09.22 Global Burden of Surgery-Related Financial Risk: A Comparative Ecological Analysis

Posted on May 12, 2025

A. Umutoni1,2, U.S. Kanmounye2, D.T. Jumbam2, R. Ayala2  1University Of Rwanda, Department Of General Medicine And Surgery, College Of Medicine And Health Sciences, Kigali, KIGALI, Rwanda 2Operation Smile, Department Of Policy And Advocacy, Norfolk, VA, USA

Introduction:

 

This abstract presents an analysis of the financial risk associated with surgical care globally. 

Methods:

The World Bank Group (WBG) risk of catastrophic and impoverishing expenditure for surgical care data from 2003 to 2022 was downloaded on August 5, 2024. Country income category and region were also extrapolated from the WBG. The data were aggregated by income category and region for comparative analysis. A generalized linear model was used to identify explanatory variables for financial risk protection. A p-value <0.05 was considered statistically significant.

Results:
 

A total of 137 of the 189 WBG member countries had financial risk data (72.5%). Seven countries were excluded because they lacked more than 60% of the outcome data. Of the 130 countries included in this analysis, the most represented regions were Europe & Central Asia (n=43, 33.1%), sub-Saharan Africa (n=32, 24.6%), and Latin America & Caribbean (n=19, 14.6%). These countries were high-income (HIC) (n=41, 31.5%), upper middle (UpMIC) (n=37, 28.5%), lower middle (LoMIC) (n=35, 26.9%), and low (LIC) (n=17, 13.1%) income. In general, there was an increased financial risk as the country income category decreased with the steepest temporal decreases seen among UpMICs (Figure 1). Both region (Wald Chi-Square: 13.2, p=0.04) and income (Wald Chi-Square: 48.8, p>0.001) were significantly associated with financial risk. However, only the income subcategories were independently correlated with financial risk (p>0.001).

Conclusion:

The study reveals significant correlations between a country's income category and the financial risk its citizens face, with a notable increase in risk as the income category decreases. These correlations strongly suggest inequity in the financial burden of surgical disease.