Disparities in mortality risk after diagnosis of hematological malignancies in 185 countries: A global data analysis

This study was to report proxy measures for mortality risk in patients with hematological malignancies across 185 countries globally and explore its association with their socioeconomic status and treatment. The incidence, mortality, and 5-year prevalence data were extracted from the GLOBOCAN database. The data regarding the human development index (HDI), gross national income (GNI), vulnerability index, and concordance with cancer Essential Medicines List (EML) were obtained from open-source reports. The ratio of mortality to 5-year-prevalence (MPR) and that of mortality to incidence (MIR) were calculated and age-standardized using Segi's world standard population. Finally, the possible associations were assessed using Pearson correlation analyses. In 2020, the global incidence, mortality, and 5-year prevalence of HMs were 1,278,362, 711,840, and 3,616,685, respectively. Global age-standardized MPR and MIR were 0.15 and 0.44, respectively; they varied significantly among 6 regions, 185 countries, 4 HM types, and 4 HDI groups worldwide. Older populations always had higher ratios. The correlation of MPRs and MIRs with HDI, GNI, and concordance with cancer EML was negative, whereas it was positive with the vulnerability index (lower was better). Increasing access to cancer drugs in resource-limited regions with a focus on vulnerable children may aid in reducing HM-related mortality risk.

Temporal patterns of breast cancer incidence, mortality, disability-adjusted life years and risk factors in 12 South American Countries, 1990-2019: an examination using estimates from the global burden of disease 2019 study

BACKGROUND AND AIM

Breast cancer (BC) is one of the leading causes of cancer deaths in females in South America. This study aims to examine the BC burden in 12 South American countries between 1990 and 2019.

DATA AND METHODS

The estimates of BC burden and risk factors were procured from the Global Burden of Disease 2019 study for the period 1990-2019. Development levels of countries were gauged using socio-demographic index (SDI). Decomposition analysis was employed to categorize the change in incidence between 1990 and 2019 into three factors: population growth, population aging and age-specific incidence rate. Estimated annual percent changes were calculated for each country and bivariate association between country-level age-standardized rates and SDI was examined using pooled regression.

RESULTS

The age-standardized rates of breast cancer were the highest in Uruguay [incidence: 72.65 per 100,000 (55.79-92.57); mortality: 29.97 per 100,000 (27.54-32.27); disability-adjusted life years (DALYs: 810.49 per 100,000 (746.22-884.55)] and lowest in Peru [incidence: 27.63 per 100,000 (20.44-36.85); mortality: 10.79 per 100,000 (8.14-14.11); DALYs: 318.27 per 100,000 (234.47-421.16)]. Mortality-to-incidence ratio (MIR) across countries varied from 0.30 in Colombia to 0.55 in Bolivia in 2019. SDI had a positive and strong association with age-standardized incidence rate [Formula: see text] and weaker positive association with age-standardized mortality rate [Formula: see text] and age-standardized DALYs rate [Formula: see text]. Most countries experienced more than 70% increase in incident cases owing to population aging and age-specific incidence rates. Alcohol Use, diet high in red meat and smoking contributed the maximum DALYs in most countries in 2019 whereas DALYs due to high body-mass index and high fasting plasma glucose increased most substantially between 1990 and 2019.

CONCLUSION

With increasing incidence, high MIR and rising BC burden due to modifiable risk factors, several public health interventions are required in South America focusing on prevention, BC awareness among general public, cost-effective early detection and treatments that suit the socio-economic setup of South American countries.

Impact of social and economic factors on global thyroid cancer incidence and mortality

PURPOSE

The incidence of thyroid cancer has increased substantially over the past few decades and is partially explained by overdiagnosis. Geographical variations in incidence rates were reported to be related to national development status. This study aimed to gain deeper insights into global thyroid cancer burden by incorporating additional social and economic factors to account for cross-national disparities.

METHODS

We performed a multivariate analysis of age-standardized incidence and mortality data from the GLOBOCAN 2020 database for 126 countries that had more than 100 incident cases of thyroid cancer. The human development index (HDI), current health expenditure, and additional Global Health Observatory indicators were extracted from multiple sources.

RESULTS

Age-standardized incidence was highly correlated with HDI (standardized coefficient beta = 0.523, 95% confidence interval [CI] = 0.275-0.771) among the countries studied. The prevalence of raised fasting blood glucose was associated with age-standardized mortality (beta = 0.277, 95% CI = 0.038-0.517). Generally, the mortality-to-incidence ratio was higher in males than in females. In multivariate analysis, HDI (beta = - 0.767, 95% CI = - 0.902 to - 0.633), current health expenditure (beta = 0.265, 95% CI = 0.137-0.394), and fine particulate matter (PM2.5) concentrations (beta = 0.192, 95% CI = 0.086-0.298) were associated with mortality-to-incidence ratios.

CONCLUSIONS

National developments gauged by HDI explain the majority of the variation in incidence rates of thyroid cancer but play a smaller role in disparities in mortality rates. The association between air pollution and thyroid cancer outcomes warrants further investigation.

Gender differences in leukemia outcomes based on health care expenditures using estimates from the GLOBOCAN 2020

BACKGROUND

Leukemia contributes significantly to the global cancer burden. Due to the importance of evaluating improvements in leukemia outcomes, the current study aimed to examine the variations in mortality-to-incidence ratio (MIR) between genders and association of MIR with the health expenditures in selected countries.

METHODS

The leukemia incidence and mortality rates were extracted from the GLOBOCAN 2020 database. In total, 56 countries were included based on the data quality reports and the exclusion of missing data. The associations of MIR and changes in MIR over time ([Formula: see text]MIR) with the human development index (HDI), current health expenditure (CHE) per capita, and current health expenditure as a percentage of gross domestic product (CHE/GDP) were investigated using Spearman's rank correlation coefficient.

RESULTS

In 2020, an estimated 474,519 new cases of leukemia were diagnosed globally, and 311,594 deaths occurred due to the disease. Male patients exhibited a higher incidence and mortality of leukemia compared to females on a global scale. Our analysis revealed that the MIRs were the highest and lowest in Egypt (0.79) and the United States (0.29), respectively. Remarkably, countries with greater HDI, higher CHE per capita, and a higher CHE/GDP tended to have lower MIR in both genders and within gender-specific subgroups. The δMIR demonstrated a significant negative correlation with HDI and CHE per capita, whereas no significant associations were observed among female patients for CHE/GDP. Besides, all three indicators showed trends towards negative correlations with δMIR among males, though these trends were not statistically significant (p>0.05).

CONCLUSIONS

Generally, leukemia MIRs tended to be most favorable (i.e., lower) in countries with high HDI and high health expenditure. The gender differences observed in leukemia outcomes may reflect the potential influence of social, material, behavioral, and biological factors.

Favorable cervical cancer mortality-to-incidence ratios of countries with good human development index rankings and high health expenditures

BACKGROUND

Cervical cancer is highly preventable. The mortality-to-incidence ratio (MIR) is a marker that reflects the available screening interventions and clinical outcomes of cancer treatments. The association between the MIR for cervical cancer and cancer screening disparities among countries is an interesting issue but rarely investigated. The present study sought to understand the association between the cervical cancer MIR and the Human Development Index (HDI).

METHODS

Cancer incidence and mortality rates were obtained from the GLOBOCAN database. The MIR was defined as the ratio of the crude mortality rate to the incidence rate. We used linear regression to analyze the correlation of MIRs with the HDI and current health expenditure (CHE) in 61 countries selected based on data quality.

RESULTS

The results showed lower incidence and mortality rates and MIRs in more developed regions. In terms of regional categories, Africa had the highest incidence and mortality rates and MIRs. The incidence and mortality rates and MIRs were lowest in North America. Furthermore, favorable MIRs were correlated with a good HDI and high CHE as a percentage of gross domestic product (CHE/GDP) (both p < 0.0001).

CONCLUSIONS

The MIR variation for cervical cancer is associated with the ranking of the health system and health expenditure, which further supports the role of cancer screening and treatment disparities in clinical outcomes. The promotion of cancer screening programs can reduce the cervical cancer global incidence and mortality rates and MIRs.

Global pattern of trends in incidence, mortality, and mortality-to-incidence ratio rates related to liver cancer, 1990-2019: a longitudinal analysis based on the global burden of disease study

Background

Liver cancer (LC) is considered as one of the most dominant malignant tumors which ranked 4^th and 6^th in terms of global mortality and incidence, respectively. This work aimed to investigate the global temporal trends in LC mortality-to-incidence ratio (MIR) and its components, with a particular focus on examining long-term effect of human development index (HDI) on these metrics in a 30-year follow-up.

Methods

The age-standardized LC incidence and mortality data were derived from the global burden of disease (GBD) study 2019. We first leveraged joinpoint piecewise linear regression analysis to ascertain time trends in LC incidence, mortality, and MIR complement [1-MIR] and the average annual percentage change (AAPC) of the rates over the period 1990–2019. Then, the association between the metrics and HDI was explored through longitudinal multilevel models (LMMs).

Results

The incidence rates paralleled the mortality rates worldwide and they had similar significant monotonic decrementing trends with AAPC values of − 1.10% (95% confidence interval (CI): − 1.40, − 0.90%) and − 1.40% (− 1.50, − 1.30%), respectively from 1990 to 2019. The [1-MIR] rates were around 0 and showed an increasing pattern from 1.70 to 8.10 per 100,000 people (AAPC, 4.90%) at the same period of time. Results from the LMMs displayed that the majority of the variation lies at the country level accounted for about 88% of the total variance. Moreover, our analysis supported that the HDI was negatively associated with either incidence or mortality over time (p < 0.05).

Conclusions

Our findings highlighted that the global long-term temporal trends of LC incidence and mortality decreased slightly during 1990–2019 which may reflect improved therapeutic strategies and public health interventions. Besides, the low rates of [1-MIR] revealed the five-year relative survival rate was poor implying LC is diagnosed late in its development. Thereby, the policymakers’ focus must be on early screening and detection of liver cancer.

Digestive cancer incidence and mortality among young adults worldwide in 2020: A population-based study

BACKGROUND

Digestive cancer has traditionally been thought of as a disease that mainly occurs in elderly individuals, and it has been ignored in young adults by both patients and physicians.

AIM

To describe the worldwide profile of digestive cancer incidence, mortality and corresponding trends among 20-39-year-olds, with major patterns highlighted by age, sex, development level, and geographical region.

METHODS

I performed a population-based study to quantify the burden of young adult digestive cancers worldwide. Global, regional, sex, and country-specific data estimates of the number of new cancer cases and cancer-associated deaths that occurred in 2020 were extracted from the GLOBOCAN Cancer Today database. To assess long-term trends in young adult digestive cancer, cancer incidence data and mortality data were obtained from the Cancer in Five Continents Plus database and the World Health Organization mortality database, respectively. The associations between the human development index (HDI) and digestive cancer burden in young adults were evaluated by linear regression analyses.

RESULTS

In 2020, there were an estimated 19292789 new cancer cases, resulting in 9958133 deaths worldwide, which equated to an age-standardized incidence rate (ASIR) of 5.16 and age-standardized mortality rate (ASMR) of 3.04, accounting for 12.24% of all new cancer cases and 25.26% of all cancer deaths occurring in young adults. The burden was disproportionally greater among males, with male: female ratios of 1.34 for incidence and 1.58 for mortality. The ASIRs were 2.1, 1.4, and 1.0 per 100000 people per year, whereas the ASMRs were 0.83, 1.1, and 0.62 per 100000 people per year for colorectal, liver, and gastric cancer, respectively. When assessed by geographical region and HDI levels, the cancer profile varied substantially, and a strong positive correlation between the mortality-to-incidence ratio of digestive cancer and HDI ranking was found (R 2 = 0.7388, P < 0.001).

CONCLUSION

The most common digestive cancer types are colorectal, liver and gastric cancer. The global digestive cancer burden among young adults is greater among males and exhibits a positive association with socioeconomic status. The digestive cancer burden is heavy in young adults, reinforcing the need for primary and secondary prevention strategies.

Cancer incidence estimation from mortality data: a validation study within a population-based cancer registry

Background

Population-based cancer registries are required to calculate cancer incidence in a geographical area, and several methods have been developed to obtain estimations of cancer incidence in areas not covered by a cancer registry. However, an extended analysis of those methods in order to confirm their validity is still needed.

Methods

We assessed the validity of one of the most frequently used methods to estimate cancer incidence, on the basis of cancer mortality data and the incidence-to-mortality ratio (IMR), the IMR method. Using the previous 15-year cancer mortality time series, we derived the expected yearly number of cancer cases in the period 2004–2013 for six cancer sites for each sex. Generalized linear mixed models, including a polynomial function for the year of death and smoothing splines for age, were adjusted. Models were fitted under a Bayesian framework based on Markov chain Monte Carlo methods. The IMR method was applied to five scenarios reflecting different assumptions regarding the behavior of the IMR. We compared incident cases estimated with the IMR method to observed cases diagnosed in 2004–2013 in Granada. A goodness-of-fit (GOF) indicator was formulated to determine the best estimation scenario.

Results

A total of 39,848 cancer incidence cases and 43,884 deaths due to cancer were included. The relative differences between the observed and predicted numbers of cancer cases were less than 10% for most cancer sites. The constant assumption for the IMR trend provided the best GOF for colon, rectal, lung, bladder, and stomach cancers in men and colon, rectum, breast, and corpus uteri in women. The linear assumption was better for lung and ovarian cancers in women and prostate cancer in men. In the best scenario, the mean absolute percentage error was 6% in men and 4% in women for overall cancer. Female breast cancer and prostate cancer obtained the worst GOF results in all scenarios.

Conclusion

A comparison with a historical time series of real data in a population-based cancer registry indicated that the IMR method is a valid tool for the estimation of cancer incidence. The goodness-of-fit indicator proposed can help select the best assumption for the IMR based on a statistical argument.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12963-021-00248-1.

Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017

Background

Cardiovascular diseases (CVDs) are one of the global leading causes of concern due to the rising prevalence and consequence of mortality and disability with a heavy economic burden. The objective of the current study was to analyze the trend in CVD incidence, mortality, and mortality-to-incidence ratio (MIR) across the world over 28 years.

Methods

The age-standardized CVD mortality and incidence rates were retrieved from the Global Burden of Disease (GBD) Study 2017 for both genders and different world super regions with available data every year during the period 1990–2017. Additionally, the Human Development Index was sourced from the United Nations Development Programme (UNDP) database for all countries at the same time interval. The marginal modeling approach was implemented to evaluate the mean trend of CVD incidence, mortality, and MIR for 195 countries and separately for developing and developed countries and also clarify the relationship between the indices and Human Development Index (HDI) from 1990 to 2017.

Results

The obtained estimates identified that the global mean trend of CVD incidence had an ascending trend until 1996 followed by a descending trend after this year. Nearly all of the countries experienced a significant declining mortality trend from 1990 to 2017. Likewise, the global mean MIR rate had a significant trivial decrement trend with a gentle slope of 0.004 over the time interval. As such, the reduction in incidence and mortality rates for developed countries was significantly faster than developing counterparts in the period 1990–2017 (p < 0.05). Nevertheless, the developing nations had a more rather shallow decrease in MIR compared to developed ones.

Conclusions

Generally, the findings of this study revealed that there was an overall downward trend in CVD incidence and mortality rates, while the survival rate of CVD patients was rather stable. These results send a satisfactory message that global effort for controlling the CVD burden was quite successful. Nonetheless, there is an urgent need for more efforts to improve the survival rate of patients and lower the burden of this disease in some areas with an increasing trend of either incidence or mortality.

Global, regional, national burden of breast cancer in 185 countries: evidence from GLOBOCAN 2018

PURPOSE

This study aims to examine the burden of breast cancer in 185 countries in 2018.

METHODS

The estimates of incidence, mortality, and prevalence of breast cancer were drawn from GLOBOCAN 2018. The overall burden of breast cancer was gauged using breast cancer burden index (BRCBI)-a novel index comprising age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), mortality-to-incidence ratio (MIR), prevalence-to-incidence ratio (PIR), and prevalence-to-mortality ratio (PMR). The socioeconomic status of countries was measured using human development index (HDI) RESULTS: Globally, breast cancer was responsible for an estimated 626,679 deaths at age-standardized rate of 13/100,000; there were 2.1 million cases diagnosed in 2018 at age-standardized rate of 46.3/100,000. The ASIR varied 22-fold from 5/100,000 (Bhutan) to 113.2/100,000 (Belgium). The ASMR varied 13-fold from 2.7/100,000 (Bhutan) to 36.9/100,000 (Fiji). The HDI exhibited a positive gradient with ASIR (r = 0.73), PIR (r = 0.98), and PMR (r = 0.85); with MIR, however, it exhibited a negative association (r = - 0.83). The BRCBI spanned from 0.70 in Somalia to 78.92 in South Korea and exhibited a positive association with HDI (r = 0.76). An additional 46,823 female lives in 2018 and a cumulative total of 333,304 lives could have been saved over 2013-2018, had countries performed as per their HDI.

CONCLUSIONS

The substantial burden of breast cancer in developing and low-resource economies calls for a holistic approach to cancer management and control that includes oncologic infrastructure to provide cost-effective screening, diagnostic, therapeutic, and palliative services, greater breast cancer awareness, and mitigation of risk factors.

Multiple Myeloma Incidence and Mortality Around the Globe; Interrelations Between Health Access and Quality, Economic Resources, and Patient Empowerment

BACKGROUND

The interrelation between the worldwide incidence, mortality, and survival of patients with multiple myeloma (MM) and relevant factors such as Health Care Access and Quality (HAQ) index, gross domestic product (GDP), health care expenditures, access to cancer drugs, and patient empowerment has not been addressed before.

MATERIAL AND METHODS

Epidemiologic data were obtained from the International Agency for Research on Cancer. The mortality-to-incidence ratio (expressed as 1-MIR) was used as proxy for 5-year survival. Information on health expenditure was obtained from Bloomberg Health-Care Efficacy ranking, the HAQ Index was used as a measure of available health care. For patient empowerment, visits to the Web site of the International Myeloma Foundation were used as proxy. Data on GDP and population per country were assessed from the International Monetary Fund and the United Nations Population Division, respectively. Possible associations were analyzed using Spearman's rank-order correlation.

RESULTS

The worldwide incidence of MM is currently 160,000, and mortality is 106,000. Age-standardized myeloma incidence varies between 0.54 and 5.3 per 100,000 and correlates with 1-MIR, patient empowerment, HAQ Index, and access to cancer drugs. The 1-MIR varies between 9% and 64% and is closely related to myeloma incidence, HAQ Index, patient empowerment, access to cancer drugs, and health care expenditures.

CONCLUSION

The global incidence and outcome of MM shows significant disparities, indicating under-recognition and suboptimal treatment in many parts of the globe. Results also highlight the importance of economic resources, access to and quality of health care, and patient education for improving diagnosis and survival of patients with MM.

IMPLICATIONS FOR PRACTICE

Multiple myeloma accounts for 10% of all hematological malignancies and has moved to the forefront of clinical interest because of the significant advances in medical treatment. Diagnosis depends on laboratory tests, imaging, and professional expertise, particularly in patients without a significant M-component. The present data show a substantial worldwide variation in incidence and mortality, that is mainly due (apart from variations due to ethnicity and lifestyle) to disparities in access to and quality of health care, a parameter strongly related to the economic development of individual countries. Improvement of quality of care and, consequently, in outcome is associated with patient empowerment.

Mortality-to-incidence ratios by US Congressional District: Implications for epidemiologic, dissemination and implementation research, and public health policy

The mortality-to-incidence ratio (MIR) can be computed from readily accessible, public-use data on cancer incidence and mortality, and a high MIR value is an indicator of poor survival relative to incidence. Newly available data on congressional district-specific cancer incidence and mortality from the U.S. Cancer Statistics (USCS) database from 2011 to 2015 were used to compute MIR values for overall (all types combined), breast, cervix, colorectal, esophagus, lung, oral, pancreas, and prostate cancer. Congressional districts in the South and Midwest, including MS, AL, and KY, had higher (worse) MIR values for all cancer types combined than for the U.S. as a whole. For all cancers combined, there was a positive correlation between each district's percent of rural residents and the MIR (r = 0.47; p < .001). The MIR for all cancer types combined was lower in districts within states that expanded Medicaid vs. those states that did not expand Medicaid (0.36 vs. 0.38; p < .001). A positive correlation was seen between the proportion of non-Hispanic Black residents and MIR (r = 0.15; p < .01 for all cancers). Lower MIRs were observed in districts in New England and in states that expanded Medicaid. However, there also were some interesting departures from this rule (e.g., Wyoming, South Dakota, parts of Wisconsin and Florida). Rural congressional districts have generally higher MIRs than more urban districts. There is some concern that poorer, more rural states that did not expand Medicaid may experience greater disparities in MIRs relative to Medicaid expansion states in the future.

Favorable gallbladder cancer mortality-to-incidence ratios of countries with good ranking of world's health system and high expenditures on health

Background

The mortality-to-incidence ratio (MIR) is a marker that reflects the clinical outcome of cancer treatment. MIR as a prognostic marker is more accessible when compared with long-term follow-up survival surveys. Theoretically, countries with good health care systems would have favorable outcomes for cancer; however, no report has yet demonstrated an association between gallbladder cancer MIR and the World’s Health System ranking.

Methods

We used linear regression to analyze the correlation of MIRs with the World Health Organization (WHO) rankings and total expenditures on health/gross domestic product (e/GDP) in 57 countries selected according to the data quality.

Results

The results showed high crude rates of incidence/mortality but low MIR in more developed regions. Among continents, Europe had the highest crude rates of incidence/mortality, whereas the highest age-standardized rates (ASR) of incidence/mortality were in Asia. The MIR was lowest in North America and highest in Africa (0.40 and 1.00, respectively). Furthermore, favorable MIRs were correlated with good WHO rankings and high e/GDP (p = 0.01 and p = 0.030, respectively).

Conclusions

The MIR variation for gallbladder cancer is therefore associated with the ranking of the health system and the expenditure on health.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7160-z) contains supplementary material, which is available to authorized users.

The burden of prostate cancer is associated with human development index: evidence from 87 countries, 1990-2016

Aim

To examine the temporal patterns of the prostate cancer burden and its association with human development.

Subject and methods

The estimates of the incidence and mortality of prostate cancer for 87 countries were obtained from the Global Burden of Disease 2016 study for the period 1990 to 2016. The human development level of a country was measured using its human development index (HDI): a summary indicator of health, education, and income. The association between the burden of prostate cancer and the human development index (HDI) was measured using pairwise correlation and bivariate regression. Mortality-to-incidence ratio (MIR) was employed as a proxy for the survival rate of prostate cancer.

Results

Globally, 1.4 million new cases of prostate cancer arose in 2016 claiming 380,916 lives which more than doubled from 579,457 incident cases and 191,687 deaths in 1990. In 2016, the age-standardised incidence rate (ASIR) was the highest in very high-HDI countries led by Australia with ASIR of 174.1/100,000 and showed a strong positive association with HDI (r = 0.66); the age-standardised mortality rate (ASMR), however, was higher in low-HDI countries led by Zimbabwe with ASMR of 78.2/100,000 in 2016. Global MIR decreased from 0.33 in 1990 to 0.26 in 2016. Mortality-to-incidence ratio (MIR) exhibited a negative gradient (r = - 0.91) with human development index with tenfold variation globally with seven countries recording MIR in excess of 1 with the USA recording the minimum MIR of 0.10.

Conclusion

The high mortality and lower survival rates in less-developed countries demand all-inclusive solutions ranging from cost-effective early screening and detection to cost-effective cancer treatment. In tackling the rising burden of prostate cancer predictive, preventive and personalised medicine (PPPM) can play a useful role through prevention strategies, predicting PCa more precisely and accurately using a multiomic approach and risk-stratifying patients to provide personalised medicine.

Favorable mortality-to-incidence ratios of kidney Cancer are associated with advanced health care systems

Background

The advancements in cancer therapy have improved the clinical outcomes of cancer patients in recent decades. However, advanced cancer therapy is expensive and requires good health care systems. For kidney cancer, no studies have yet established an association between clinical outcome and health care disparities.

Methods

We used the mortality-to-incidence ratio (MIR) for kidney cancer as a marker of clinical outcome to compare World Health Organization (WHO) country rankings and total expenditures on health/gross domestic product (e/GDP) using linear regression analyses.

Results

We included 57 countries based on data from the GLOBOCAN 2012 database. We found that more highly developed regions have higher crude and age-standardized rates of kidney cancer incidence and mortality, but a lower MIR, when compared to less developed regions. North America has the highest crude rates of incidence, but the lowest MIRs, whereas Africa has the highest MIRs. Furthermore, favorable MIRs are correlated with countries with good WHO rankings and high e/GDP expenditures (p < 0.001 and p = 0.013, respectively).

Conclusions

Kidney cancer MIRs are positively associated with the ranking of health care systems and health care expenditures.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4698-6) contains supplementary material, which is available to authorized users.

Health disparities are associated with gastric cancer mortality-to-incidence ratios in 57 countries

AIM

To evaluate the association between mortality-to-incidence ratios (MIRs) and health disparities.

METHODS

In this study, we used the GLOBOCAN 2012 database to obtain the cancer incidence and mortality data for 57 countries, and combined this information with the World Health Organization (WHO) rankings and total expenditures on health/gross domestic product (e/GDP). The associations between variables and MIRs were analyzed by linear regression analyses and the 57 countries were selected according to their data quality.

RESULTS

The more developed regions showed high gastric cancer incidence and mortality crude rates, but lower MIR values than the less developed regions (0.64 vs 0.80, respectively). Among six continents, Oceania had the lowest (0.60) and Africa had the highest (0.91) MIR. A good WHO ranking and a high e/GDP were significantly associated with low MIRs (P = 0.001 and P = 0.001, respectively).

CONCLUSION

The MIR variation for gastric cancer would predict regional health disparities.

Human development index is associated with mortality-to-incidence ratios of gastrointestinal cancers

AIM: To identify the role of human development in the incidence and mortality rates of gastrointestinal cancers worldwide.

METHODS: The age-standardized incidence and mortality rates for gastrointestinal cancers, including cancers of the esophagus, stomach, pancreas, liver, gallbladder, and colorectum, were obtained from the GLOBOCAN 2008 database and United States Cancer Statistics (USCS) report. The human development index (HDI) data were calculated according to the 2011 Human Development Report. We estimated the mortality-to-incidence ratios (MIRs) at the regional and national levels, and explored the association of the MIR with development levels as measured by the HDI using a modified “drug dose to inhibition response” model. Furthermore, countries were divided into four groups according to the HDI distribution, and the MIRs of the four HDI groups were compared by one-way ANOVA followed by the Tukey-Kramer post-hoc test. State-specific MIRs in the United States were predicted from the estimated HDI using the fitted non-linear model, and were compared with the actual MIRs calculated from data in the USCS report.

RESULTS: The worldwide incidence and mortality rates of gastrointestinal cancers were as high as 39.4 and 54.9 cases per 100000 individuals, respectively. Linear and non-linear regression analyses revealed an inverse correlation between the MIR of gastrointestinal cancers and the HDI at the regional and national levels (β < 0; P = 0.0028 for regional level and < 0.0001 for national level, ANOVA). The MIR differed significantly among the four HDI areas (very high HDI, 0.620 ± 0.033; high HDI, 0.807 ± 0.018; medium HDI, 0.857 ± 0.021; low HDI, 0.953 ± 0.011; P < 0.001, one-way ANOVA). Prediction of the MIRs for individual United States states using best-fitted non-linear models showed little deviation from the actual MIRs in the United States. Except for 28 data points (9.93% of 282), the actual MIRs of all gastrointestinal cancers were mostly located in the prediction intervals via the best-fit non-linear regression models.

CONCLUSION: The inverse correlation between HDI and MIR demonstrates that more developed areas have a relatively efficacious healthcare system, resulting in low MIRs, and HDI can be used to estimate the MIR.