Trends of Testicular Cancer Mortality-to-Incidence Ratios in Relation to Health Expenditure: An Ecological Study of 54 Countries.

Shao-Chuan Wang,Wen-Jung Chen,Wen-Wei Sung,Min-Hsin Yang,Sung-Lang Chen,Nai-Wen Chang

doi:10.3390/ijerph18041546

Abstract

Favorable testicular cancer mortality-to-incidence ratios (MIRs) are associated with health care disparities, including health care expenditures, but the trends of testicular MIR and health care disparity remain unclear. We evaluated changes in MIR as the difference between 2012 and 2018, termed delta MIR (δMIR). Health care expenditures and the human development index (HDI) were obtained from the World Health Organization and the Human Development Report Office of the United Nations Development Programme. The association between the variables was analyzed by Spearman’s rank correlation coefficient. A total of 54 countries were included in the criteria of data quality reports and missing data. By continent, the most favorable MIR was in Oceania (0.03) while it was 0.36 in Africa. In these areas, the incidence rates were positively correlated to health care expenditure, but the mortality rates showed a reversed correlation. The MIR ranged from 0.01 to 0.34 and the δMIR ranged from −0.05 to 0.34. The favorable MIRs are correlated to high health care expenditure and HDI (all p < 0.001). Interestingly, favorable δMIRs tend to be seen in countries with relatively low health care expenditure and HDI (all p < 0.001). In conclusion, favorable testicular cancer MIRs are associated with high HDI and health care expenditure, but the improvement in MIR between 2012 and 2018 (δMIR) is negatively correlated with HDI and health care expenditure.

Highlights

Testicular cancer is a relatively rare neoplasm, accounting for just under 1%of cancers and ranking 26th for cancer incidence in men, the annual incidence increased1.80-fold over 25 years, from 37,231 in 1990 to 66,833 new cases in 2016, with the increase notable in Caucasian males [1,2]
This study describes the trends for this disease by clarifying the associations between the human development index (HDI), current health expenditure (CHE), testicular cancer’s incidence and mortality, and the change in mortality-to-incidence ratios (MIRs), termed delta MIR during the period of 2012–2018
CHE as a percentage of gross domestic product (GDP) are significantly associated with the mortality-to-incidence ratios (MIR)

Summary

Introduction

Testicular cancer is a relatively rare neoplasm, accounting for just under 1%of cancers and ranking 26th for cancer incidence in men, the annual incidence increased1.80-fold over 25 years, from 37,231 in 1990 to 66,833 new cases in 2016, with the increase notable in Caucasian males [1,2]. The gap between highand low-incidence countries has narrowed, mainly within Europe, with the incidence stabilizing in high-incidence countries while increasing in some formerly low-incidence countries [3] This trend may be related to the improved detection of testicular cancer and the qualities of the cancer registries in the formerly low-incidence countries [4]. It seems to be associated with increased exposure to environmental factors, such as maternal exposure to exogenous toxins and chemical pollutants [5,6]. The multifactorial etiology remains unclear, the risk factors described above have led to geographical variations in the distribution of the incidence of testicular cancer [7]

Methods

Results

Conclusion