Abstract
Geographic disparity for colorectal cancer (CRC) incidence and mortality according to the human development index (HDI) might be expected. This study aimed at quantifying the effect measure of association HDI and its components on the CRC incidence and mortality. In this ecological study, CRC incidence and mortality was obtained from GLOBOCAN, the global cancer project for 172 countries. Data were extracted about HDI 2013 for 169 countries from the World Bank report. Linear regression was constructed to measure effects of HDI and its components on CRC incidence and mortality. A positive trend between increasing HDI of countries and age-standardized rates per 100,000 of CRC incidence and mortality was observed. Among HDI components education was the strongest effect measure of association on CRC incidence and mortality, regression coefficients (95% confidence intervals) being 2.8 (2.4, 3.2) and 0.9 (0.8, 1), respectively. HDI and its components were positively related with CRC incidence and mortality and can be considered as targets for prevention and treatment intervention or tracking geographic disparities.
Highlights
Colorectal cancer (CRC) incidence and mortality rates have been well studied in developed and under developed countries
Through application of global data, the present study demonstrated that colorectal cancer (CRC) incidence and mortality more occurred in developed countries
Human Development Index (HDI) as a key socioeconomic determinant of health is composite of three main components including education, life expectancy, gross national income and additional factors such as urbanization level and age standardized obesity in adults
Summary
Colorectal cancer (CRC) incidence and mortality rates have been well studied in developed and under developed countries. An decreasing CRC incidence and mortality rate is identified in the United States and Europe (Jemal et al, 2009), CRC is still a public health concern in most developed countries in compared to under developed countries (Sonnenberg et al, 2000). The etiology of geographic disparity in CRC incidence and mortality can be constellation of many factors including earlier diagnosis by high effectiveness screening program, improved access to health care, or the availability of therapy modalities (Hébert et al, 2009; Altobelli et al, 2014). Previous global study showed higher CRC mortality to incidence ratio (MIR) is as a result of lower health system quality (Sunkara and Hébert, 2015). HDI is summary measure of human development, which is a composite index of three basic dimensions of human development including education as mean years of schooling, health as life expectancy at birth, and living standards as gross national income per capita
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