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Burden of emergency conditions and emergency care usage: new estimates from 40 countries
  1. Cindy Y Chang1,
  2. Samer Abujaber2,
  3. Teri A Reynolds3,
  4. Carlos A Camargo Jr4,5,
  5. Ziad Obermeyer2,5
  1. 1Harvard Affiliated Emergency Medicine Residency Program, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
  4. 4Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Ziad Obermeyer, Department of Emergency Medicine, Brigham and Women's Hospital, Neville House, 10 Vining Street, Boston, MA 02115, USA; zobermeyer{at}


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.

Findings 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.

  • global health
  • emergency department utilisation
  • emergency care systems
  • access to care

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  • Twitter Follow Ziad Obermeyer at @oziadias.

  • Contributors All authors participated in the conception and design of the study. CYC and ZO designed the study. CYC and SA performed the data collection. CYC performed the data analysis and drafted and revised the manuscript. TAR, CAC and ZO provided guidance and edited the manuscript. ZO provided methodological oversight. All authors participated in the critical revisions of the manuscript for important intellectual content and approved the final manuscript.

  • Funding NIH Office of the Director grant# DP5 OD012161.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.