{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:02:05Z","timestamp":1791806525370,"version":"4.3.4"},"reference-count":113,"publisher":"BMJ","license":[{"start":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T00:00:00Z","timestamp":1683676800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2023,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>172 countries and territories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Databases of the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The main outcome was age standardized all cause mortality per 100\u2009000 population in relation to HRH density per 10\u2009000 population, and secondary outcome was age standardized cause specific mortality. The Lorenz curve and the concentration index (CCI) were used to assess trends and inequalities in HRH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Globally, the total HRH density per 10\u2009000 population increased, from 56.0 in 1990 to 142.5 in 2019, whereas age standardized all cause mortality per 100\u2009000 population decreased, from 995.5 in 1990 to 743.8 in 2019. The Lorenz curve lay below the equality line and CCI was 0.43 (P&lt;0.05), indicating that the health workforce was more concentrated among countries and territories ranked high on the human development index. The CCI for HRH was stable, at about 0.42-0.43 between 1990 and 2001 and continued to decline (narrowed inequality), from 0.43 in 2001 to 0.38 in 2019 (P&lt;0.001). In the multivariable generalized estimating equation model, a negative association was found between total HRH level and all cause mortality, with the highest levels of HRH as reference (low: incidence risk ratio 1.15, 95% confidence interval 1.00 to 1.32; middle: 1.14, 1.01 to 1.29; high: 1.18, 1.08 to 1.28). A negative association between total HRH density and mortality rate was more pronounced for some types of cause specific mortality, including neglected tropical diseases and malaria, enteric infections, maternal and neonatal disorders, and diabetes and kidney diseases. The risk of death was more likely to be higher in people from countries and territories with a lower density of doctors, dentistry staff, pharmaceutical staff, aides and emergency medical workers, optometrists, psychologists, personal care workers, physiotherapists, and radiographers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inequalities in HRH have been decreasing over the past 30 years globally but persist. All cause mortality and most types of cause specific mortality were relatively higher in countries and territories with a limited health workforce, especially for several specific HRH types among priority diseases. The findings highlight the importance of strengthening political commitment to develop equity oriented health workforce policies, expanding health financing, and implementing targeted measures to reduce deaths related to inadequate HRH to achieve universal health coverage by 2030.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2022-073043","type":"journal-article","created":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T20:00:37Z","timestamp":1683748837000},"page":"e073043","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":71,"title":["Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study"],"prefix":"10.1136","volume":"381","author":[{"given":"Wenxin","family":"Yan","sequence":"first","affiliation":[{"name":"School of Public Health, Peking University, Haidian District, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyuan","family":"Qin","sequence":"additional","affiliation":[{"name":"School of Public Health, Peking University, Haidian District, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyuan","family":"Tao","sequence":"additional","affiliation":[{"name":"Research Center of Clinical Epidemiology, Peking University Third Hospital, Haidian District, Beijing, China"},{"name":"Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Institutional Reform, National Health Commission of the People\u2019s Republic of China, Xicheng District, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Public Health, Peking University, Haidian District, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Du","sequence":"additional","affiliation":[{"name":"School of Public Health, Peking University, Haidian District, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongdan","family":"Chen","sequence":"additional","affiliation":[{"name":"World Health Organization Representative Office for China, Chaoyang District, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wannian","family":"Liang","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, China"},{"name":"Institute for Healthy China, Tsinghua University, Haidian District, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Public Health, Peking University, Haidian District, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1938-9365","authenticated-orcid":false,"given":"Jue","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Public Health, Peking University, Haidian District, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Haidian District, Beijing, China"},{"name":"Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health, Peking University, Haidian District, Beijing, China"},{"name":"Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Haidian District, Beijing, China"},{"name":"Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,10]]},"reference":[{"key":"2025110102114165000_381.may10_13.e073043.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2011.10.012"},{"key":"2025110102114165000_381.may10_13.e073043.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00532-3"},{"key":"2025110102114165000_381.may10_13.e073043.3","unstructured":"World Health Organization. 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