Determinants Of Non-Hodgkin Lymphoma Mortality In 117 Countries: An Ecological Study

Abstract

Introduction: Non Hodgkin's Lymphoma (NHL) mortality has been increasing worldwide, and it is one the most incident among hematologic cancers. HIV and pesticides exposure have been associated with NHL mortality, but it is also important to understand how, and if, social determinants are associated with mortality by this cancer. The aim of this study was to estimate an association between NHL Standardized Mortality Rates (NHL-SMR) and social determinants, having Human Development Index (HDI) and Country Income Level (CIL) as proxy of these determinants. Methods: secondary data from 117 Countries were collected from: NHL-SMR (as outcome) from GLOBOCAN/IARC-2012; CIL from World Bank (divided into: high; upper middle; lower middle; and low income Countries); pesticide per capita consumption (as a proxy of the population exposure to these chemicals and divided into tertiles of pesticide consumption) from FAO/WHO; HDI from UNDP/WHO; and HIV prevalence (HIVp) from UNAIDS/WHO. A GLM model (with gamma distribution) was used to establish association between NHL-SMR and HDI and CIL, having per capita pesticide consumption and HIVp as potential confounders. Results: The high level income Countries had lower NHL-SMR (beta=-0.562; p=0.041 - compared with the low income Countries), and the HDI is inversely associated with NHL-SMR (beta=-0.142; p=0.016), adjusting for per capita pesticide consumption (beta=0,462; p=0.02 – higher tertiles compared with the lower tertiles), and for HIVp (beta=0.024; p