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Peer-reviewedCC BY 4.0PLOS Medicine

Global, regional, and national impact of epidemic disasters on health workforce equality between 1990 and 2019: An ecological and modeling study

  • Manman Chen1
  • Wanzhou Wang2
  • Feng Sha3
  • Zichen Ye4
  • Yuankai Zhao5
  • Chao Yang6
  • Ze Liang7
  • Yu Jiang8
  • Xijie Wang9
  • Jinling Tang
9 affiliations
  1. 1School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  2. 2National Institute of Health Data Science, Peking University, Beijing, China
  3. 3Center for Digital Health and Artificial Intelligence, Peking University First Hospital, Beijing, China
  4. 4Department of Computational Biology and Medical Big Data, Faculty of Computer Science and Artificial Intelligence, Shenzhen University of Advanced Technology, Shenzhen, Guangdong, China
  5. 5Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
  6. 6School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  7. 7Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
  8. 8School of Economics and Management, Harbin Institute of Technology, Harbin, China
  9. 9School of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
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Abstract

Background: Global distribution of human resources for health (HRH) is highly unequal and less resourced regions may particularly be vulnerable to disastrous emergencies. We examined HRH losses attributable to epidemics of infectious diseases, both globally and geographically. Methods and findings: First, using 30-year ecological data from the 1990 to 2019 records at international Emergency Events Database and HRH density statistics from the Global Burden of Disease study, we extracted estimates of annual country-specific epidemic events and cadre-specific HRH density data across 194 countries and territories. The association between the number of epidemics and HRH density (number of HRH per 10,000 population) was established using the Generalized Estimating Equation model, adjusted for geographic and socioeconomic status. Second, based on the country- and year-specific number of epidemics, HRH density, and epidemic-HRH density associations, we further estimated the annual average absolute number of HRH losses and the average relative number of HRH losses per 10,000 HRHs that can be attributed to epidemic events, globally, by region, and by country. Conclusions: Epidemics of infectious diseases are associated with HRH losses globally, particularly in low- and middle-income countries, further aggravating the global inequity in the health workforce. Why was this study done?: What did the researchers do and find?: What do these findings mean?: Manman Chen, Wanzhou Wang and colleagues examined how infectious disease epidemics were associated with changes in the health workforce across 194 countries and territories from 1990 to 2019. Their findings suggest that epidemic events were linked to health workforce losses worldwide, with the largest relative impacts observed in low- and middle-income countries.

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Cite

BibTeXRIS
BibTeX
@article{chen2026global,
  title = {{Global, regional, and national impact of epidemic disasters on health workforce equality between 1990 and 2019: An ecological and modeling study}},
  author = {Manman Chen and Wanzhou Wang and Feng Sha and Zichen Ye and Yuankai Zhao and Chao Yang and Ze Liang and Yu Jiang and Xijie Wang and Jinling Tang},
  journal = {PLOS Medicine},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pmed.1005134},
  url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005134},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Global, regional, and national impact of epidemic disasters on health workforce equality between 1990 and 2019: An ecological and modeling study
AU  - Manman Chen
AU  - Wanzhou Wang
AU  - Feng Sha
AU  - Zichen Ye
AU  - Yuankai Zhao
AU  - Chao Yang
AU  - Ze Liang
AU  - Yu Jiang
AU  - Xijie Wang
AU  - Jinling Tang
PY  - 2026
DA  - 2026/09/22
JO  - PLOS Medicine
DO  - 10.1371/journal.pmed.1005134
UR  - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005134
AB  - Background: Global distribution of human resources for health (HRH) is highly unequal and less resourced regions may particularly be vulnerable to disastrous emergencies. We examined HRH losses attributable to epidemics of infectious diseases, both globally and geographically. Methods and findings: First, using 30-year ecological data from the 1990 to 2019 records at international Emergency Events Database and HRH density statistics from the Global Burden of Disease study, we extracted estimates of annual country-specific epidemic events and cadre-specific HRH density data across 194 countries and territories. The association between the number of epidemics and HRH density (number of HRH per 10,000 population) was established using the Generalized Estimating Equation model, adjusted for geographic and socioeconomic status. Second, based on the country- and year-specific number of epidemics, HRH density, and epidemic-HRH density associations, we further estimated the annual average absolute number of HRH losses and the average relative number of HRH losses per 10,000 HRHs that can be attributed to epidemic events, globally, by region, and by country. Conclusions: Epidemics of infectious diseases are associated with HRH losses globally, particularly in low- and middle-income countries, further aggravating the global inequity in the health workforce. Why was this study done?: What did the researchers do and find?: What do these findings mean?: Manman Chen, Wanzhou Wang and colleagues examined how infectious disease epidemics were associated with changes in the health workforce across 194 countries and territories from 1990 to 2019. Their findings suggest that epidemic events were linked to health workforce losses worldwide, with the largest relative impacts observed in low- and middle-income countries.
SN  - 1549-1676
ER  -