{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T12:38:15Z","timestamp":1773232695411,"version":"3.50.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Universal Health Coverage (UHC) has garnered widespread attention since its inception. However, systematic research on the dynamic inequalities in UHC for Non-Communicable Diseases (NCDs) remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study investigates the inequalities in UHC for NCDs from 2000 to 2021, offering evidence and policy recommendations to promote global UHC equality for NCDs. Using multiple cross-national datasets, this study examines UHC inequality for NCDs. A panel fixed-effects model analyzes influencing factors, while the Gini coefficient and other indices measure inequality. The Oaxaca-Blinder decomposition method identifies sources of inequality differences among countries with varying income levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During this period, the global Non-Communicable Diseases Service Coverage Index (NCD-SCI) increased from the 50s to the 60s, while the Gini coefficient decreased from 0.115 to 0.095. Government health expenditure as a percentage of GDP significantly positively impacted NCD-SCI (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.24,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01), whereas physician density per 10,000 people did not (95% CI included 0). The interaction between resource endowment and return rate contributed up to 53.26% to the SCI gap compared to low-income countries. Higher national income reduced the contribution of resource endowment differences to the SCI gap while increasing interaction effects. Differences between high-income and upper-middle-income countries were mainly due to health expenditure (contribution rate 116.67%), while those with low-income countries were driven by medical resource endowment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study reveals long-term trends in UHC for NCDs amid global economic disparities and proposes measures to enhance UHC levels and promote equality in different regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1756485","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T07:06:07Z","timestamp":1770707167000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cross-national disparities in non-communicable disease: a universal health coverage-based service coverage index perspective, 2000\u20132021"],"prefix":"10.3389","volume":"14","author":[{"given":"Mingzhu","family":"Zhou","sequence":"first","affiliation":[{"name":"School of Pharmaceutical Business, Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Pharmaceutical Business, Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaying","family":"Zhu","sequence":"additional","affiliation":[{"name":"School of Pharmaceutical Business, Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiyong","family":"Li","sequence":"additional","affiliation":[{"name":"School of Pharmaceutical Business, Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Sun","sequence":"additional","affiliation":[{"name":"College of Physical Education and Health, Chongqing College of International Business and Economics","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangfang","family":"Gao","sequence":"additional","affiliation":[{"name":"Shenzhen Nanshan Hospital of Chinese Medicine (Nanshan Hospital, The First Affiliated Hospital of Guangzhou University of Chinese Medicine)","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaiyuan","family":"Weng","sequence":"additional","affiliation":[{"name":"School of Pharmaceutical Business, Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center","place":["Guangzhou, Guangdong, China"]},{"name":"Medicine & Health Science College, Guangzhou Huashang College","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"ref1","year":"2025"},{"key":"ref2","year":"2015"},{"key":"ref3","volume-title":"Monitoring progress towards Universal Health Coverage at country and global levels: framework, measures, and targets","year":"2014"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e1001728","DOI":"10.1371\/journal.pmed.1001728","article-title":"Monitoring intervention coverage in the context of universal health coverage","volume":"11","author":"Boerma","year":"2014","journal-title":"PLoS Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"100989","DOI":"10.1016\/S2214-109X(24)00044-7","article-title":"Inequalities in non-communicable disease management in China and progress toward universal health coverage: an analysis of nationwide household survey data from 2004 to 2018","volume":"44","author":"Zhou","year":"2024","journal-title":"Lancet Reg Health West Pac"},{"key":"ref6","volume-title":"Primary health care on the road to universal health coverage: 2019 global monitoring report","year":"2019"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"107963","DOI":"10.1016\/j.maturitas.2024.107963","article-title":"Public expenditure on health care and the incidence of non-communicable diseases (NCDs) in China from 2008 to 2018","volume":"183","author":"Feng","year":"2024","journal-title":"Maturitas"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"117832","DOI":"10.1016\/j.socscimed.2025.117832","article-title":"Examining the association between service coverage of UHC and global disease burden: a cross-country panel analysis","volume":"369","author":"Chakma","year":"2025","journal-title":"Soc Sci Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1016\/S0140-6736(22)00267-3","article-title":"NCD countdown 2030: efficient pathways and strategic investments to accelerate progress toward the sustainable development goal target 3.4 in low-income and middle-income countries","volume":"399","year":"2022","journal-title":"Lancet"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e1528","DOI":"10.1016\/S2214-109X(21)00303-6","article-title":"Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries","volume":"9","author":"Allen","year":"2021","journal-title":"Lancet Glob Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"100989","DOI":"10.1016\/j.lanwpc.2023.100989","article-title":"Inequalities in non-communicable disease management in China and progress toward universal health coverage: an analysis of nationwide household survey data from 2004 to 2018","volume":"44","author":"Zhou","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1016\/S0140-6736(18)31992-5","article-title":"NCD countdown 2030: worldwide trends in non-communicable disease mortality and progress towards sustainable development goal target 3.4","volume":"392","year":"2018","journal-title":"Lancet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990\u20132021: a systematic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref14","volume-title":"Tracking Universal Health Coverage: 2023 global monitoring report","year":"2023"},{"key":"ref15","volume-title":"Report of the first meeting of the strategic and technical advisory group for noncommunicable diseases: virtual meeting, 27\u201328 October 2021","year":"2021"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e002259","DOI":"10.1136\/bmjgh-2019-002259","article-title":"Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review","volume":"5","author":"Gibbs","year":"2020","journal-title":"BMJ Glob Health"},{"key":"ref17","volume-title":"STEPS site report","year":"2022"},{"key":"ref18","volume-title":"Tracking Universal Health Coverage: 2023 global monitoring report","year":"2024"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"102382","DOI":"10.1016\/j.arr.2024.102382","article-title":"Trends and cross-country inequalities in the global burden of osteoarthritis, 1990\u20132019: a population-based study","volume":"99","author":"Cao","year":"2024","journal-title":"Ageing Res Rev"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1016\/j.jhep.2018.12.001","article-title":"The trends in incidence of primary liver cancer caused by specific etiologies: results from the global burden of disease study 2016 and implications for liver cancer prevention","volume":"70","author":"Liu","year":"2019","journal-title":"J Hepatol"},{"key":"ref21","volume-title":"Econometric analysis of cross section and panel data","author":"Wooldridge","year":"2010"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e8434","DOI":"10.7717\/peerj.8434","article-title":"Gini coefficients for measuring the distribution of sexually transmitted infections among individuals with different levels of sexual activity","volume":"8","author":"Gsteiger","year":"2020","journal-title":"PeerJ"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e16362","DOI":"10.1016\/j.heliyon.2023.e16362","article-title":"A research of the evaluation of preschool education resource allocation level and spatio - temporal differences: based on repeated indicators method and Theil index","volume":"9","author":"Sun","year":"2023","journal-title":"Heliyon"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1136\/jech.2006.052969","article-title":"Income inequality measures","volume":"61","author":"De Maio","year":"2007","journal-title":"J Epidemiol Community Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1186\/s12939-023-01958-8","article-title":"Inequalities in the burden of non - communicable diseases across European countries: a systematic analysis of the global burden of disease 2019 study","volume":"22","author":"Andrade","year":"2023","journal-title":"Int J Equity Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1704","DOI":"10.1377\/hlthaff.2014.1453","article-title":"Assessing Latin America\u2019s progress toward achieving universal health coverage","volume":"34","author":"Wagstaff","year":"2015","journal-title":"Health Aff"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2338308","DOI":"10.1080\/23288604.2024.2338308","article-title":"Institutionalizing health technology assessment and priority setting in South Korea's Universal Health Coverage journey","volume":"9","author":"Oh","year":"2024","journal-title":"Health Syst Reform"},{"key":"ref28","volume-title":"Primary health care on the road to universal health coverage: 2019 monitoring report","year":"2019"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"100042","DOI":"10.1016\/j.lana.2021.100042","article-title":"Income inequality and non - communicable disease mortality and morbidity in Brazil states: a longitudinal analysis 2002 - 2017","volume":"2","author":"Gaspar","year":"2021","journal-title":"Lancet Reg Health Am"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1016\/S0140-6736(14)61646-9","article-title":"Health-system reform and universal health coverage in Latin America","volume":"385","author":"Atun","year":"2015","journal-title":"Lancet"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1016\/S0140-6736(20)30750-9","article-title":"Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990\u20132019: a systematic analysis for the global burden of disease study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1949","DOI":"10.1016\/S0140-6736(11)60135-9","article-title":"Chronic non-communicable diseases in Brazil: burden and current challenges","volume":"377","author":"Schmidt","year":"2011","journal-title":"Lancet"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e152","DOI":"10.1016\/S2214-109X(17)30472-2","article-title":"Monitoring universal health coverage within the sustainable development goals: development and baseline data for an index of essential health services","volume":"6","author":"Hogan","year":"2018","journal-title":"Lancet Glob Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e39","DOI":"10.1016\/S2214-109X(19)30463-2","article-title":"A comprehensive assessment of universal health coverage in 111 countries: a retrospective observational study","volume":"8","author":"Wagstaff","year":"2020","journal-title":"Lancet Global Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"546","DOI":"10.17843\/rpmesp.2016.333.2338","article-title":"Reforma del sector salud en el Per\u00fa: Derecho, gobernanza, cobertura universal y respuesta contra riesgos sanitarios [Health sector reform in Peru: law, governance, universal coverage, and responses to health risks]","volume":"33","author":"Vel\u00e1squez","year":"2016","journal-title":"Rev Peru Med Exp Salud Publica"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2239031","DOI":"10.1080\/16549716.2023.2239031","article-title":"Protecting the healthcare workers in low- and lower-middle-income countries through vaccination: barriers, leverages, and next steps","volume":"16","author":"Kroflin","year":"2023","journal-title":"Glob Health Action"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1017\/S0144686X19001843","article-title":"Socio-economic-related health inequality in non-communicable diseases among older people in Viet Nam","volume":"41","author":"Le","year":"2021","journal-title":"Ageing Soc"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"605912","DOI":"10.3389\/fmed.2021.605912","article-title":"Socio-economic and demographic correlates of non-communicable disease risk factors among adults in Saudi Arabia","volume":"8","author":"Al-Hanawi","year":"2021","journal-title":"Front Med"},{"key":"ref39","volume-title":"Sudan: remote health services provision during the COVID-19 pandemic","year":"2024"},{"key":"ref40","year":"2025"},{"key":"ref41","year":""}],"updated-by":[{"DOI":"10.3389\/fpubh.2026.1817661","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000}}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1756485\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T15:40:51Z","timestamp":1773157251000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1756485\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":41,"alternative-id":["10.3389\/fpubh.2026.1756485"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1756485","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]},"article-number":"1756485"}}