{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T03:16:41Z","timestamp":1790392601534,"version":"4.1.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T00:00:00Z","timestamp":1744848000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The health status of a population is influenced by multiple determinants, including clinical care, health behaviors, the physical environment, and socioeconomic factors. This study examines the impact of these determinants on life expectancy (LE) and health-adjusted life expectancy (HALE) at both regional and global levels using econometric analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This ecological study included all 194 WHO member countries from 2000 to 2018. The County Health Rankings Model was used to identify key health determinants. Thirty-six indicators were selected to measure these determinants, with data collected from the World Bank, World Health Observatory, Global Health Expenditure Database, Gapminder, United Nations Human Development Reports, and Global Burden of Disease Studies. LE and HALE were used as health status indicators, with data extracted from the Global Burden of Disease Study 2019 database. A multilevel mixed-effects linear regression model was applied for statistical analysis using Stata 16 software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At the global level, the regression coefficients (\u03b2) with LE and HALE were 0.09 and 0.10 for education, \u22120.04 and \u22120.10 for injuries, 0.5 and 0.6 for urbanization, 0.10 and 0.8 for access to basic drinking water, \u22120.5 and \u22120.4 for drug use, 0.4 and 0.3 for obesity, and \u22120.15 and \u22120.16 for sexually transmitted infections, respectively. Sexually transmitted infections (\u03b2 = \u22120.25) in the African region, access to basic drinking water (\u03b2 = 0.30), alcohol consumption (\u03b2 = \u22120.06), and drug use (\u03b2 = \u22120.02) in the Americas, injuries (\u03b2 = \u22120.16), air pollution (\u03b2 = \u22120.10), and obesity (\u03b2 = \u22120.24) in the Eastern Mediterranean, urbanization (\u03b2 = 0.08) in Southeast Asia, and education (\u03b2 = 0.36) and smoking (\u03b2 = \u22120.06) in the Western Pacific had the greatest impact on HALE compared to other regions (<jats:italic>P<\/jats:italic> &amp;lt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>To reduce inequalities, improve public health outcomes, and ensure efficient resource allocation, global and interregional policies should prioritize the determinants with the highest \u03b2 values for health indicators in each region. These determinants are expected to yield greater marginal health benefits, making investments in them more cost-effective.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1566469","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T05:23:21Z","timestamp":1744867401000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Global and regional impact of health determinants on life expectancy and health-adjusted life expectancy, 2000\u20132018: an econometric analysis based on the Global Burden of Disease study 2019"],"prefix":"10.3389","volume":"13","author":[{"given":"Kamran","family":"Irandoust","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajabali","family":"Daroudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Tajvar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Yaseri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1093\/milmed\/usy213","article-title":"Toward a contemporary definition of health","volume":"183","author":"Bradley","year":"2018","journal-title":"Military Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"9002","DOI":"10.1007\/s11356-015-5707-9","article-title":"Ecological determinants of health: food and environment on human health","volume":"24","author":"Li","year":"2017","journal-title":"Environ Sci Pollut Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2458-10-296","article-title":"Determinants of health disparities between Italian regions","volume":"10","author":"Franzini","year":"2010","journal-title":"BMC Public Health."},{"key":"B4","doi-asserted-by":"crossref","DOI":"10.2139\/ssrn.1616544","article-title":"Health status determinants: lifestyle, environment, health care resources and efficiency","volume-title":"Environment, Health Care Resources and Efficiency (May 27, 2010). OECD Economics Department Working Paper No. 627.","author":"Joumard","year":"2010"},{"key":"B5","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1093\/heapro\/daq025","article-title":"Determinants of health-promoting lifestyle behaviour in the rural areas of Hungary","volume":"25","author":"Paulik","year":"2010","journal-title":"Health Promot Int."},{"key":"B6","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1016\/S2468-1253(19)30347-4","article-title":"The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"4","author":"Pourshams","year":"2019","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e1675","DOI":"10.1016\/S2214-109X(19)30451-6","article-title":"National Burden Estimates of healthy life lost in India, 2017: an analysis using direct mortality data and indirect disability data","volume":"7","author":"Menon","year":"2019","journal-title":"Lancet Global Health."},{"key":"B8","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S0140-6736(20)30977-6","article-title":"Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950\u20132019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Wang","year":"2020","journal-title":"Lancet."},{"key":"B9","doi-asserted-by":"publisher","first-page":"773","DOI":"10.3967\/bes2022.102","article-title":"Key social determinants to narrow the gap between health-adjusted life expectancy and life expectancy in megacities","volume":"35","author":"Xi","year":"2022","journal-title":"Biomed Environm Sci."},{"key":"B10","volume-title":"Biological Ages: Correlations, Genetic Determinants, and Health Outcomes.","author":"Li","year":"2021"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e06820","DOI":"10.1136\/bmj-2021-068208","article-title":"Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study","volume":"376","author":"Collaborators","year":"2022","journal-title":"BMJ"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.25318\/82-003-x202000100001-eng","article-title":"Socioeconomic disparities in life and health expectancy among the household population in Canada","volume":"31","author":"Bushnik","year":"2020","journal-title":"Health Rep."},{"key":"B13","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1093\/ije\/dyh386","article-title":"Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries","volume":"34","author":"Dalstra","year":"2005","journal-title":"Int J Epidemiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1016\/S0140-6736(05)17867-2","article-title":"Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations","volume":"365","author":"Huisman","year":"2005","journal-title":"Lancet."},{"key":"B15","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/S0140-6736(11)61511-0","article-title":"Social determinants of health in Europe","volume":"379","author":"Jakab","year":"2012","journal-title":"Lancet."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12963-015-0044-2","article-title":"The county health rankings: rationale and methods","volume":"13","author":"Remington","year":"2015","journal-title":"Popul Health Metr."},{"key":"B17","unstructured":"Obesity"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1478-7954-11-21","article-title":"Comparing life expectancy and health-adjusted life expectancy by body mass index category in adult Canadians: a descriptive study","volume":"11","author":"Steensma","year":"2013","journal-title":"Popul Health Metr."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1016\/S0140-6736(04)16133-3","article-title":"Gender-based violence and HIV\/AIDS: recognising links and acting on evidence","volume":"363","author":"Martin","year":"2004","journal-title":"Lancet."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2458-12-994","article-title":"Widening social inequality in life expectancy in Denmark. A register-based study on social composition and mortality trends for the Danish population","volume":"12","author":"Br\u00f8nnum-Hansen","year":"2012","journal-title":"BMC Public Health."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13690-019-0330-8","article-title":"Evolution of educational inequalities in life and health expectancies at 25 years in Belgium between 2001 and 2011: a census-based study","volume":"77","author":"Renard","year":"2019","journal-title":"Arch Public Health."},{"key":"B22","doi-asserted-by":"publisher","first-page":"53306","DOI":"10.1007\/s11356-022-19644-7","article-title":"Non-linear relations between life expectancy, socio-economic, and air pollution factors: a global assessment with spatial disparities","volume":"29","author":"Pu","year":"2022","journal-title":"Environ Sci Pollut Res."},{"key":"B23","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/BF03404221","article-title":"Body mass index and risk of cardiovascular disease, cancer and all-cause mortality","volume":"103","author":"Katzmarzyk","year":"2012","journal-title":"Can J Public Health."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2211","DOI":"10.1056\/NEJMoa1000367","article-title":"Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, et al. Body-mass index and mortality among 146 million white adults","volume":"363","author":"Berrington","year":"2010","journal-title":"N Engl J Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1056\/NEJMoa055643","article-title":"Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old","volume":"355","author":"Adams","year":"2006","journal-title":"N Engl J Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12992-018-0430-1","article-title":"Health care expenditure and health outcome nexus: new evidence from the SAARC-ASEAN region","volume":"14","author":"Rahman","year":"2018","journal-title":"Global Health."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4102\/phcfm.v9i1.1370","article-title":"To what extent does access to improved sanitation explain the observed differences in infant mortality in Africa?","volume":"9","author":"Alemu","year":"2017","journal-title":"Afric J Primary Health Care Family Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"189","DOI":"10.35198\/01-2019-004-0003","article-title":"Key indicators and determinants in the context of the financial aspects of health systems in selected countries","volume":"19","author":"Sopko","year":"2019","journal-title":"Adiktologie."},{"key":"B29","doi-asserted-by":"publisher","first-page":"6834","DOI":"10.1021\/acs.est.9b00103","article-title":"Impacts of urban expansion on terrestrial carbon storage in China","volume":"53","author":"Liu","year":"2019","journal-title":"Environ Sci Technol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"137509","DOI":"10.1016\/j.scitotenv.2020.137509","article-title":"Urban expansion and its impact on water security: the case of the Para\u00edba do Sul River Basin, S\u00e3o Paulo, Brazil","volume":"720","author":"da Encarna\u00e7\u00e3o Paiva","year":"2020","journal-title":"Sci Total Environm."},{"key":"B31","doi-asserted-by":"publisher","first-page":"134635","DOI":"10.1016\/j.scitotenv.2019.134635","article-title":"Impact of urban expansion on the air pollution landscape: a case study of Hanoi, Vietnam","volume":"702","author":"Hien","year":"2020","journal-title":"Sci Total Environm."},{"key":"B32","doi-asserted-by":"publisher","first-page":"04051","DOI":"10.7189\/jogh.14.04051","article-title":"Assessing health determinants worldwide: econometric analysis of the global burden of diseases study 2000\u201318\u2013highlighting impactful factors on DALY, YLL, and YLD indicators","volume":"14","author":"Irandoust","year":"2024","journal-title":"J Glob Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1566469\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T05:23:24Z","timestamp":1744867404000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1566469\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,17]]},"references-count":32,"alternative-id":["10.3389\/fpubh.2025.1566469"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1566469","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,17]]},"article-number":"1566469"}}