{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:15:55Z","timestamp":1791951355700,"version":"4.3.4"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,18]],"date-time":"2021-12-18T00:00:00Z","timestamp":1639785600000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Equity Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>To improve health outcomes to their maximum level, defining indices to measure healthcare quality and accessibility is crucial. In this study, we implemented the novel Quality of Care Index (QCI) to estimate the quality and accessibility of care for patients with gallbladder and biliary tract cancer (GBBTC) in 195 countries, 21 Global Burden of Disease (GBD) regions, Socio-demographic Index (SDI) quintiles, and sex groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Method<\/jats:title>\n                <jats:p>This cross-sectional study extracted estimates on GBBTC burden from the GBD 2017, which presents population-based estimates on GBBTC burden for higher than 15-year-old patients from 1990 to 2017. Four secondary indices indicating quality of care were chosen, comprising Mortality to incidence, Disability-Adjusted Life Year (DALY) to prevalence, prevalence to incidence, and years of life lost (YLL) to years lived with disability (YLD) ratios. Then, the whole dataset was analyzed using Principal Component Analysis to combine the four indices and create a single all-inclusive measure named QCI. The QCI was scaled to the 0\u2013100 range, with 100 indicating the best quality of care among countries. Gender Disparity Ratio (GDR) was defined as the female to male QCI ratio to show gender inequity throughout the regions and countries.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Global QCI score for GBBTC was 33.5 in 2017, which has increased by 29% since 1990. There was a considerable gender disparity in favor of men (GDR\u2009=\u20090.74) in 2017, showing QCI has moved toward gender inequity since 1990 (GDR\u2009=\u20090.85). Quality of care followed a heterogeneous pattern among regions and countries and was positively correlated with the countries\u2019 developmental status reflected in SDI (r\u2009=\u20090.7; CI 95%: 0.61\u20130.76; <jats:italic>P<\/jats:italic> value&lt;\u20090.001). Accordingly, High-income North America (QCI\u2009=\u200972.4) had the highest QCI; whereas, Eastern Sub-Saharan Africa (QCI\u2009=\u20093) had the lowest QCI among regions. Patients aged 45 to 80 had lower QCI scores than younger and older adults. The highest QCI score was for the older than 95 age group (QCI\u2009=\u200954), and the lowest was for the 50\u201354 age group (QCI\u2009=\u200926.0).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>QCI improved considerably from 1990 to 2017; however, it showed heterogeneous distribution and inequity between sex and age groups. In each regional context, plans from countries with the highest QCI and best gender equity should be disseminated and implemented in order to decrease the overall burden of GBBTC.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12939-021-01596-y","type":"journal-article","created":{"date-parts":[[2021,12,18]],"date-time":"2021-12-18T12:02:37Z","timestamp":1639828957000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Global, regional, and national quality of care of gallbladder and biliary tract cancer: a systematic analysis for the global burden of disease study 1990\u20132017"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9853-454X","authenticated-orcid":false,"given":"Javad","family":"Khanali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8648-5402","authenticated-orcid":false,"given":"Mohammad-Reza","family":"Malekpour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4543-4633","authenticated-orcid":false,"given":"Mohammadreza","family":"Azangou-Khyavy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3112-9179","authenticated-orcid":false,"given":"Sahar","family":"Saeedi Moghaddam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7047-7638","authenticated-orcid":false,"given":"Negar","family":"Rezaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0178-3732","authenticated-orcid":false,"given":"Ali-Asghar","family":"Kolahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8405-7482","authenticated-orcid":false,"given":"Mohsen","family":"Abbasi-Kangevari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9592-2611","authenticated-orcid":false,"given":"Esmaeil","family":"Mohammadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4241-1783","authenticated-orcid":false,"given":"Nazila","family":"Rezaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9043-9679","authenticated-orcid":false,"given":"Moein","family":"Yoosefi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5728-7848","authenticated-orcid":false,"given":"Mohammad","family":"Keykhaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7321-5665","authenticated-orcid":false,"given":"Yosef","family":"Farzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6938-3447","authenticated-orcid":false,"given":"Fateme","family":"Gorgani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5386-7597","authenticated-orcid":false,"given":"Bagher","family":"Larijani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8288-4046","authenticated-orcid":false,"given":"Farshad","family":"Farzadfar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,18]]},"reference":[{"key":"1596_CR1","unstructured":"Quality of care. [cited 2021 Oct 26]. Available from: https:\/\/www.who.int\/health-topics\/quality-of-care#tab=tab_1"},{"key":"1596_CR2","unstructured":"Palmer K. Quality of care. Practitioner 1989;233:1223\u20134. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/30212166\/"},{"key":"#cr-split#-1596_CR3.1","unstructured":"Barber RM, Fullman N, Sorensen RJD, Bollyky T, McKee M, Nolte E, et al. Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: A novel analysis from the global burden of disease study 2015. Lancet"},{"key":"#cr-split#-1596_CR3.2","unstructured":"2017 390:231-66. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/28528753\/"},{"key":"1596_CR4","doi-asserted-by":"crossref","unstructured":"Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the sustainable development goals: development and baseline data for an index of essential health services. Lancet Glob Heal; 2018 6:e152\u201368. [cited 2021 Oct 29] Available from: http:\/\/www.thelancet.com\/article\/S2214109X17304722\/fulltext","DOI":"10.1016\/S2214-109X(17)30472-2"},{"key":"1596_CR5","unstructured":"Primary Health Care Performance Initiative Report (PHCPI) [cited 2021 Oct 29]. Available from: http:\/\/phcperformanceinitiative.org\/indicator\/coverage-index"},{"key":"1596_CR6","unstructured":"Fullman N, Yearwood J, Abay SM, Abbafati C, Abd-Allah F, Abdela J, et al. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016. Lancet; 2018 391:2236\u201371. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/29893224\/"},{"key":"1596_CR7","unstructured":"Organization WH. The World health report\u00a0: 2000\u00a0: Health systems\u00a0: improving performance. World Health Organization; 2000."},{"key":"1596_CR8","doi-asserted-by":"crossref","unstructured":"Aminorroaya A, Yoosefi M, Rezaei N, Shabani M, Mohammadi E, Fattahi N, et al. Global, regional, and national quality of care of ischaemic heart disease from 1990 to 2017: a systematic analysis for the Global Burden of Disease Study 2017. Eur J Prev Cardiol; 2021 ; [cited 2021 Sep 22] Available from: https:\/\/academic.oup.com\/eurjpc\/advance-article\/doi\/10.1093\/eurjpc\/zwab066\/6285554","DOI":"10.1093\/eurjpc\/zwab066"},{"key":"1596_CR9","doi-asserted-by":"crossref","unstructured":"Azadnajafabad S, Moghaddam SS, Mohammadi E, Rezaei N, Ghasemi E, Fattahi N, et al. Global, regional, and national burden and quality of care index (QCI) of thyroid cancer: A systematic analysis of the Global Burden of Disease Study 1990\u20132017. Cancer Med; 2021 10:2496\u2013508. [cited 2021 Sep 22] Available from: https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/cam4.3823","DOI":"10.1002\/cam4.3823"},{"key":"1596_CR10","doi-asserted-by":"crossref","unstructured":"Mohammadi E, Ghasemi E, Azadnajafabad S, Rezaei N, Moghaddam SS, Meimand SE, et al. A global, regional, and national survey on burden and Quality of Care Index (QCI) of brain and other central nervous system cancers; global burden of disease systematic analysis 1990\u20132017. PLoS One; 2021 16:e0247120. [cited 2021 Sep 29] Available from: https:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0247120","DOI":"10.1371\/journal.pone.0247120"},{"key":"1596_CR11","doi-asserted-by":"crossref","unstructured":"Keykhaei M, Masinaei M, Mohammadi E, Azadnajafabad S, Rezaei NN, Saeedi Moghaddam S, et al. A global, regional, and national survey on burden and quality of Care index (QCI) of hematologic malignancies; global burden of disease systematic analysis 1990\u20132017. BioMed Central; 2021 10:1\u201315. [cited 2021 Sep 22] Available from: https:\/\/link.springer.com\/articles\/10.1186\/s40164-021-00198-2","DOI":"10.1186\/s40164-021-00198-2"},{"key":"1596_CR12","doi-asserted-by":"crossref","unstructured":"Aryannejad A, Tabary M, Ebrahimi N, Mohammadi E, Fattahi N, Roshani S, et al. Global, regional, and national survey on the burden and quality of care of pancreatic cancer: a systematic analysis for the global burden of disease study 1990\u20132017. Pancreatology. 2021;","DOI":"10.1016\/j.pan.2021.09.002"},{"key":"1596_CR13","unstructured":"Fitzmaurice C, Abate D, Abbasi N, Abbastabar H, Abd-Allah F, Abdel-Rahman O, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study. JAMA Oncol; 2019;5:1749\u201368. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31560378\/"},{"key":"1596_CR14","doi-asserted-by":"crossref","unstructured":"Torre LA, Siegel RL, Islami F, Bray F, Jemal A. Worldwide burden of and trends in mortality from gallbladder and other biliary tract cancers. Clin Gastroenterol Hepatol; 2018;16:427\u201337. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/28826679\/","DOI":"10.1016\/j.cgh.2017.08.017"},{"key":"1596_CR15","doi-asserted-by":"crossref","unstructured":"Valle JW, Kelley RK, Nervi B, Oh DY, Zhu AX. Biliary tract cancer. Lancet. 2021. p. 428\u201344. [cited 2021 Feb 16]Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/33516341\/","DOI":"10.1016\/S0140-6736(21)00153-7"},{"key":"1596_CR16","doi-asserted-by":"crossref","unstructured":"Wernberg JA, Lucarelli DD. Gallbladder cancer. Surg. Clin. North Am. 2014. p. 343\u201360. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/24679425\/","DOI":"10.1016\/j.suc.2014.01.009"},{"key":"1596_CR17","doi-asserted-by":"crossref","unstructured":"Van Dyke AL, Shiels MS, Jones GS, Pfeiffer RM, Petrick JL, Beebe-Dimmer JL, et al. Biliary tract cancer incidence and trends in the United States by demographic group, 1999\u20132013. Cancer; 2019 125:1489\u201398. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/30645774\/","DOI":"10.1002\/cncr.31942"},{"key":"1596_CR18","doi-asserted-by":"crossref","unstructured":"Are C, Ahmad H, Ravipati A, Croo D, Clarey D, Smith L, et al. Global epidemiological trends and variations in the burden of gallbladder cancer. J Surg Oncol; 2017 115:580\u201390. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/28138977\/","DOI":"10.1002\/jso.24546"},{"key":"1596_CR19","doi-asserted-by":"crossref","unstructured":"Beal EW, Mehta R, Tsilimigras DI, Hyer JM, Paredes AZ, Merath K, et al. Travel to a high volume hospital to undergo resection of gallbladder cancer: does it impact quality of care and long-term outcomes? HPB [Internet] Elsevier BV; 2020 22:41\u20139. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31186198\/","DOI":"10.1016\/j.hpb.2019.05.004"},{"key":"1596_CR20","doi-asserted-by":"crossref","unstructured":"Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, et al. Global cancer surgery: Delivering safe, affordable, and timely cancer surgery. Lancet Oncol; 2015 ;1193\u2013224. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/26427363\/","DOI":"10.1016\/S1470-2045(15)00223-5"},{"key":"1596_CR21","unstructured":"Methods of Multivariate Analysis - Alvin C. Rencher - Google Books. [cited 2020 Nov 15]. Available from: https:\/\/books.google.com\/books?hl=en&lr=&id=SpvBd7IUCxkC&oi=fnd&pg=PR5&dq=%22Methods+of+multivariate+analysis%22&ots=IvSFxCHbB0&sig=zeYbv0qJyWxG3MML2M0cUZxN9Uw#v=onepage&q&f=false"},{"key":"1596_CR22","doi-asserted-by":"crossref","unstructured":"Jolliffe IT, Cadima J. Principal component analysis: a review and recent developments. Philos Trans R Soc A Math Phys Eng Sci; 2016 374:20150202. [cited 2020 Dec 24] Available from: https:\/\/royalsocietypublishing.org\/doi\/10.1098\/rsta.2015.0202","DOI":"10.1098\/rsta.2015.0202"},{"key":"1596_CR23","doi-asserted-by":"publisher","unstructured":"Mohammadi E, Ghasemi E, Moghaddam S, Yoosefi M, Roshani S, Ahmadi N, et al. Quality of Care Index (QCI). 2020 [Cited 2020 Nov 22] Available from: https:\/\/doi.org\/10.17504\/protocols.io.bprjmm4n.","DOI":"10.17504\/protocols.io.bprjmm4n"},{"key":"1596_CR24","unstructured":"University of Washington. Socio-demographic Index (SDI) | Institute for Health Metrics and Evaluation. Inst. Heal. Metrics Eval. 2019 [cited 2020 Nov 15]. Available from: http:\/\/www.healthdata.org\/taxonomy\/glossary\/socio-demographic-index-sdi"},{"key":"1596_CR25","unstructured":"Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2017 (GBD 2017) Socio-Demographic Index (SDI) 1950\u20132017 | GHDx. Inst. Heal. Metrics Eval. 2018 [cited 2021 Feb 6]. Available from: http:\/\/ghdx.healthdata.org\/record\/ihme-data\/gbd-2017-socio-demographic-index-sdi-1950\u20132017"},{"key":"1596_CR26","unstructured":"University of Washington. GBD 2017 Resources | Institute for Health Metrics and Evaluation. Inst. Heal. Metrics. [cited 2020 Nov 17]. Available from: http:\/\/www.healthdata.org\/gbd\/gbd-2017-resources"},{"key":"1596_CR27","unstructured":"Global burden of disease data visualiation I for HM and. GBD compare | IHME Viz hub. Glob Burd Dis 2017 [cited 2020 Dec 23]. Available from: https:\/\/gbd2017.healthdata.org\/gbd-compare\/"},{"key":"1596_CR28","doi-asserted-by":"crossref","unstructured":"Moses MW, Pedroza P, Baral R, Bloom S, Brown J, Chapin A, et al. Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016. Lancet Public Heal.; 2019 4:e49\u201373. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/30551974\/","DOI":"10.1016\/S2468-2667(18)30213-5"},{"key":"1596_CR29","unstructured":"The R Foundation. R: The R Project for Statistical Computing. 2018 [cited 2021 Sep 22]. Available from: https:\/\/www.r-project.org\/"},{"key":"1596_CR30","unstructured":"Charlton M, Schlichting J, Chioreso C, Ward M, Vikas P. Challenges of Rural Cancer Care in the United States. Oncology. 2015 633\u201340. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/26384798\/"},{"key":"1596_CR31","doi-asserted-by":"crossref","unstructured":"De Souza JA, Hunt B, Asirwa FC, Adebamowo C, Lopes G. Global health equity: Cancer care outcome disparities in high-, middle-, and low-income countries. J. Clin. Oncol.; 2016 6\u201313. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/26578608\/","DOI":"10.1200\/JCO.2015.62.2860"},{"key":"1596_CR32","doi-asserted-by":"publisher","unstructured":"Boulhol H. Improving the Health-Care System in Poland. OECDiLibrary. 2012 [cited 2021 Jan 4]; Available from: https:\/\/doi.org\/10.1787\/5k9b7bn5qzvd-en.","DOI":"10.1787\/5k9b7bn5qzvd-en"},{"key":"1596_CR33","unstructured":"Lozano R, Fullman N, Abate D, Abay SM, Abbafati C, Abbasi N, et al. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. Lancet Publishing Group; 2018 392:2091\u2013138. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/30496107\/"},{"key":"1596_CR34","doi-asserted-by":"publisher","unstructured":"Naja SJ, Chehab M. An ageing world of the 21st century: a literature review Osteoporosis Knowledge among Women in Qatar View project Psychometric properties of the Arabic version of EPDS and BDI-II as a screening tool for antenatal depression: evidence from Qatar View project. Artic Int J Community Med Public Heal. 2017 [Cited 2021 Jan 6]; Available from: https:\/\/doi.org\/10.18203\/2394-6040.ijcmph20175306.","DOI":"10.18203\/2394-6040.ijcmph20175306"},{"key":"1596_CR35","doi-asserted-by":"crossref","unstructured":"Roa I, Ibacache G, Mu\u00f1oz S, De Aretxabala X. Gallbladder cancer in Chile: pathologic characteristics of survival and prognostic factors: analysis of 1,366 cases. Am J Clin Pathol; 2014 141:675\u201382. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/24713738\/","DOI":"10.1309\/AJCPQT3ELN2BBCKA"},{"key":"1596_CR36","doi-asserted-by":"crossref","unstructured":"Roa I, De Aretxabala X. Gallbladder cancer in Chile: What have we learned?. Curr. Opin. Gastroenterol.; 2015 p. 269\u201375. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/25693005\/","DOI":"10.1097\/MOG.0000000000000164"},{"key":"1596_CR37","doi-asserted-by":"crossref","unstructured":"Luisa Mardones M, Frenz P. Changes in gallbladder cancer mortality and hospital discharges due to preventive cholecystectomy in Chile. Rev Med Chil; 2019 147:860\u20139. [cited 2020 Dec 5]Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31859984\/","DOI":"10.4067\/S0034-98872019000700860"},{"key":"1596_CR38","doi-asserted-by":"crossref","unstructured":"Kanungo S, Bhowmik K, Mahapatra T, Mahapatra S, Bhadra UK, Sarkar K. Perceived morbidity, healthcare-seeking behavior and their determinants in a poor-resource setting: Observation from India. PLoS One; 2015 10. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/25965382\/","DOI":"10.1371\/journal.pone.0125865"},{"key":"1596_CR39","unstructured":"Hussain R, Rashidian A, Hafeez A, Mirzaee N. Factors influencing healthcare seeking behaviour at primary healthcare level, in Pakistan. J Ayub Med Coll Abbottabad 2019 31:201\u20136. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31094117\/"},{"key":"1596_CR40","doi-asserted-by":"crossref","unstructured":"Shaikh BT, Hatcher J. Health seeking behaviour and health service utilization in Pakistan: Challenging the policy makers. J. Public Health (Bangkok). J Public Health (Oxf); 2005 p. 49\u201354. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/15590705\/","DOI":"10.1093\/pubmed\/fdh207"},{"key":"1596_CR41","doi-asserted-by":"crossref","unstructured":"Wallace J, Jiang K, Goldsmith-Pinkham P, Song Z. Changes in racial and ethnic disparities in access to Care and Health among US adults at age 65 years. JAMA Intern Med 2021;181:1207\u201315. [cited 2021 Sep 23] Available from: https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2782345","DOI":"10.1001\/jamainternmed.2021.3922"},{"key":"1596_CR42","doi-asserted-by":"crossref","unstructured":"Wray CM, Khare M, Keyhani S. Access to Care, cost of Care, and satisfaction with Care among adults with private and public Health insurance in the US. JAMA Netw Open; 2021;4. [cited 2021 Sep 23] Available from: \/pmc\/articles\/PMC8170543\/.","DOI":"10.1001\/jamanetworkopen.2021.10275"},{"key":"1596_CR43","doi-asserted-by":"crossref","unstructured":"Barocas DA, Penson DF. Racial variation in the pattern and quality of care for prostate cancer in the USA: mind the gap. BJU Int. Access; 2010;106:322. [cited 2021 Sep 23] Available from: \/pmc\/articles\/PMC2910169\/.","DOI":"10.1111\/j.1464-410X.2010.09467.x"},{"key":"1596_CR44","doi-asserted-by":"crossref","unstructured":"Nunez-Smith DM, Bradley DEH, Herrin DJ, Santana DC, Curry DLA, Normand DS-LT, et al. Quality of Care in the US territories. Arch Intern Med Access; 2011;171:1528. [cited 2021 Sep 23] Available from: \/pmc\/articles\/PMC3251926\/.","DOI":"10.1001\/archinternmed.2011.284"},{"key":"#cr-split#-1596_CR45.1","unstructured":"James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet [Internet]. Lancet Publishing Group"},{"key":"#cr-split#-1596_CR45.2","unstructured":"2018 392:1789-858. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/30496104\/"},{"key":"#cr-split#-1596_CR46.1","unstructured":"Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet [Internet]. Lancet Publishing Group"},{"key":"#cr-split#-1596_CR46.2","unstructured":"2018;392:1736-88. [cited 2020 Dec 5] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/30496103\/"},{"key":"1596_CR47","doi-asserted-by":"crossref","unstructured":"Duffy SW, Nagtegaal ID, Wallis M, Cafferty FH, Houssami N, Warwick J, et al. Correcting for Lead time and length Bias in estimating the effect of screen detection on Cancer survival. Am J Epidemiol ; 2008 ;168:98\u2013104. [cited 2021 Nov 6] Available from: https:\/\/academic.oup.com\/aje\/article\/168\/1\/98\/123920","DOI":"10.1093\/aje\/kwn120"}],"container-title":["International Journal for Equity in Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-021-01596-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12939-021-01596-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-021-01596-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,18]],"date-time":"2021-12-18T12:07:35Z","timestamp":1639829255000},"score":1,"resource":{"primary":{"URL":"https:\/\/equityhealthj.biomedcentral.com\/articles\/10.1186\/s12939-021-01596-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":50,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1596"],"URL":"https:\/\/doi.org\/10.1186\/s12939-021-01596-y","relation":{},"ISSN":["1475-9276"],"issn-type":[{"value":"1475-9276","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"26 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the institutional review board of Endocrinology and Metabolism Research Institute at Tehran University of Medical Sciences (IR.TUMS.EMRI.REC.1400.011).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no conflict of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"259"}}