The gender difference and mortality-to-incidence ratio relate to health care disparities in bladder cancer: National estimates from 33 countries

Shao-Chuan Wang,Wen-Wei Sung,Yu-Lin Kao,Horng-Rong Chang,Sung-Lang Chen,Wen-Jung Chen,Tzuo-Yi Hsieh

doi:10.1038/s41598-017-04083-z

Abstract

The variation in the mortality-to-incidence ratio (MIR) between countries and genders reflects the complex etiology and intervention of bladder cancer. In this study, we investigated the MIR variation between genders and health care disparities among countries. Cancer incidence and mortality were obtained from the GLOBOCAN 2012 database. The ranking and the total expenditure on health of countries were obtained from the World Health Organization. Linear regression was used to estimate the significance between variables. We estimated the role of MIRs from 33 countries. Bladder cancer incidence and mortality rates were higher in more developed regions, Europe, and the Americas. The MIRs were higher in less developed regions. Analysis according to country revealed Germany to have the lowest MIR. High relative MIRs (female MIR/male MIR) for bladder cancer were noted in many developed countries. A correlation between MIR and health care disparities among countries was indicated by a significant association between the World Health Organization ranking and total expenditure on health/GDP with the MIR and relative MIR. Low bladder cancer MIR is prone to be more prevalent in countries with good health care system.

Highlights

Bladder cancer shows a high incidence and mortality that differs with gender, race, and ethnicity[1, 2]
The mortality-to-incidence ratio (MIR) and relative MIRs are correlated with the WHO ranking and expenditure on health/ GDP (e/GDP), suggesting a role that reflects health disparities. This is the first study to demonstrate a correlation between the MIR of bladder cancer and the health care disparities among countries
We followed up the gender differences in the MIR using an updated database

Summary

Introduction

Bladder cancer shows a high incidence and mortality that differs with gender, race, and ethnicity[1, 2]. The incidence and mortality rates vary across countries due to the differences in risk factors, detection, diagnostic practices, and treatments[2,3,4,5]. A recent global study showed that the incidence and mortality rates had decreased in most Western countries but had increased in some eastern European and developing countries[2, 6]. This evidence confirms the need for continued surveillance and analysis of the patterns and trends in bladder cancer incidence, mortality, and survival among countries. Only 4% of the countries had relative MIR values less than one

Methods

Results

Conclusion