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Letters |
Department of Biology, University of Hartford, West Hartford, CT 06117
To the Editor:
The World Health Organization reported mortality (number of deaths) and morbidity (number of disability-adjusted life-years) data for 1999 for each of 97 different causes of morbidity and mortality in a world composite population and 14 regional populations covering most of the world (1). The 14 regional populations are defined by geographic location and mortality rate as listed in Table 1
.
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I scanned each editorial, article, case report, technical brief, letter to the editor, and independent abstract published in four sources in Clinical Chemistry: volume 47, number S6; volume 47, numbers 1–12 excluding S6; volume 48, number S6; and volume 48, numbers 1–12 excluding S6. The S6, National Meeting, issue was treated separately because the criteria for publishing in S6 differ from those for publishing in the other issues. I assigned each publication to one of two categories according to whether it did or did not address 1 or more of the 97 causes of morbidity and mortality.
The numbers and percentages of all publications that addressed 1 or more of these 97 causes are as follows: volume 47, number S6 = 528 or 58%; volume 47, numbers 1–12 excluding S6 = 401 or 75%; volume 48, number S6 = 432 or 62%; volume 48, numbers 1–12 excluding S6 = 358 or 77%.
For each population, I calculated correlation coefficients between the number of deaths from each cause and the number of publications on that cause in each of the four sources in Clinical Chemistry. The mean correlations for all four sources are described in Table 1
.
For each population, I also calculated correlation coefficients between the number of disability-adjusted life-years from each cause and the number of publications on that cause in each of the four sources in Clinical Chemistry. The mean correlations for all four sources are described in Table 1
.
The validity of these rank orders is confirmed by the consistency among the four selected sources in the Journal. The same five populations exhibited the five highest correlation coefficients for both mortality and morbidity in all four sources. Similarly, the Western Pacific low-mortality population exhibited the third lowest correlation coefficient, and the two African populations the two lowest correlation coefficients, for both mortality and morbidity in all four sources.
I conclude that the enormous health needs of Africa and the less-developed countries of the Western Pacific are not being addressed by the AACC and offer this conclusion as an example of the Inverse Care Law, i.e., the availability of medical care varies inversely with its need (2). One strategy for overthrowing this law involves objective assessment of national and regional health (3). Such assessment would facilitate objective priority setting and recognition, and eventual control, of a currently unnoticed medical error (4), i.e., misplaced priority.
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References
Department of Pathology, and Immunology, Division of Laboratory Medicine, Washington University, School of Medicine, St Louis, MO 63110
To the Editor:
The letter by Dr. Dix raises questions about the lack of coverage by Clinical Chemistry of diseases that have higher prevalences in less-developed countries. The data he uses are based on the WHO 2000 report, and he correlates the number of articles related to 97 causes of morbidity and mortality separately for low- and high-mortality areas of the world as classified by WHO.
It is of interest that WHO in its World Health Report 2002 (1) also looked at health in relation to 20 leading selected risk factors (Fig. 1
). Several of the risk factors have a disproportionate effect on health in developing countries; these risk factors include underweight (malnutrition), unsafe sex, unsafe water, and iron and vitamin A deficiency. Other risk factors, such as blood pressure, tobacco, alcohol, cholesterol, and overweight, all tend to lead to chronic diseases, which have a large array of laboratory testing; these risk factors have similar effects on health in developed and developing countries.
Nevertheless, I have little doubt that this journal has many more pages devoted to diseases more common in the more-developed countries because that is where most authors work and where the technology is being funded and developed, and the description of technology and its use are the focus of Clinical Chemistry. I believe that similar correlations would be found in most high-ranking medical journals, with the possible exception of The Lancet.
There are several reasons for this, from research funding priorities to reader interest. In addition, in myexperience, it is effective delivery of laboratory and health services that are major problems in less-developed countries and not usually the new technology. Nevertheless, there are innovative laboratory tests that have not been approved by the US Food and Drug Administration or its European counterparts that would probably be of interest to readers of this journal. One group of tests that quickly comes to mind is the relatively large number of rapid, finger-stick, whole-blood tests for HIV antibodies that have been validated by WHO and are in routine use in many countries.
References
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