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Published on 9. Authors of this article:. Background: The advances achieved in technology, medicine, and communications in the past decades have created an excellent scenario for the improvement and expansion of eHeath and mHealth in particular. Mobile phones, smartphones, and tablets are exceptional means for the application of mobile health, especially for those diseases and health conditions that are the deadliest worldwide.

Objective: The main aim of this paper was to compare the amount of research and the of mobile apps dedicated to the diseases and conditions that are the leading causes of death according to the World Health Organization grouped by different income regions. Methods: Two reviews were conducted.

: Search queries up to June located papers and apps related to the leading causes of death, and the following findings were obtained. Alzheimer disease and other dementias are included in the diseases with more apps, although it is not among the top 10 causes of death worldwide, whereas lower respiratory infections, the third leading cause of death, is one of the less researched and with fewer apps.

Two diseases that are the first and second of low-income countries lower respiratory infections and diarrheal diseases have very little research and few commercial applications. Trachea, bronchus, and lung cancers are the third cause of death in high-income countries but are one of the least researched diseases with regard to apps.

Conclusions: Concerning mobile apps, there is more work done in the commercial field than in the research field, although the distribution among the diseases is similar in both fields. In general, apps for common diseases of low- and middle-income countries are not as abundant as those for typical diseases of developed countries. The advances in science and medicine in developed countries have caused an elderly population and long-term survival of individuals who suffer chronic diseases due to modern treatments and cures.

This has increased the quality of life expectation of health care consumers [ 1 ]. For satisfying this expectation, there have been important improvements in health care delivery supported by the use of the Internet, also known as eHealth, defined by the International Telecommunication Union as the paradigm that encompasses all of the information and communication technologies necessary to make the health system work [ 2 , 3 ]. This paradigm has evolved ificantly to the point of creating mobile health mHealth as a branch of eHealth.

There are many definitions of mHealth. What is clear is that mobile devices are used for providing health care. The reality is that important advances in technology and communications have been achieved in the past few years and mHealth has taken advantage of them [ 8 - 12 ]. In addition to this, advances in technology for smartphones and tablets have caused their incredible growth, especially in high-income countries. There were 6 billion mobile subscriptions in and more than 1.

With these s, it is obvious that these devices must be used in the field of mHealth to assist every person with one of these gadgets. Indeed, mHealth is already using them as shown by the great of health applications currently available [ 22 - 25 ]. These devices can be especially useful for the prevention and management of those diseases that cause high rates of mortality. Some of the leading causes of death are presented in Figure 1 , which shows the percentage of deaths caused by these diseases and distributed according to different income zones [ 27 ].

The 6 leading causes of death for each zone and worldwide in are shown. Some data are presented below. Considering randomly individuals dead in , statistically would have come from high-income countries, from middle-income countries, and from low-income countries [ 28 ].

Cardiovascular diseases CVDs are the deadliest diseases— Among these diseases, ischemic heart disease IHD is the leading cause of death globally with an estimated 7. Stroke produces not only death, but also disabilities and high probabilities of death in the future.

Its burden is projected to rise from approximately 38 million DALYs disability-adjusted life years worldwide in to 61 million DALYs in [ 35 - 38 ]. Sixty-five million people had chronic obstructive pulmonary disease COPD and more than 3 million died in [ 44 - 48 ].

Diarrheal disease is a major problem in developing countries and the second leading cause of mortality in children under 5 years of age, killing 1. In , there were 34 million people living with HIV and 1. According to the WHO, there were million cases of malaria and , deaths in [ 58 - 60 ]. However, other studies have worse s: Murray et al estimated 1. Cancer caused 7. There are The main aim of this paper is to continue the research begun by the authors about mobile apps for the most prevalent health conditions [ 71 ], focusing on the diseases and conditions that are leading causes of death by the WHO grouped according to different income regions [ 27 ].

For this purpose, two reviews have been done. The first was a literature review carried out by searching published articles in several systems, and the second was a review of commercial apps done in the most important mobile phone apps stores considering the market share of the operative systems used for smartphones.

The main objective is to find out which diseases are more researched and which have more apps, comparing these findings with their weight in mortality, not only globally but also distributed according to different income regions. In April , two reviews were developed: a literature review and research in commercial applications stores.

The procedures used for each review are explained below. When searching for a specific disease, a combination of search words was used. If the of obtained was too low, another combination of words was used until a more ificant of was obtained. These terms were used on all the systems mentioned. The process was repeated with each disease studied. The search strings were used only for metadata and the article search was limited to the past 10 years, from Figure 2 shows a flowchart with the steps followed in both literature and commercial reviews.

All the systems returned , with repeated or with an irrelevant title for this study. Of the remaining papers, were dismissed after reading their abstract or the whole paper when necessary. Finally, a total of papers For considering a paper relevant, it had to fulfil some criteria: it must be focused on applications using mobile phones or devices, it must be written in English, and it has to be about a mobile app or apps deed for the sought condition.

This means that papers centered on applications for several and different diseases were dismissed even if one of the illnesses treated was the one sought. For the search strings, in some cases Britain and US terms for the same word were used to ensure that every relevant document was revealed. The second review was carried out in the most important applications stores of the smartphones industry considering the market share of the operative systems for smartphones [ 23 - 25 , 72 ].

The process is similar to the one followed in the literature review. Table 2 shows the different terms used in the search of the applications related to each disease and the flowchart of Figure 2 shows the steps followed in the commercial review. A total of apps were initially found although, after checking whether the apps were relevant to the study and whether some conditions were fulfilled, only The requisites to include an app in the study were applications not in English or with the description in a different language from English or the one of the country where the search was done Spanish were dismissed, the same as those included in the of games, music, or entertainment.

Applications that use flashcards for helping medical students in their exams and applications for conferences were also dismissed. The of relevant papers for each condition and each system are presented in Table 3. The last column shows the total of different papers found on all the systems.

The of the search of the respiratory system cancers can be broken down into nine for lung cancer and no for the rest of the search strings trachea cancer, bronchus cancer, and respiratory system cancer. In light of the , heart diseases are the most researched ones. LRI and COPD hold the fifth and sixth places, respectively, in descending order of research done and the last places are for malaria, trachea, bronchus, lung cancers, and diarrheal diseases with very little investigation; only 28 articles among them.

The majority of papers found were relative to the de, development, or implementation of mobile systems, whole systems [ 77 ], complement systems to a mobile phone [ 78 ], or part of the system [ 79 ]. There are also evaluations and validations of these mobile systems [ 80 ]. Other types with a great of papers found are interventions using mobile systems [ 81 ], apps [ 82 ], or mobile phones [ 83 ] and the studies and evaluations of these interventions [ 84 ]. Another type of paper found, but less frequent, are those dedicated to applications for smartphones, with add-on complements [ 85 ] or without them [ 86 ] and reviews of the existing apps for a specific objective [ 87 ].

The findings of the commercial apps review are revealed in Table 4. Each cell shows the of relevant apps out of the total of found in each commercial store. The last row contains the addition of the applications found for all the diseases at each store and the last column presents the addition of the applications found at all the stores for each sought disease.

Nevertheless, this does not represent the total of different apps in all the stores, because there are apps developed by the same creator for different operative systems, being the same or similar app for different smartphones software. There are some diseases issued by the WHO that are actually a group, so in Table 4 these groups are divided into its illnesses. This way, the groups stroke and other cerebrovascular diseases and Alzheimer and other dementias are divided each one into two rows, one for stroke and cerebrovascular diseases and another for Alzheimer and dementia, respectively.

The same occurs with the group trachea, bronchus, and lung cancers, split into three rows corresponding to the three types of cancer. The third position is for heart diseases with applications and the fourth is for stroke and other cerebrovascular diseases despite the fact that there are no for cerebrovascular diseases. After a gap of more than 40 apps, COPD holds the fifth position and trachea, bronchus, and lung cancers the sixth, although there are no apps for the two first mentioned cancers, only for lung cancer.

The seventh and eighth positions are malaria and diarrheal diseases, and the last is LRI with only 6 apps. The main types of apps for LRI are guides and calculators for health care professionals, although there are also some informative apps for patients. In the case of diarrheal diseases, the most common apps are natural and personal remedies as well as some guides.

The great majority of apps for heart disease are heart rate monitors for patients and algorithms and calculators for specialists [ 91 ]. The principal focus of malaria apps is to use the smartphone as a mosquito repellant, followed by informative apps about it. The most usual apps for stroke and other cerebrovascular diseases are stroke detectors and stroke scale calculators. There are also some informative apps.

Referring to COPD, the majority of apps are informative and guides for health care professionals, followed by some COPD trackers and apps for learning to use inhalers, both destined for patients. Focusing on lung cancer there are no specific apps for the rest of cancers studied , most apps are destined for cancer stage determination and help in its diagnosis for professionals.

For patients, informative apps are common. Finally, typical apps for Alzheimer and other dementias are games useful for their prevention, supportive apps for patients and relatives, as well as trackers and apps for auto-checking the status of a dementia. LRI is the disease with the least percentage of apps in all the zones, followed by diarrheal diseases in low- and middle-income countries and trachea, bronchus, and lung cancers in high-income countries.

Some important conclusions can be obtained from the analysis of the . Comparing the s of the literature review with the s of the commercial apps review, it is clear that there is more work done in the commercial field than in the research field. This is quite logical because the main objective of developers is earning money with their apps and, therefore, they focus on commerce.

Unfortunately, what can be extracted from the of this study is that most developers only do the market investigation or they do not publish the of their studies while developing their apps. Contrasting the literature review with the commercial review, there are two differentiated groups. On one hand, there are four diseases with the highest percentage of work done in developing research and applications.

The s of the commercial apps review for the first three diseases mentioned before are similar and over apps while for stroke and other cerebrovascular diseases the of apps is much higher than the rest, which enforces the idea of two groups. On the other hand, the second group is formed by the rest of diseases, having much less work done in both research and commercial fields. Another piece of information extracted from this comparison is that the position held by a disease in of apps or papers found is similar in both reviews, with a maximum difference of two positions except for LRI with the fifth and ninth positions in the literature and commercial reviews, respectively.

Hence, for the majority of the studied diseases, there is a concordance in the proportion of work done for each disease in both fields, which means that both researchers and developers generally agree on the importance given to each disease. Contrasting the order of diseases according to the of apps and papers and by mortality worldwide, there are some interesting issues.

The most striking is that the diseases with more commercial apps, Alzheimer and other dementias, are not included in the top 10 causes of death worldwide. Therefore, why is there so much effort and work done in these illnesses? As exposed below, the answer is easy: Alzheimer and dementias are typical of high-income countries [ 27 ] where there is a social conscience of these illnesses and the population is very much aware of the consequences and dysfunctions that they cause, as shown by the great of associations worldwide [ 93 , 94 ]. This reason, added to the facts that the majority of developers and developers groups are located in these countries [ 95 - 97 ] and deing apps for richer zones is more profitable, explains this issue.

The contrary occurs with LRI. Worldwide, this disease is the third leading cause of death, but the reviews carried out in this study show that its s do not correspond with this position it is the fifth disease more researched and the last in commercial stores. This can be explained by several reasons: the first is that it is the first cause of death in low-income countries but it is not among the top 3 in middle- and high-income countries and, because developers are generally aware of these countries [ 95 - 97 ], this disease is not a priority for them.

Another important reason is that this disease is typical of children younger than 5 years old [ 40 ] and, as a result, developers have no reasons to create apps for LRI patients.

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