Beyond GDP: a review and conceptual framework for measuring sustainable and inclusive wellbeing.

Policy making has long focused on economic growth as measured by gross domestic product (GDP), diverting attention from sustainable wellbeing for all. Despite high-quality proposals to go beyond GDP, their integration into policy and societal discourse remains limited. A new UN initiative, Valuing What Counts, provides an opportunity for establishing and institutionalising global measurement of metrics beyond GDP, a crucial step to enable a transition into a safe and just space for humanity. Here, we inform this process by consolidating 50 years of literature on Beyond GDP metrics, addressing three core challenges. First, we resolve the lack of interdisciplinary collaboration by integrating five scientific schools of thought in one measurement approach. Second, we alleviate confusion arising from numerous Beyond GDP alternatives, offering a structured analysis of 65 metrics, delineating their measurement objectives. Finally, we bridge the divide between scientific proposals and country-specific approaches. We unite country-specific needs with a standardised and interdisciplinary measurement approach, presenting a dashboard for sustainable and inclusive wellbeing.

The influence of social, demographic and economic factors on fertility trends in Gulf Cooperation Council countries: A longitudinal time trend analysis-1980-2021.

OBJECTIVES: To analyze the fertility rate trends in the GCC countries and their association with socioeconomic factors so that policymakers may use the study findings for future healthcare plans. METHODS: Total population, crude death rate, life expectancy, literacy rate, human development index (HDI), female employment, unemployment rate, urbanisation, gross domestic product (GDP) per capita and inflation were chosen as possible predictors of TFR trends. The data were collected for the Global Burden of Disease 2021 study and other official databases such as the World Bank, the United Nations Development Program and Our World in Data for the 6 Gulf Cooperation Council (GCC) countries. Mean with standard deviation and percentage change was calculated to assess trends of TFR and all other variables from 1980-2021. RESULTS: The fertility rate declined in all 6 countries in 2021 compared to 1980. The highest decline was found in the United Arab Emirates (75.5%), while the lowest was in Kuwait (60.9%). From 1980-2021, total population, life expectancy, HDI, literacy rate, GDP, urbanisation, and female labor force increased in all GCC countries. The total population, life expectancy, urbanisation, female labor force, GDP and HDI were negatively and significantly correlated with TFR (p<0.01). The literacy rate showed a negative and significant correlation with TFR in Bahrain, Kuwait, Saudi Arabia, and Qatar. CONCLUSION: The TFR is declining in GCC countries. The plausible causes include the inclination towards postponement of marriages and excessive costs of living. These trends and associations need to be evaluated by policymakers so that they identify priority areas for interventions, allocate resources and formulate developmental plans accordingly to ensure strategic progress of the region.

How enabling factors determine unmet healthcare needs? A panel data approach for countries.

Health service need refers to the essential care required to achieve optimal health outcomes within resource constraints. When necessary services to address identified health issues are not received, unmet needs arise. This research focuses on the determinants of unmet healthcare needs across the 34 countries within the European region from 2011 to 2019, focusing on Andersen's Behavioral Model's enabling factors. We employed a static and robust panel regression model using Stata 14.0 software. Key determinants analyzed include GDP per capita, urbanization rate, and physicians per capita. Findings reveal that lower GDP per capita and lower urbanization rates are significantly correlated with higher levels of unmet healthcare needs, highlighting income level and geographical accessibility as critical factors. Additionally, a higher number of physicians per capita is associated with reduced unmet healthcare needs, indicating the importance of healthcare resources in addressing healthcare access gaps. These findings underscore the importance of targeted healthcare policies that address income level, improve healthcare accessibility, and enhance healthcare resource allocation to reduce unmet healthcare needs effectively. These findings equip policymakers and administrators with empirically grounded insights to comprehend the factors contributing to unmet healthcare needs and to develop policies aimed at addressing this challenge.

The global health and economic value of COVID-19 vaccination.

INTRODUCTION: The COVID-19 pandemic triggered one of the largest global health and economic crises in recent history. COVID-19 vaccination (CV) has been the central tool for global health and macroeconomic recovery, yet estimates of CV's global health and macroeconomic value remain scarce. METHODS: We used regression analyses to measure the impact of CV on gross domestic product (GDP), infections and deaths. We combined regression estimates of vaccine-averted infections and deaths with estimates of quality-adjusted life years (QALY) losses, and direct and indirect costs, to estimate three broad value components: (i) QALY gains, (ii) direct and indirect costs averted and (iii) GDP impacts. The global value is the sum of components over 148 countries between January 2020 and December 2021 for CV generally and for Pfizer-BioNTech specifically. RESULTS: CV's global value was US$5.2 (95% CI US$4.1 to US$6.2) trillion, with Pfizer-BioNTech's vaccines contributing over US$1.9 (95% CI US$1.5 to US$2.3) trillion. Varying key parameters results in values 10%-20% higher or lower than the base-case value. The largest value component was GDP impacts, followed by QALY gains, then direct and indirect costs averted. CV provided US$740 of value per dose, while Pfizer-BioNTech specifically provided >US$1600 per dose. We estimated conservative benefit-cost ratios of 13.9 and 30.8 for CV and Pfizer-BioNTech, respectively. CONCLUSIONS: We provide the first estimates of the broad value of CV incorporating GDP, QALY and direct and indirect cost impacts. Through December 2021, CV produced significant health and economic value, represented strong value for money and produced significant macroeconomic benefits that should be considered in vaccine evaluation.

Do tobacco regulatory and economic factors influence smoking cessation outcomes? A post-hoc analysis of the multinational EAGLES randomised controlled trial.

INTRODUCTION: We previously reported global regional differences in smoking cessation outcomes, with smokers of US origin having lower quit rates than smokers from some other countries. This post-hoc analysis examined global regional differences in individual-level and country-level epidemiological, economic and tobacco regulatory factors that may affect cessation outcomes. METHODS: EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study) was a randomised controlled trial that evaluated first-line cessation medications and placebo in 8144 smokers with and without psychiatric disorders from 16 countries across seven regions. Generalised linear and stepwise logistic regression models that considered pharmacotherapy treatment, psychiatric diagnoses, traditional individual-level predictors (eg, demographic and smoking characteristics) and country-specific smoking prevalence rates, gross domestic product (GDP) per capita, relative cigarette cost and WHO-derived MPOWER scores were used to predict 7-day point prevalence abstinence at the end of treatment. RESULTS: In addition to several traditional predictors, three of four country-level variables predicted short-term abstinence: GDP (0.54 (95% CI 0.47, 0.63)), cigarette relative income price (0.62 (95% CI 0.53, 0.72)) and MPOWER score (1.03 (95% CI 1.01, 1.06)). Quit rates varied across regions (22.0% in Australasia to 55.9% in Mexico). With northern North America (USA and Canada) as the referent, the likelihood of achieving short-term abstinence was significantly higher in Western Europe (OR 1.4 (95% CI 1.14, 1.61)), but significantly lower in Eastern Europe (0.39 (95% CI 0.22, 0.69)) and South America (0.17 (95% CI 0.08, 0.35)). CONCLUSIONS: Increased tobacco regulation was associated with enhanced quitting among participants in the EAGLES trial. Paradoxically, lower GDP, and more affordable cigarette pricing relative to a country's GDP, were also associated with higher odds of quitting. Geographical region was also a significant independent predictor. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT01456936.

Understanding the interplay of GDP, renewable, and non-renewable energy on carbon emissions: Global wavelet coherence and Granger causality analysis.

This study examines the causality of Per Capita Gross Domestic Production (PGDP), Renewable Energy Consumption (REC), and Non-Renewable Energy Consumption (NREC) on Carbon dioxide (CO2) emissions at the global level utilising data gathered from 1995 to 2020 across various countries categorised based on income levels as High, Low, Upper Middle and Lower Middle and analysed through wavelet coherence. The findings reveal both bidirectional and unidirectional causality between the variables which have evolved. Globally, a bi-directional relationship is observed with a positive correlation between PGDP and NREC and in contrast, a negative correlation with REC. Furthermore, the analysis highlights varying causalities between CO2 emissions and PGDP, except for high-income and lower-middle-income country categories, all other shows one-way causality in different periods in the short term. Moreover, CO2 and REC, show unidirectional causality throughout the short-term, exceptionally medium & long term have both unidirectional and bidirectional causalities across all country categories with a positive correlation. In contrast, CO2 and NREC depict similar causalities to REC, however, with a negative correlation. A cross-country analysis was performed between CO2 and PGDP, CO2 and REC, and CO2 and NREC using Granger causality which shows mixed relationships. The findings hold significant implications for policymakers, providing valuable insights into the trade-offs between economic growth, energy consumption, and carbon emissions.

The impact of renewable energy, eco-innovation, and GDP growth on CO2 emissions: Pathways to the UK's net zero target.

In May 2019, the Climate Change Committee (CCC) recommended that the UK adopt a net-zero target, aiming to reduce its greenhouse gas emissions (GHG) by 100% from the 1990s baseline by 2050. The government accepted the recommendation, and the UK became the first major economy to establish a net-zero emissions law. To progress towards its climate objectives, the government took several initiatives, such as increasing its reliance on renewable energy sources and investing in climate mitigation technologies, which are commonly referred to as process eco-innovation. This study examines the impact of eco-innovation, process eco-innovation, renewable energy consumption, and economic growth on CO2 emissions in the UK using data from 1988 to 2020. We used the ARDL bound test with an error correction model (ECM) to examine the long-run and short-run cointegration between the variables of concern. We found that eco-innovation, process eco-innovation, and renewable energy consumption have significant roles in mitigating CO2 emissions, while economic growth contributes to environmental degradation in the UK. We also found that the effect of eco-innovation on CO2 emissions abatement is stronger than that of process eco-innovation in the short and long-run. Our robustness tests have confirmed the accuracy of those findings. In addition, the results from the Toda-Yamamoto causality revealed a one-way causality from process eco-innovation to CO2, renewable energy to CO2, and eco-innovation to CO2 emissions. Further, a bidirectional causality was found between GDP and CO2 emissions. The evidence presented in this paper provides great insight for shaping the energy policy in the UK and for establishing the climate budget in line with the country's net-zero target.

Energy dynamics affecting the US economy; natural energy investments, carbon emissions, production, exports and GDP per Capita.

This study investigates how carbon dioxide emissions, natural gas, energy consumption, energy investment, coal and crude oil, and per capita exports affected the economic growth of the United States from 1993 to 2023 using the Vector Error Correction (VEC) model. The findings highlight the importance of exports and energy investment in driving both short- and long-term economic growth, while also highlighting interactions between carbon emissions, coal use and crude oil. It was determined that changes in natural gas and exports affected energy investment in the short term, while coal and exports affected natural gas. These results provide valuable information about the dynamics of the American economy and contribute to our understanding of the complex interactions between various factors and their effects on economic growth, offering implications for further research and policy development to promote sustainable economic development.

National income accounting attributes and economic welfare. Evidence from Pakistan.

Economic welfare is essential in the modern economy since it directly reflects the standard of living, distribution of resources, and general social satisfaction, which influences individual and social well-being. This study aims to explore the relationship between national income accounting different attributes and the economic welfare in Pakistan. However, this study used data from 1950 to 2022, and data was downloaded from the World Bank data portal. Regression analysis is used to investigate the relationship between them and is very effective in measuring the relationship between endogenous and exogenous variables. Moreover, generalized methods of movement (GMM) are used as the robustness of the regression. Our results show that foreign direct investment outflow, Gross domestic product growth rate, GDP per capita, higher Interest, market capitalization, and population growth have a significant negative on the unemployment rate, indicating the rise in these factors leads to a decrease in the employment rate in Pakistan. Trade and savings have a significant positive impact on the unemployment rate, indicating the rise in these factors leads to an increase in the unemployment rate for various reasons. Moreover, all the factors of national income accounting have a significant positive relationship with life expectancy, indicating that an increase in these factors leads to an increase in economic welfare and life expectancy due to better health facilities, many resources, and correct economic policies. However, foreign direct investment, inflation rate, lending interest rate, and population growth have significant positive effects on age dependency, indicating these factors increase the age dependency. Moreover, GDP growth and GDP per capita negatively impact age dependency. Similarly, all the national income accounting factors have a significant negative relationship with legal rights that leads to decreased legal rights. Moreover, due to better health facilities and health planning, there is a negative significant relationship between national income accounting attributes and motility rate among children. Our study advocated the implications for the policymakers and the government to make policies for the welfare and increase the social factors.

The hidden costs of inflation: A critical analysis of industrial development and environmental consequences.

The study draws attention to the associations between monetary and economic elements and their potential environmental impacts. The study uses time series data from 1960 to 2022 to examine the connection between CO2 emissions, industrial growth, GNE, and inflation in China. The researchers utilized the well-known econometric technique of nonlinear autoregressive distributed lag (NARDL) to examine nonlinear correlations between these variables. The results reveal that GDP, inflation, and economic development influence long-term CO2 emissions. The strong positive correlation between gross national expenditures and economic activity increases CO2 emissions. In the short run, CO2 emissions are positively and statistically significantly affected by inflation. While inflation temporarily affects CO2 emissions, this effect dissipates with time. Industrial activity increases CO2 emissions, and China's fast industrialization has damaged the environment. The energy-intensive fertiliser manufacturing process and fossil fuels increase CO2 emissions. The research shows how government officials and academics may collaborate to create tailored measures to alleviate the environmental impacts of economic activity.

Spatial-structural analysis of macroeconomic factors' impact on carbon emissions in East Africa: a spatial econometric panel study.

Despite the abundance of research on reducing carbon emissions, there is a significant gap in understanding the influence of macroeconomic factors on carbon dioxide (CO2) emissions from a spatial-structural perspective. This study aims to contribute to the literature by investigating the impact of macroeconomic factors on carbon dioxide emissions in six East African countries between 1989 and 2020. Using spatial econometric panel models, the study analyzed spatial dependence among the variables. The empirical findings indicate that gross domestic product (GDP) per capita and electricity consumption have positive direct and indirect effects on carbon emissions, while fuel prices and exports have negative direct effects, but positive spillover effects on neighboring countries. Imports have a positive impact on local economies, but negative spillover effects. Additionally, the urban population has no significant impact on the environment. These findings provide important policy implications for optimizing spatial growth patterns and achieving a low-carbon economy in East African countries.

International Trade Reshapes the Decoupling of Emissions from Economic Growth.

Efforts to stabilize the global climate change while also continuing human development depend upon "decoupling" economic growth from fossil fuel CO2 emissions. However, evaluations of such decoupling have typically relied on production-based emissions, which do not account for emissions embodied in international trade. Yet international trade can greatly change emissions accounting and reshape the decoupling between emissions and economic growth. Here, we evaluate decoupling of economic growth from different accounts of emissions in each of the 159 countries and analyze the drivers of decoupling. We find that between 1995 and 2015, although 29 countries exhibited strong decoupling of territorial emissions (growing economies and decreasing emissions), only 19 countries achieved economic growth while their consumption-based emissions decreased. Most developed countries have achieved decoupling of emissions related to domestic goods and services, but have not achieved decoupling of emissions related to imported goods and services. The U-test confirms that the domestic component of consumption-based emissions exhibits a stronger decoupling trend from gross domestic product (GDP) growth than consumption-based emissions, and emissions from imports continue to rise with GDP per capita without a corresponding decline, providing a statistical validation of the decoupling analysis. Moreover, in the countries where economic growth and consumption-based emissions are most decoupled, a key driver is decreasing emissions intensity due to technological progress─and especially reductions in the intensity of imported goods and services. Our results reveal the importance of assessing decoupling using consumption-based emissions; successful decoupling may require international cooperation and coordinated mitigation efforts of trading partners.

The public health and economic burden of long COVID in Australia, 2022-24: a modelling study.

OBJECTIVE: To estimate the number of people in Australia with long COVID by age group, and the associated medium term productivity and economic losses. STUDY DESIGN: Modelling study: a susceptible-exposed-infected-recovered (SEIR) model to estimate the number of people with long COVID over time following single infections, and a labour supply model to estimate productivity losses as a proportion of gross domestic product (GDP). SETTING: Australia, 2022-2024. MAIN OUTCOME MEASURES: Estimated number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during 2022-2023 (based on serosurvey data) who have long COVID, 2022-2024, by age group; estimated GDP loss during 2022 caused by reduced labour supply attributable to long COVID. RESULTS: Our model projected that the number of people with long COVID following a single infection in 2022 would peak in September 2022, when 310 341-1 374 805 people (1.2-5.4% of Australians) would have symptoms of long COVID, declining to 172 530-872 799 people (0.7-3.4%) in December 2024, including 7902-30 002 children aged 0-4 years (0.6-2.2%). The estimated mean labour loss attributable to long COVID in 2022 was projected to be 102.4 million (95% confidence interval [CI], 50.4-162.2 million) worked hours, equivalent to 0.48% (95% CI, 0.24-0.76%) of total worked hours in Australia during the 2020-21 financial year. The estimated mean GDP loss caused by the projected decline in labour supply and reduced use of other production factors was $9.6 billion (95% CI, $4.7-15.2 billion), or 0.5% of GDP. The estimated labour loss was greatest for people aged 30-39 years (27.5 million [95% CI, 16.0-41.0 million] hours; 26.9% of total labour loss) and people aged 40-49 years (24.5 million [95% CI, 12.1-38.7 million] hours; 23.9% of total labour loss). CONCLUSION: Widespread SARS-CoV-2 infections in Australia mean that even a small proportion of infected people developing long COVID-related illness and disability could have important population health and economic effects. A paradigm shift is needed, from a sole focus on the immediate effects of coronavirus disease 2019 (COVID-19) to preventing and treating COVID-19 and treating long COVID, with implications for vaccine and antiviral policy and other mitigation of COVID-19.

How feasible is it to mobilize $31 billion a year for pandemic preparedness and response? An economic growth modelling analysis.

BACKGROUND: Covid-19 has reinforced health and economic cases for investing in pandemic preparedness and response (PPR). The World Bank and World Health Organization (WHO) propose that low- and middle-income governments and donor countries should invest $31.1 billion each year for PPR. We analyse, based on the projected economic growth of countries between 2022 and 2027, how likely it is that low- and middle-income country governments and donors can mobilize the estimated funding. METHODS: We modelled trends in economic growth to project domestic health spending by low- and middle-income governments and official development assistance (ODA) by donors for years 2022 to 2027. We modelled two scenarios for countries and donors - a constant and an optimistic scenario. Under the constant scenario we assume that countries and donors continue to dedicate the same proportion of their health spending and ODA as a share of gross domestic product (GDP) and gross national income (GNI), respectively, as they did during baseline (the latest year for which data are available). In the optimistic scenario, we assume a yearly increase of 2.5% in health spending as a share of GDP for countries and ODA as a share of GNI for donors. FINDINGS: Our analysis shows that low-income countries would need to invest on average 37%, lower-middle income countries 9%, and upper-middle income countries 1%, of their total health spending on PPR each year under the constant scenario to meet the World Bank WHO targets. Donors would need to allocate on average 8% of their total ODA across all sectors to PPR each year to meet their target. CONCLUSIONS: The World Bank WHO targets for PPR will not be met unless low- and middle-income governments and donors spend a much higher share of their funding on PPR. Even under optimistic growth scenarios, low-income and lower-middle income countries will require increased support from global health donors. The donor target cannot be met using the yearly increase in ODA under any scenario. If the country and donor targets are not met, the highest-impact health security measures need to be prioritized for funding. Alternative sources of PPR financing could include global taxation (e.g., on financial transactions, carbon, or airline flights), cancelling debt, and addressing illicit financial flows. There is also a need for continued work on estimating current PPR costs and funding requirements in order to arrive at more enduring and reliable estimates.

Investment Hysteresis: An Empirical Essay Turkish Case.

After the 2008 World Crisis, there is a view that the economic recovery has not been adequate. In this context, the debate on hysteresis and especially investment hysteresis has increased in the last decade. The aim of this study is to analyze the investment hysteresis and the basic dynamics of hysteresis in the Turkish economy. Structural break tests are used to identify hysteresis. Traditional and asymmetric causality tests are used to identify the fundamental dynamics of hysteresis. Investment, GDP, interest rate, and productivity variables are used to analyze investment hysteresis. Structural break tests were applied to the variables, while conventional and asymmetric causality tests were applied between investments and their determinants. Structural break tests prove the existence of hysteresis. According to the Granger causality test, there is no causality from interest rates, GDP and productivity to investments. The fact that interest rates have no effect on investments proves hysteresis. According to the asymmetric causality test, there is no relationship between interest rates and investments. There is an inverse relationship between GDP and investments. There is an asymmetric relationship between productivity and investments. The fact that productivity shocks cause asymmetric effects on investments makes productivity shocks the main dynamic of hysteresis. In addition, there is considerable evidence that the strong hysteresis and high uncertainty of TFP exacerbate investment hysteresis. Therefore, productivity shocks should be taken into account in policymaking for hysteresis.

Factors influencing IMF assistance in the Sub-Saharan African region.

This study examines the determinants influencing the likelihood of Sub-Saharan African (SSA) countries seeking assistance from the International Monetary Fund (IMF). The IMF, as a global institution, aims to promote sustainable growth and prosperity among its member countries by supporting economic strategies that foster financial stability and collaboration in monetary affairs. Utilising panel-probit regression, this study analyses data from thirty-nine SSA countries spanning from 2000 to 2022, focusing on twelve factors: Current Account Balance (CAB), inflation, corruption, General Government Net Lending and Borrowing (GGNLB), General Government Gross Debt (GGGD), Gross Domestic Product Growth (GDPG), United Nations Security Council (UNSC) involvement, regime types (Closed Autocracy, Electoral Democracy, Electoral Autocracy, Liberal Democracy) and China Loan. The results indicate that corruption and GDP growth rate have the most significant influence on the likelihood of SSA countries seeking IMF assistance. Conversely, factors such as CAB, UNSC involvement, LD and inflation show inconsequential effects. Notable, countries like Sudan, Burundi, and Guinea consistently rank high in seeking IMF assistance over various time frames within the observed period. Sudan emerges with a probability of more than 44% in seeking IMF assistance, holding the highest ranking. Study emphasises the importance of understanding SSA region rankings and the variability of variables for policymakers, investors, and international organisations to effectively address economic challenges and provide financial assistance.

Chinese FDI outflows and host country environment.

This study provides first evidence on the effects of Chinese FDI (Foreign Direct Investment) outflows on host country environments. The study draws upon a comprehensive dataset covering aggregate Chinese FDI outflows and sector specific data into 65 host nations over the 2007-2019 period. Employing a STIRPAT (Stochastic Regression on Population, Affluence and Technology) model and several different techniques including DID (Difference-in-Difference), pooled OLS (Ordinary Least Squares), quantile regression, IV (Instrumental Variable) estimation, threshold and Tobit regression, the findings suggest that Chinese FDI leads to an increase in host country CO2 (Carbon Dioxide) emissions, aligning with the pollution haven hypothesis at the aggregate level. A closer investigation at the development regime and sectoral levels indicates that in the low development regime, FDI inflows into the financial and real estate sector increase emissions. Conversely in the high-income regime, Chinese FDI into the entertainment sector is associated with an increase in carbon emissions. Chinese FDI is further found to lead to an increase in emissions in countries with a per capita GDP (Gross Domestic Product) of below USD72041.7. However, as per capita income rises above USD72041.7, FDI leads to a fall in carbon emissions.

A multifaceted ecological approach to explore links between environmental factors and the epidemiology of disorders of gut-brain interaction.

BACKGROUND: Disorders of gut-brain interaction (DGBI) are characterized by debilitating symptoms not explained by structural or biochemical abnormalities. While functional conditions present with complex, likely heterogeneous pathophysiology, we aimed to investigate if proxy measures of sociocultural and environmental factors are associated with the prevalence of various DGBI in populations across the world. METHODS: We performed an ecological study utilizing peer-reviewed published datasets reporting for 26 countries prevalence rates of DGBI (Rome Foundation Global Epidemiology Study, RFGES), with six independent variables: Helicobacter pylori prevalence and household size as proxy measures for orofecal infections, gross domestic product per capita (GDP), and median age as a proxy measures for socioeconomic development, density of fast food outlets (FFO) per 100,000 population as proxy measure for processed food exposure, and suicide mortality rate per 100,000 people, and world happiness scores were used as a proxy for psychological stress. The data were retrieved from publicly accessible datasets (United Nations, CIA World Factbook, World Bank, World Happiness Report, commercial/financial reports of a global FFO chain). We used linear regression to assess variables in univariate and multivariate analysis and report standardized ß coefficients with 95% confidence intervals (CI). KEY RESULTS: The regression model revealed that the overall prevalence of DGBI was inversely associated with both GDP per capita (ß = -0.57, 95% CI: -0.92, -0.22, p = 0.002) and happiness scores (ß = -0.433 95% CI: 0.821, -0.065, p = 0.023), while being positively associated with H. pylori prevalence (ß = 0.40, 95% CI: 0.008, 0.81, p = 0.046). The prevalence of functional constipation (FC) was also inversely associated with GDP per capita (ß = -0.50, 95% CI: -0.86, -0.13, p = 0.01) and happiness scores (ß = -0.497, 95% CI: -0.863, -0.132, p = 0.01), while being positively associated with H. pylori prevalence (ß = 0.53, 95% CI: 0.16, 0.91, p = 0.007). The Multivariate model analysis revealed that combining the factors of H. pylori prevalence, suicide rate, household size and happiness scores showed statistically significant association with FC (p = 0.039). Household size (ß = -0.43, 95% CI: -0.82, 0.038, p = 0.033) and suicide rates (ß = 0.55, 95% CI: 0.19, 0.90, p = 0.004) were statistically significantly associated with functional diarrhea. Irritable bowel syndrome (IBS) was associated with GDP per capita (ß = -0.40, 95% CI: -0.79, -0.014, p = 0.043) and happiness scores (ß = -0.390, 95% CI: -0.778, -0.003, p = 0.049). CONCLUSIONS & INFERENCES: Utilizing publicly available data, the prevalence of DGBI across diverse countries is linked to various socio-cultural and environmental factors. Collectively, the data suggests that the prevalence of DGBI is increased in less prosperous regions of the world.

Impact of health spending on hospitalization rates in Baltic countries: a comparative analysis.

INTRODUCTION: This study examines the association between healthcare indicators and hospitalization rates in three high-income European countries, namely Estonia, Latvia, and Lithuania, from 2015 to 2020. METHOD: We used a sex-stratified generalized additive model (GAM) to investigate the impact of select healthcare indicators on hospitalization rates, adjusted by general economic status-i.e., gross domestic product (GDP) per capita. RESULTS: Our findings indicate a consistent decline in hospitalization rates over time for all three countries. The proportion of health expenditure spent on hospitals, the number of physicians and nurses, and hospital beds were not statistically significantly associated with hospitalization rates. However, changes in the number of employed medical doctors per 10,000 population were statistically significantly associated with changes of hospitalization rates in the same direction, with the effect being stronger for males. Additionally, higher GDP per capita was associated with increased hospitalization rates for both males and females in all three countries and in all models. CONCLUSIONS: The relationship between healthcare spending and declining hospitalization rates was not statistically significant, suggesting that the healthcare systems may be shifting towards primary care, outpatient care, and on prevention efforts.

Epidemiological evolution and economic impact of the COVID-19 pandemic in the European Union and worldwide and effects of control strategies on them: An ecological study.

OBJECTIVE: To evaluate the epidemiological evolution and economic impact of COVID-19 pandemic in the European Union (EU) and worldwide, and the effects of control strategies on them. MATERIAL AND METHODS: We collected incidence, mortality, and gross domestic product (GDP) data between the first quarter of 2020 and of 2023. Then, we reviewed the effectiveness of the mitigation and zero-COVID control strategies. The statistical analysis was done calculating the incidence rate ratio (IRR) of two rates and its 95% confidence interval (CI). RESULTS: In the EU, COVID-19 presented six epidemic waves. The sixth one at the beginning of 2022 was the biggest. Globally, the biggest wave occurred at the beginning of 2023. Highest mortality rates were observed in the EU during 2020-2021 and globally at the beginning of 2021. In mitigation countries, mortality was much higher than in zero-COVID countries (IRR=6.82 [95% CI: 6.14-7.60]; p<0.001). A GDP reduction was observed worldwide, except in Asia. None of the eight zero-COVID countries presented a GDP growth percentage lower than the EU percentage in 2020, and 3/8 in 2022 (p=0.054). COVID-19 pandemic caused epidemic waves with high mortality rates and a negative impact on GDP. CONCLUSION: The zero-COVID strategy was more effective in avoiding mortality and potentially had a lower impact on GDP in the first pandemic year.