difference in mortality rates between HICs and LMICs after controlling for relevant factors and attended births is attributable to quality of care. Variable Definitions Variable Definition Source Share of attended births Share of live births WHO GHO attended by a health care professional Neonatal mortality rate Neonatal mortality rate per World Bank Development 1,000 live births Indicators (modeled)
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We took the difference between this and the neonatal mortality rate among high-income countries and multiplied it by the number of estimated attended births in each LMIC to obtain an estimate of excess neonatal mortality. VACCINATIONS Vaccine-Preventable Mortality Assumption 1.
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We assumed that all rotavirus deaths were preventable. We used 2.5 as the mean age of death.
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If a factor analysis was conducted, we pulled the results from each of the subquestions to see which factors influenced overall experience in a given context and how those factors might differ by context. Variable Definitions Variable Definition Source Overall rating (primary)
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From page 343... ...
throughout the literature Literature review, a summary of which can be found in Table 4-9; additional data on time with physician was collected through existing survey tools Examples: Did not have a problem with the wait time at this visit (SPA) ; patients reporting having spent enough time with any doctor during the consultation (OECD)
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average disability weights YLL = total deaths – untreated, undiagnosed deaths COSTING For the low and high estimates of the cost attributable to poor quality care, the average gross national income (GNI) per capita for all LMICs was taken from the World Bank.
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, 358 Community-Acquired Pneumonia, 362 4 Noncommunicable Diseases 363 Acute Myocardial Infarctions (AMIs) , 363 Stroke, 364 Congestive Heart Failure, 368 Chronic Obstructive Pulmonary Disease (COPD)
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We conducted new systematic reviews for five safety events: adverse drug events, thromboembolism from medical care, falls in hospital, pressure sores and decubitus ulcers, and ventilator-associated pneumonia; we used the earlier Jha and colleagues (2013) analysis for catheter-associated urinary tract infections.
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From page 347... ...
• Meta-analyses or case studies • Intervention studies that do not provide control group data Clinical setting • Health system • Setting is specifically stated to • Inpatient care be outside the health system • Facilities can include anything • Population-based studies within the health system (e.g., asthma prevalence and including hospitals, nursing treatment among the general homes, clinics, health centers population) Mortality rate • the study reports data on If • mortality rate is recorded A patients diagnosed with the but the cause of death is not target indicator and die as a specified as caused by the target result of said indicator indicator
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Pressure Ulcer OR Ulcer Decubitus Ulcer* Iatrogenic Disease AND Pressure Ulcer Pressure Ulcer*
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Ulcer AND Iatrogenic Disease HAC AND Ulcer* Ulcer AND Iatrogenic Disease hospital acquired condition AND ulcer*
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Accidents OR Accidental Falls Page 350 PRISMA Diagram
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Focused only on rates of drug-specific ADEs 4. Occurred due to patient noncompliance • The clinical setting was the ICU Exceptions Search Terms Title/Abstract MESH Adverse Drug Event*
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AND error* Drug-Related Side Effects and Adverse Reactions Page 351 Diagram PRISMA Page 354 Venous Thromboembolisms (VTEs)
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APPENDIX D 353 Exclusion Criteria Content Inclusion Exclusion Indicator • Presence of the indicator in the • The indicator is not included in article's text: the full text • The clinical setting was the ICU Numerator: Patients contracting a VTE during their admission to a health care facility Denominator: All patients in the study admitted to the health care facility(ies) in the study Exceptions Search Terms Title/Abstract MESH Venous Thromboembolism Venous thromboembolism VTE Venous thromboembolism Hospital acquired AND venous Venous thromboembolism thromboembolism Hospital AND venous thromboembolism Venous thromboembolism Venous Thromboembolism Venous thromboembolism AND Iatrogenic Disease VTE Venous thromboembolism AND Iatrogenic Disease Hospital acquired AND venous Venous thromboembolism AND Iatrogenic thromboembolism Disease Hospital AND venous thromboembolism Venous thromboembolism AND Iatrogenic Disease VTE AND hospital Venous thromboembolism Venous Thromboembolism Iatrogenic Disease VTE Iatrogenic Disease Hospital acquired AND venous Iatrogenic Disease thromboembolism Hospital AND venous thromboembolism Iatrogenic Disease
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From page 354... ...
. Exclusion Criteria Content Inclusion Exclusion Indicator • Presence of the indicator in the • The indicator is not included in article's text: the full text • The pneumonia is not specified Numerator: Ventilated patients in as hospital-acquired the ICU diagnosed with ventilator- • The clinical setting is outside associated pneumonia the ICU Denominator: All ventilated patients in the ICU during the study period Exceptions
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From page 355... ...
APPENDIX D 355 Search Terms Title/Abstract MESH Nosocomial pneumonia Pneumococcal Infections Nosocomial PN Pneumococcal Infections Nosocomial pneumonia Iatrogenic Disease Nosocomial PN Iatrogenic Disease Nosocomial pneumonia pneumonia AND Iatrogenic Disease Nosocomial PN pneumonia AND Iatrogenic Disease Hospital acquired AND pneumonia pneumonia AND Iatrogenic Disease Hospital acquired AND nosocomial pneumonia AND Iatrogenic Disease pneumonia Hospital acquired AND nosocomial Pneumococcal Infections pneumonia Hospital acquired AND nosocomial pneumonia pneumonia Hospital acquired pneumonia pneumonia Hospital acquired AND pneumonia pneumonia Hospital acquired AND PN pneumonia Hospital Acquired AND PN pneumonia AND Iatrogenic Disease in hospital AND pneumonia pneumonia hospital AND pneumonia Pneumonia in-hospital AND pneumonia Pneumonia Ventilator associated pneumonia Pneumonia, Ventilator-Associated ventilator-associated pneumonia Pneumonia, Ventilator-Associated ventilator-associated AND pneumonia iatrogenic Disease ventilator associated AND pneumonia iatrogenic Disease Ventilator associated pneumonia pneumonia AND iatrogenic Disease ventilator-associated pneumonia pneumonia AND iatrogenic Disease ventilator-associated AND pneumonia Pneumonia, Ventilator-Associated ventilator associated AND pneumonia Pneumonia, Ventilator-Associated Hospital acquired AND pneumonia AND iatrogenic Disease ventilator-associated Hospital acquired AND Ventilator pneumonia AND iatrogenic Disease associated pneumonia Hospital acquired AND ventilator- Pneumococcal Infections associated pneumonia
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From page 356... ...
356 CROSSING THE GLOBAL QUALITY CHASM Title/Abstract MESH Hospital acquired AND Ventilator Pneumonia associated pneumonia Hospital-acquired AND pneumonia AND iatrogenic Disease ventilator-associated Hospital-acquired AND Ventilator pneumonia AND iatrogenic Disease associated pneumonia Hospital-acquired AND ventilator- Pneumococcal Infections associated pneumonia Hospital acquired AND Ventilator Pneumonia associated pneumonia in-hospital AND pneumonia Pneumonia, Ventilator-Associated hospital AND pneumonia Pneumonia, Ventilator-Associated in-hospital AND pneumonia Pneumonia, Ventilator-Associated VAP Pneumonia, Ventilator-Associated PRISMA Diagram Figure on p.
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From page 357... ...
We also focus the search in countries defined as low or middle income by the World Bank. Exclusion Criteria Content Inclusion Exclusion Timing • The literature search is limited • The study is outside the to studies published between designated time frame 2006 and 2016 Country • Any World Bank defined low- • The study groups multiple and middle-income country countries and does not provide individual country-level data • The country of interest is designated high income by the World Bank Database • PubMed • The study has been pulled from any other database Language • Full text in English • The full text is not available in English Condition • Community-acquired • The main diagnosis is pneumonia (CAP)
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From page 358... ...
study given HIV treatment Study • Defined study population • The study provides no, or an population or • Patients who have sought care unclear, population size population of for HIV and received treatment • The entire study population interest is not from the study country (e.g., medical tourists)
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From page 359... ...
• Meta-analyses or case studies • Intervention studies that do not provide control group data Clinical setting • Single site or multiple sites of • setting is specifically stated to If care delivery be outside the health system • Population-based studies (e.g., HIV mortality among the general population) Search Terms Title/Abstract MESH Full Text Quality of Care HIV Quality of Care AND HIV Quality of Care AND human immunodeficiency virus HIV HIV AND Viral load viral load Human immunodeficiency HIV AND Viral load viral load virus HIV AND Viral load HIV HIV AND Viral load HIV AND Viral load HIV virologic failure HIV late diagnos*
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From page 360... ...
HIV PCP Prophylaxis HIV pneumonia, pneumocystis pneumocystis pneumonia HIV pneumonia, pneumocystis pneumocystis AND pneumonia HIV AND pneumonia, pneumocystis AND pneumocystis pneumonia HIV AND pneumonia, pneumocystis pneumonia pneumocystis HIV AND pneumonia, pneumocystis pneumonia pneumocystis AND prophylaxis HIV pneumonia, pneumocystis pneumocystis pneumonia AND prophylaxis HIV prevention & control antiretroviral* AND prescri*
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From page 361... ...
therapy, highly active HIV AND antiretroviral pregnant agents x-dign-CD4 protein, human AND HIV HIV AND x-dign-CD4 CD4 test* protein, human HIV lipid panel AND ART*
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From page 362... ...
Study • Defined study population • The study provides no, or an population or unclear, population size population of • The population is outside of the interest designated age range • The entire study population is not from the study country (e.g., medical tourists) Study type • original research studies not All • Case studies (unless cases have noted for exclusion multiple patients)
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From page 363... ...
. Exclusion Criteria Content Inclusion Exclusion Timing • The literature search is limited • The study is outside the to studies published between designated time frame 2006 and 2016 Country • Any World Bank defined low- • The study groups multiple and middle-income country countries and does not provide individual country-level data • The country of interest is designated high income by the World Bank Database • PubMed • The study has been pulled from any other database Language • Full text in English • The full text is not available in English Condition • Acute myocardial infarction • The main diagnosis is a (AMI)
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From page 364... ...
• Study protocols • Consensus papers (often do not use original data) • Meta-analyses or case studies • Intervention studies that do not provide control group data Clinical setting • Single site or multiple site of • Setting is specifically stated to care delivery be outside the health system • Population-based studies (e.g., AMI mortality among the general population)
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From page 365... ...
Study type • original research studies not All • Case studies (unless cases have noted for exclusion multiple patients) • Study protocols • Consensus papers (often do not use original data)
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From page 366... ...
366 CROSSING THE GLOBAL QUALITY CHASM Content Inclusion Exclusion Clinical setting • Health system, health care • Setting is specifically stated to facility be outside the health system • Population-based studies (e.g., stroke mortality among the general population) Age of death • Age of death reported • not include age of death if Do of those who specifically for those who died cause of death is not specified died from of stroke to stroke stroke Search Terms: CAP, AMI, and Stroke Title/Abstract MESH Full Text Quality of Care Myocardial mortality Infarction Quality of Care Stroke mortality Quality of Care Pneumonia mortality Quality of Care AND ami mortality Quality of Care AND stroke mortality Quality of Care AND pneumonia mortality Quality of Care AND acs mortality Quality of Care AND acute myocardial mortality infarction Quality of Care AND acute coronary mortality syndrome inpatient mortality Myocardial Infarction inpatient mortality Stroke inpatient mortality Pneumonia in-hospital mortality Myocardial Infarction in-hospital mortality Stroke in-hospital mortality Pneumonia hospital mortality Myocardial Infarction hospital mortality Stroke hospital mortality Pneumonia mortality Myocardial Infarction
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From page 367... ...
APPENDIX D 367 Title/Abstract MESH Full Text mortality Stroke mortality Pneumonia inpatient mortality AND ami inpatient mortality AND acs inpatient mortality AND acute myocardial infarction inpatient mortality AND acute coronary syndrome inpatient mortality AND stroke inpatient mortality AND pneumonia in-hospital mortality AND ami in-hospital mortality AND acs in-hospital mortality AND acute myocardial infarction in-hospital mortality AND acute coronary syndrome in-hospital mortality AND stroke in-hospital mortality AND pneumonia hospital mortality AND ami hospital mortality AND acs hospital mortality AND acute myocardial infarction hospital mortality AND acute coronary syndrome hospital mortality AND stroke hospital mortality AND pneumonia mortality AND ami mortality AND acs mortality AND acute myocardial infarction mortality AND acute coronary syndrome mortality AND stroke mortality AND pneumonia
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From page 368... ...
. Exclusion Criteria Content Inclusion Exclusion Indicator • Presence of the indicator in the • The indicator is not included in article's text: the full text Numerator: CHF patients who died Denominator: All patients in the study diagnosed with CHF or who sought care for CHF Figure on p.
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From page 369... ...
• Meta-analyses or case studies • Intervention studies that do not provide control group data Clinical setting • Health system (because the • setting is specifically stated to If indicator is inpatient mortality, be outside the health system the patients must have sought • Population-based studies (e.g., care) CHF mortality among the general population)
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From page 370... ...
Indicator • Presence of the indicator in the • The indicator is not included in article's text: the full text Numerator: COPD patients who died Denominator: All patients in the study diagnosed with COPD or who sought care for COPD Study • Defined study population • The study provides no, or an population or • Patients who have sought care unclear, population size population of for COPD (COPD may be • The population is outside of the interest primary or secondary diagnosis) designated age range • The entire study population is not from the study country (e.g., medical tourists)
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From page 371... ...
. Exclusion Criteria Content Inclusion Exclusion Timing • The literature search is limited • The study is outside the to studies published between designated time frame 2006 and 2016 Country • Any non-OECD country • The study groups multiple countries and does not provide individual country-level data Database • PubMed • The study has been pulled from any other database Language • Full text in English • The full text is not available in English Focus • Patient experiences of care • The focus of the paper is not patient experience or perceptions of care Study • Human subjects • Animal subjects population • Lab-based research with no human subjects (e.g., biological samples)
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From page 372... ...
• Study protocols • Consensus papers (often do not use original data) • Meta-analyses or case studies • Intervention studies that do not provide control group data • Studies assessing satisfaction with a specific medical technology Clinical setting • Health system • Setting is specifically stated to be outside the health system (e.g., population-based studies regarding overall perceptions of the health system, but the study subject has not been a patient)
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From page 373... ...
OR abus* PRISMA Diagram Figure on p.
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From page 374... ...
2015. Disability weights for the Global Burden of Disease Study 2015.
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