Mortality-to-incidence Ratio Research Articles

Trends in oncological disease burden: A comparative study between higher and lower-middle-income countries.

10560 Background: Cancer is a major cause of morbidity and mortality worldwide. Ten million cancer-related deaths were recorded in 2020, a rise of 66% over the preceding two decades. Malignancies of the breast, lung, prostate and colon account for over 40% of new cancer diagnoses worldwide. This study observes trends in oncological disease burden among higher (HIC’s) and lower-middle-income countries (LMIC’s) between 2000 and 2019. Methods: Mortality to incidence ratios (MIR) were calculated using the Global Burden of Disease database by extracting age standardized mortality and incidence rates per 100 000 for breast, lung, prostate and colorectal cancer for the years 2000-2019. The European Union (EU) 15+ countries were taken to represent HIC’s. 8 of the LMIC’s in the World Bank group were included as their data quality rating was 3/5 or higher. This cohort comprised Egypt, Sri Lanka, Ukraine, El Salvador, Republic of Moldova, Philippines, Kyrgyzstan and Nicaragua. Breast, lung, colorectal and prostate cancer were included as the tumor types with highest global incidence. Median MIR (with interquartile range) were computed for each LMIC and EU15+ groups for males and females for each of the four tumor types. Results: Between 2000 and 2019 median MIR for the LMIC group was higher than for EU15+ group for all four cancer types in males and females. Wilcoxon rank sum of the 2019 data showed a statistically significant difference (p <0.001) in MIR between HIC’s and LMIC’s (table 1). For breast, prostate and colorectal cancer the difference in median MIR between LMIC group and EU15+ decreased over the observation period, for lung cancer the difference increased. Conclusions: Globally there are wide geographical variations in MIR. Cancer outcomes appear consistently worse in LMIC’s compared to HIC’s. Availability of cancer screening, access to treatment and risk-factor prevalence may contribute to the above trends. Identifying these regional disparities provides an opportunity to target resource allocation to regions that would derive the greatest benefit. [Table: see text]

Trends of leukemia mortality in the United States, 1999-2018.

e19034 Background: Malignant neoplasms are the second leading cause of mortality in the United States. Among the cancer sites, leukemia is the seventh most common cause of deaths. It accounts for 3.2% of all new cases of cancer and 3.9% of all cancer deaths. The Mortality-to-Incidence Ratio (MIR) has previously been applied as a measure to examine health disparities and outcomes of cancer therapy. In this study, we aim to analyze leukemia incidence, mortality, and trends of MIR for gender and race over the previous two decades. Methods: We conducted a retrospective population-based study using Cancer Statistics from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research system (CDC WONDER). Subjects with leukemia as the cancer site were selected. Age-adjusted mortality and age-adjusted incidence rates for race and gender were obtained and reported over 100,000 people. Negative binomial regression analysis using age-adjusted rates was subsequently used to analyze mortality, incidence, and trends of MIR. Results: 448,893 deaths were reported to be associated with leukemia between 1999 and 2018, of which males accounted for 56.85%. A total of 894,726 incident cases of leukemia were recorded during the same period. Males had a higher age-adjusted mortality rate than females (9.3 vs 5.2, OR: 1.70 [1.48-1.95]). Compared to Native Americans, African Americans and White cohorts had substantially higher age-adjusted mortality rates (3.5, 6.0, 7.2, OR: reference, 1.74, 2.05), whereas Asians had a non-significantly higher rate (3.8, OR: 1.09 [0.87-1.36]). In males, incidence rates were significantly higher (17.9, OR: 1.61 [1.58-1.64]). Against White population, Asian and African American race had a significantly lower age-adjusted incidence rate (14.4, 7.9, 10.6, OR: reference, 0.60, 0.79), while Native American race had a significantly higher rate (8.2, OR: 1.15 [1.06-1.24]. The mortality-to-incidence ratio has decreased significantly over time in both male and female populations (22.82% and 27.62%, respectively), as well as in African American and White cohorts (24.36% and 23.24%, respectively). Conclusions: Over the last 20 years, the mortality-to-incidence rate ratio significantly declined, possibly suggesting the effectiveness of cancer treatment outcomes in the United States. Yet, the reduction in mortality was not observed in all races. More efforts and further research are needed to guide the policy change.

Determinants of birth asphyxia among newborn live births in public hospitals of Gamo and Gofa zones, Southern Ethiopia

BackgroundBirth asphyxia is the inability of a newborn to start and conserve breathing immediately after birth. Globally, 2.5 million infants die within their first month of life every year, contributing nearly 47% of all deaths of children. It is the third cause of neonatal deaths next to infections and preterm birth. Ethiopia is one of the countries with the highest neonatal mortality and high burden of birth asphyxia in the world. The state of birth asphyxia is about 22.52% in Ethiopia, with incidence of 18.0% in East Africa Neonatal mortality incidence ratio was 9.6 deaths per 1000 live births among which 13.5% of neonatal mortality cases were due to birth asphyxia in southern Ethiopia. The effect of birth asphyxia is not only limited to common clinical problems and death; it also has a socio-economic impact on the families. Therefore, this study is aimed to identify determinants of birth asphyxia among newborn live births in public hospitals Southern Ethiopia.MethodsAn Institution based unmatched case–control study was conducted among newborn live births in public hospitals of Gamo & Gofa zones, with a total sample size of 356 (89 cases and 267 controls, 1:3 case to control ratio) from March 18 to June 18, 2021, after obtaining ethical clearance from Arba Minch University. Cases were selected consecutively and controls were selected by systematic random sampling method. Data were collected using an adapted pretested semi-structured questionnaire through face-to-face interviews and record reviews using an extraction checklist for intrapartum & neonatal-related information. The collected data were entered into Epi data version 4.4 and exported to STATA version 14 for analysis. Finally, bi-variable and multivariable logistic regression analyses were performed to identify determinants of birth asphyxia. Statistical significance was declared at p-value ≤ 0.05 along with corresponding 95% CI of AOR used to declare statistical significance. Results: Anemia during pregnancy [AOR = 3.87, 95% CI (1.06- 14.09)], breech presentation [AOR = 3.56, 95% CI (1.19–10.65)], meconium stained amniotic fluid [AOR = 6.16, 95% CI (1.95–19.46)], cord prolapse [AOR = 4.69, 95%CI (1.04–21.05)], intrapartum fetal distress [AOR = 9.83, 95% CI (3.82–25.25)] and instrumental delivery [AOR = 5.91, 95% CI (1.51–23.07)] were significantly associated with birth asphyxia.ConclusionThe study revealed that anemia during pregnancy, breech presentation, meconium-stained amniotic fluid, cord prolapse, intrapartum fetal distress, and instrumental delivery were identified as determinants of birth asphyxia. Therefore, health professional and health institutions should give emphasis on care of mother and the newborn in actively detecting and managing asphyxia.

Burden of type 1 diabetes mellitus in the North Africa and Middle East Region, 1990–2019; findings from the global burden of disease study

AimsWe aimed to report the burden of type 1 diabetes mellitus (T1DM) in the North Africa and Middle East region and its 21 countries from 1990 to 2019. MethodsInformation related to incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and years lived with disability (YLDs) of T1DM was acquired from the 2019 Global Burden of Disease study. The burden was estimated by sex, age groups, and socio-demographic index (SDI) in 21 countries. ResultsOver the past 30 years, regional incidence, prevalence, mortality, and DALYs of T1DM increase by 188.7%, 304.8%, 43.7%, and 71.6%, respectively. While the age-standardized incidence and prevalence rates increased by 84% and 91%, the mortality and DALYs rates decreased by 34% and 13%. During these years, the contribution of YLDs to total DALYs increased considerably (from 17% to 42%). The highest increase in the incidence and prevalence rates occurred in high SDI countries. Moreover, the Mortality to Incidence Ratio (MIR) decreased in the region countries. ConclusionsDespite progress made in diabetes care, there is a persistently increasing burden of T1DM in the region countries. This indicates that T1DM is still one of the major health challenges in the region countries, especially in high SDI Arab countries.

Prioritizing Cancer Care in Low and Middle-Income Countries Using Delta Mortality-to-Incidence Ratios

PURPOSE Cancer outcomes are disparate around the world. Low- and middle-income countries (LMICs) face higher cancer mortality rates than high-income countries (HICs), and the burden will only intensify as cancer incidence is projected to rise 81% by 2040. Mortality-to-incidence ratios (MIR), calculated by dividing mortality rates by incidence rates, have been used to study disparities in cancer control. By calculating delta mortality-to-incidence ratios (dMIR), the difference between MIRs in HICs and LMICs, we can develop country-specific cancer priority lists for cancer control planning and resource allocation. METHODS We extracted country-specific incidence and mortality rates for 35 cancer types from 183 countries using GLOBACAN 2020. Countries were grouped into income categories as defined by the World Bank. Development indicators and country metadata were extracted from the United Nations Development Program. MIRs were calculated for each cancer in every country. Linear regression was used to test relationships between MIRs and development indicators. Delta MIR was calculated for each cancer type by subtracting the average MIR for HICs from the average MIR for LMICs. RESULTS For all cancers combined, MIRs varied widely across the globe, ranging from 0.33 in Australia to 0.80 in Gambia. Variation in MIR was low for certain diseases such as pancreas cancer (range = 0.80-1.0), but high for screenable cancers such as breast (0.11-0.63) and colon (0.28-1.0) cancers. Upon multivariate linear regression, MIRs were associated with life expectancy and income index. Cancers of the nasopharynx (0.90), Kaposi sarcoma (0.51), anus (0.46), salivary grands (0.38) and prostate (0.34) had the highest dMIRs. CONCLUSION Delta MIRs can be employed to systematically address disparities in global cancer survival. Cancers with the highest dMIRs represent those with the greatest proportion of potentially avoidable deaths and should be targeted first for maximum impact on global cancer mortality. These data can inform country-specific cancer priority lists.

Interstitial lung disease incidence and mortality in the UK and the European Union: an observational study, 2001-2017.

ObjectiveTo compare the trends in age-standardised incidence and mortality from interstitial lung diseases (ILD) in the UK and the European Union (EU).MethodsThis was an observational study using data obtained from the Global Burden of Disease Study on residents of the UK and of the 27 EU countries. The main outcome measures were ILD age-standardised incidence rates per 100 000 (ASIR), age-standardised death rates per 100 000 (ASDR) and mortality-to-incidence ratios (MIRs), which are presented for men and women separately for each country for the years 2001–2017. Trends were analysed using joinpoint regression analysis.ResultsIn 2017, the median incidence of ILD was 7.22 (IQR 5.57–8.96) per 100 000 population for men and 4.34 (IQR 3.36–6.29) per 100 000 population for women. In 2017, the median ASDR attributed to ILD was 2.04 (IQR 1.13–2.71) per 100 000 population for men and 1.02 (0.68–1.37) per 100 000 population for women. There was an overall increase in ASDR during the observation period, with a median increase of +20.42% (IQR 5.44–31.40) for men and +15.44% (IQR −1.01–31.52) for women. Despite increases in mortality over the entire observation period, there were decreasing mortality trends in the majority of countries at the end of the observation period (75% for men and 86% for women).ConclusionOver the past two decades, there have been increases in the incidence and mortality of ILD in Europe. The most recent trends, however, demonstrate decreases in mortality from ILD in the majority of European countries for both men and women. These data support the ongoing improvements in the diagnosis and management of ILD.

Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020.

ObjectiveCancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries.MethodsThe estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles.ResultsIn Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 – 1.3 million] and 711,429 [611,604 – 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa.ConclusionHigh cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.

Cancer Burden Among Arab World Males in 2020: The Need for a Better Approach to Improve Outcome.

PURPOSECancer is a leading cause of increased morbidity and mortality worldwide. This work aims to study the Arab world males' cancers (AMCs) and the similarities and disparities with the world males' cancers (WMCs) from different burden points of view.MATERIALS AND METHODSA descriptive review of the 2020 Global Cancer Observatory revealed AMCs compared with the 2020 WMCs and the 2018 AMCs. Data on the top 27 AMCs were compared among the region's countries and the world groups.RESULTSIn 2020, a total estimate of 217,203 new AMCs, 2.2% of WMCs, with an average age-standardized rate of 133.5/100,000 population, compared with 222/100,000 population of WMCs, was observed. Death estimates were 148,395, 2.7% of WMCs, with an average age-standardized rate of 95/100,000 population, compared with 120.8/100,000 population of WMCs. The five-year prevalence was observed in 442,014, 1.8% of WMCs. The average AMC mortality to incidence ratio (MIR) was 0.68, compared with 0.55 in WMCs and 0.54 in Arab females. Lung cancer was the top in incidence and mortality, whereas penile cancer was the lowest. The range of MIRs among the 27 cancer types was 0.19-0.96.CONCLUSIONThe descriptive review of the 2020 males' cancers in the Arab world revealed a relatively high MIR, compared with males' cancers worldwide and the females' cancers in the Arab world. This requires further evaluation to discern the underlying causes and address them systematically. More cancer control actions are warranted.

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

BackgroundLiver cancer (LC) is considered as one of the most dominant malignant tumors which ranked 4th and 6th 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.MethodsThe 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).ResultsThe 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).ConclusionsOur 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.

Cancer Burden Among Arab-World Females in 2020: Working Toward Improving Outcomes.

PURPOSECancer is the leading cause of morbidity and mortality worldwide. This work presents the Arab-world females' cancers (AFCs) statistics in 2020, compared with the 2018 AFCs statistics, the Arab-world male cancers statistics, and the world females' cancers (WFCs) statistics in 2020. This can help set the stage for a better policy for cancer control programs and improve outcomes.MATERIALS AND METHODSA descriptive review of the 2020 Global Cancer Observatory concerning AFCs was performed. Data on various cancers were compiled and compared among the countries in the region and WFCs.RESULTSA total estimate of 244,317 new cases and 132,249 deaths is reported in AFCs; representing 2.65% and 2.99% of WFCs, respectively, with an average crude incidence/mortality ratio of 116.2 (/100,000 population)/62.9 (/100,000 population) and an age-standardized incidence/mortality ratio of 137.7(/100,000 population)/77.2(/100,000 population) compared with 238.8(/100,000 population)/114.6(/100,000 population) and 186(/100,000 population)/84.2(/100,000 population) of WFCs, respectively. Five-year prevalent cases were 585,295; 2.28% of WFCs. In comparison to males, females accounted for 47.8% of the whole population, 52.9% in incidence, 46.9% in mortality, and 56.9% in the prevalence of patients with cancer. Mortality-to-incidence ratio (MIR) was 0.54 (range 0.39-0.62 in Arab countries, compared with 0.48 globally), and it ranged from 0.14 to 0.97 in the 30 AFC types. Breast cancer was the most common cancer in incidence and mortality, with an MIR of 0.39.CONCLUSIONThe 2020 descriptive analysis of the females' cancers in the Arab world revealed a relatively high MIR compared with females' cancers worldwide; a lower MIR compared with the males; and comparable MIR to 2018 one. We call for more in-depth studies to determine the causes of these differences that might translate into actionable interventions and better outcomes.

Trends in disease burden from prostate cancer amongst different regions of the world and extensively the European Union 15+ countries, from 1990 to 2019: Estimates from the Global Burden of Disease study.

187 Background: Prostate cancer was the third most commonly diagnosed cancer in 2020 and the fifth leading cause of cancer mortality worldwide. Global variations in the burden of prostate cancer have been observed in the past decades. This study aimed to assess the trends in incidence, mortality, and disability-adjusted life years from prostate cancer in the World Health Organization (WHO) regions and extensively in the European Union (EU) 15+ countries from 1990 to 2019. Methods: The Global Burden of Disease Study database was used to extract the mortality data of prostate cancer, based on the International Classification of Diseases versions 10 and 9. Data acquired for different WHO regions and each country of the EU15+ nations, per year from 1990 to 2019, included age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and disability-adjusted life years (DALYs). Mortality-to-incidence ratios (MIR) were then computed. Trends were assessed using Joinpoint regression. Results: Between 1990 and 2019, ASIRs increased worldwide (+13.16%), except in the American region, with the largest growth in the Eastern Mediterranean Region (EMR) (+72.43%). While ASDRs and DALYs increased in Africa, South-East Asia, and EMR, they decreased in the Americas, Europe, and Western Pacific Region (WPR). MIRs decreased universally (-25.52%), mainly in the WPR (-43.49%). In EU15+ countries, ASIRs increased in all countries, except for Canada (-11.27%) and the United States of America (USA) (-10.37%), with the largest rise in Finland (+75.11%). ASDRs decreased in all countries, with the widest drop in Luxembourg (-41.89%) and the lowest in Denmark (-13.96%). MIRs decreased in all countries, with the highest drop in Finland (-55.37%). Similarly, DALYs decreased in all countries, with the highest decrease in Luxembourg (-40.56%). In 2019, the highest ASIR was in the USA (118.24/100,000), whereas Denmark had the highest ASDR (31.35/100,000), MIR (0.38/100,000), and DALY (498.03/100,000). Conclusions: Over the 30 years, the incidence of prostate cancer has been rising worldwide, excluding Canada and the USA. However, the universal decrease of MIRs highlights improved outcomes and efficient screening and therapeutic strategies. All indices are represented per 100,000 population.[Table: see text]

Trends of kidney cancer burden from 1990 to 2019 in European Union 15+ countries.

393 Background: Kidney cancer is among the most common cancers worldwide and is increasing in incidence. During 2020, around 400,000 new cases of kidney cancer were reported, with 180,000 estimated deaths. In recent decades, significant variability in the incidence and mortality of kidney cancer has been universally reported. This study aimed to compare geographical trends in incidence, mortality, and disability-adjusted life years from kidney cancer between European Union (EU) 15+ countries from 1990 to 2019. Methods: The mortality data of kidney cancer were extracted from the Global Burden of Disease Study database. Versions 10 and 9 of the International Classification of Diseases were adopted. Age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and disability-adjusted life years (DALYs) were collected, per year and per country of the EU15+ group. Mortality-to-incidence ratios (MIR) were calculated. Data was then dichotomized into males and females. Joinpoint regression was done for analysis of trends. Results: From 1990 to 2019, ASIRs increased in most of the countries except for Luxembourg for males, the United States of America (USA) for females, and Austria and Sweden for both sexes. The largest rises of ASIRs were in Denmark for males and females (+89.3% and +82.8%, respectively). ASDRs increased in 10/19 countries for males and 9/19 in females, with the highest rise in Denmark for males and females (+41.7% and +37.7% respectively), and the largest drop in Austria for males and females (-33.8% and -35.8% respectively). MIRs decreased in all countries, for both sexes, with the widest declines in Portugal for males (-29.0%) and in Ireland for females (-26.6%). Trends in DALYs were variable, with the highest rise in Denmark for males and females (+38.6% and +30.2% respectively) and the largest drop in Austria for males and females (-39.5% and -41.2%, respectively). In 2019, the highest ASIR was observed in the USA for males (16.7/100,000) and in Finland for females (8.3/100,000), the highest ASDR in the Netherlands for males (6.1/100,000) and Finland for females (3.0/100,000), highest MIR in Sweden for both genders (0.6/100,000 each), and highest DALYs in the Netherlands for males (132.3/100,000) and in Finland for females (62.6/100,000). Conclusions: The incidence and mortality from kidney cancer rose in most EU15+ countries from 1990 to 2019. Interestingly, an improvement in the outcomes is predicted by the drop in MIR in all countries.[Table: see text]

An observational epidemiological study to analyze intracerebral hemorrhage across the United States: Incidence and mortality trends from 1990 to 2017

ObjectivesIntracerebral Hemorrhage (ICH) accounts for 10% of strokes annually in the United States (US). Up-to-date trends in disease burden and regional variations remain unknown. Our study reports updated trends of ICH incidence, mortality, and mortality to incidence ratio (MIR) across the US. Materials and MethodsObservational study to evaluate the incidence and mortality from ICH across the US. Data was obtained from Global Burden of Disease (GBD) database. Age-Standardized Incidence (ASIRs) and Death (ASDRs) Rates, as well as the Mortality- to-Incidence ratios (MIRs) for ICH in the US overall and state-wise from 1990-2017. Joinpoint regression analysis was used, with presentation of estimated annual percentage changes (EAPCs). ResultsOverall decrease in ASIRs, ASDRs, and MIRs in the US for both sexes. The 2017 mean ASIR was 25.67/100,000 for men and 19.17/100,000 for women, whereas mean ASDR was 13.96/100,000 for men and 11.35/100,000 for women. District of Columbia had greatest decreases in ASIR EAPCs for both men and women at -41.25% and -40.58%, respectively, and greatest decreases in ASDR EAPCs for men and women at -55.38% and -48.51%, respectively. MIR between 1990-2017 decreased in men by -12.12% and women by -7.43%. MIR increased in men from 2014-2017 (EAPC +2.2%) and in women from 2011-2017 (EAPC +1.0%). ConclusionDecreasing trends in incidence, mortality, and MIR. No significant trends in mortality were found in the last 6 years of the study period. MIR worsened in males from 2014-2017 and females from 2011-2017, suggesting decreased ICH-related survival lately.

Mapping of global, regional and national incidence, mortality and mortality-to-incidence ratio of lung cancer in 2020 and 2050.

AimLung cancer is the leading cause of cancer deaths worldwide. This study examines the current and future burden of lung cancer at global, regional, and national levels.MethodsThe estimates of lung cancer incident cases, deaths, and their age-standardized rates are drawn from GLOBOCAN 2020 for 21 regions and 185 countries. Mortality-to-incidence ratio (MIR) is considered as a proxy indicator of 5-year survival rates. Lung cancer burden in 2050 is projected using age-specific incidence and death rates in 2020.ResultsIn 2020, there were 2.21 million new cases and 1.8 million deaths due to lung cancer worldwide with age-standardized incidence rate (ASIR) of 22.4/100,000 (male: 31.5; female: 14.6) and age-standardized mortality rates (ASMR) of 18.0/100,000, (male: 25.9; female: 11.2/100,000). Global MIR of lung cancer was 0.82 (males 0.83; females: 0.79), varying from 0.59 (Japan) to 1.0 (Belize). Hungary had the highest age-standardized rates (ASIR: 50.1/100,000; ASMR: 42.4/100,000) and Nigeria (ASIR: 0.88; ASMR: 0.86) had the lowest age-standardized rates in 2020. Both ASIR and ASMR were positively correlated with country-level tobacco smoking prevalence and human development index (HDI), whereas MIR exhibited a negative correlation with HDI. As per our projections, there will be 3.8 million incident cases and 3.2 million deaths globally due to lung cancer in 2050.ConclusionWith close to 2 million cases and deaths already in 2020, lung cancer has already become a global public health threat. Even with current risk levels and age-specific rates, lung cancer annual cases are expected to reach 3.8 million in 2050. Until smoking prevalence is reduced and ambient air pollution levels are checked, particularly in low/medium HDI countries, the lung cancer epidemic will continue unfolding.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10147-021-02108-2.

The relationship between urologic cancer outcomes and national Human Development Index: trend in recent years

ObjectivesTo describe the influence of the socioeconomic development on worldwide age-standardized incidence and mortality rates, as well as mortality-to-incidence ratio (MIR) and 5-year net survival of urologic cancer patients in recent years.MethodsThe Human Development Index (HDI) values were obtained from the United Nations Development Programme, data on age-standardized incidence/mortality rates of prostate, bladder and kidney cancer were retrieved from the GLOBOCAN database, 5-year net survival was provided by the CONCORD-3 program. We then evaluated the association between incidence/MIR/survival and HDI, with a focus on geographic variability as well as temporal patterns during the last 6 years.ResultsUrologic cancer incidence rates were positively correlated with HDIs, and MIRs were negatively correlated with HDIs. Prostate cancer survival also correlated positively with HDIs, solidly confirming the interrelation among cancer indicators and socioeconomic factors. Most countries experienced incidence decline over the most recent 6 years, and a substantial reduction in MIR was observed. Survival rates of prostate cancer have simultaneously improved.ConclusionDevelopment has a prominent influence on urologic cancer outcomes. HDI values are significantly correlated with cancer incidence, MIR and survival rates. HDI values have risen along with increased incidence and improved outcomes of urologic caner in recent years.

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019.

SummaryBackgroundIn estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults.MethodsUsing the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults.FindingsThere were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally.InterpretationAdolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts.FundingBill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute.

Density of Health Workforce Correlates to Disease Outcomes: Evidence From Global Data in Otolaryngology.

ObjectiveTo better understand the impact of the otolaryngology-specific workforce on the burden of related diseases.Study DesignRetrospective analysis of existing workforce density data as compared with the incidence, mortality, and morbidity data for 4 otolaryngologic diseases.SettingAn overall 138 countries with known otolaryngology–head and neck surgery workforce and epidemiologic data.MethodsWe obtained raw data on workforce estimates of ear, nose, and throat surgical specialists from the World Health Organization. Disease burdens for 4 conditions were estimated via 2 ratios, the mortality:incidence ratio (MIR) and YLD:incidence ratio (years lost to disability), as specified in the Global Burden of Disease database. These were correlated to country-specific otolaryngologist density data in univariate and multivariate analyses.ResultsIncreased density of the ear, nose, and throat workforce correlated with better outcomes for otolaryngologic-treated surgical diseases. A 10% increase in otolaryngology workforce density was associated with a 0.27% reduction in YLD:incidence ratio for chronic otitis media, a 0.94% reduction in MIR for lip and oral cavity cancer, a 1.46% reduction in MIR for laryngeal cancer, and a 1.34% reduction in MIR for pharyngeal cancer (all P < .001)—an effect that remained after adjustment for health systems factors for all conditions but chronic otitis media.ConclusionThe density of the surgical workforce is assumed to affect disease outcomes, but ours is the first analysis to show that increased workforce density for a specific surgical specialty correlates with improved disease outcomes. While there is a consensus to increase access to health care providers, quantifying the effect on disease outcomes is an important metric for those performing health economics modeling, particularly where resources are limited.

Association between the Leukemia Mortality-to-Incidence Ratio and State Geographic Healthcare Disparities in the United States

INTRODUCTION: Leukemia is the seventh leading cause of cancer death in the United States (US) in 2021. The Mortality Incidence Rate Ratio, also known as Mortality-to-Incidence Ratio (MIR), is calculated by dividing the mortality rate by the incidence rate for selected cancers and population. The MIR provides a population-based indicator of cancer survival which has previously been used to assess healthcare disparities among different countries. Here weevaluated the potential association between leukemia MIR and state-based health disparities in the US.METHODS: Leukemia (AML, CML, ALL, CLL and other leukemias) MIRs for 2008-2017 were obtained from United States Cancer Statistics (USCS) database provided by the Centers for Disease Control and Prevention (CDC). America's Health Rankings (AHR), a partnership of the United Health Foundation and the American Public Health Association, evaluates the nation's health on a state-by-state basis by using weighted measures in 5 different categories (25% for Behaviors, 22.5% for Community & Environment, 12.5% for Policy, 15% for Clinical Care, and 25% for Outcomes). AHR then determines state health rankings and reflects state health disparities based on these specific factors. Here we analyzed the potential association between leukemia MIRs and state health rankings by linear regression.RESULTS: From 2008 to 2017, a total of 489,037 people were diagnosed with leukemia and 231,069 people died from leukemia in the US. The 10-year average of age-adjusted incidence rate and mortality rate were 14.2 and 6.7 per 100,000 population respectively. The average MIR between all states was calculated to be 0.470. As seen in Table 1, the lowest MIR (best survival) was found in Florida (0.374), New York (0.391), and New Jersey (0.412) with AHR 34, 19 and 11 respectively. The highest MIR (worst survival) was found in Mississippi (0.579), Wyoming (0.570), and Ohio (0.569) with AHR 50, 24 and 37 respectively. According to AHR, over the last decade, the states with the highest health rankings were reported in Vermont (No. 1), Hawaii (No. 2), and Massachusetts (No. 3) with MIR 0.508, 0.439 and 0.502 respectively. The states with the lowest health rankings were reported in Arkansas (No. 48), Louisiana (No. 49), and Mississippi (No. 50) with MIR 0.559, 0.503 and 0.579 respectively. In our analysis, states with better health rankings were significantly associated with lower MIRs (R 2=0.232, P<0.001), as seen in Figure 1.CONCLUSIONS: There is a remarkable geographic difference in leukemia MIRs in the US between 2008-2017. Leukemia MIR was significantly associated with state health rankings reported by the AHR. Although the quality of clinical care for leukemia patients remains to be an important predictor of mortality, our findings suggest that other aggregate determinants of health, including social, economic, and community and physical environment may also play a vital role in influencing leukemia survival. More in-depth analysis of these data focusing on specific leukemia subtypes as well as other factors (race, gender, age) may be helpful in identifying and addressing other non-medical issues negativity impacting on leukemia outcomes in different geographical regions in the United States. [Display omitted] DisclosuresWang: Kura Oncology: Consultancy, Honoraria, Other: Advisory board, steering committee, Speakers Bureau; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees; Stemline Therapeutics: Consultancy, Honoraria, Other: Advisory board, Speakers Bureau; Kite Pharmaceuticals: Consultancy, Honoraria, Other: Advisory Board; Takeda: Consultancy, Honoraria, Other: Advisory board; Pfizer: Consultancy, Honoraria, Other: Advisory Board, Speakers Bureau; Novartis: Consultancy, Honoraria, Other: Advisory Board; Mana Therapeutics: Consultancy, Honoraria; BMS/Celgene: Membership on an entity's Board of Directors or advisory committees; Genentech: Membership on an entity's Board of Directors or advisory committees; GlaxoSmithKline: Consultancy, Honoraria, Other: Advisory Board; Jazz Pharmaceuticals: Consultancy, Honoraria, Other: Advisory Board; DAVA Oncology: Consultancy, Speakers Bureau; Rafael Pharmaceuticals: Other: Data safety monitoring committee; Gilead: Consultancy, Honoraria, Other: Advisory board; Daiichi Sankyo: Consultancy, Honoraria, Other: Advisory board; PTC Therapeutics: Consultancy, Honoraria, Other: Advisory board; Genentech: Consultancy; MacroGenics: Consultancy.

Global, regional and national burden of bladder cancer and its attributable risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019

IntroductionThe current study determined the level and trends associated with the incidence, death and disability rates for bladder cancer and its attributable risk factors in 204 countries and territories, from...

Spatial analysis of colorectal cancer outcomes and socioeconomic factors in Virginia

BackgroundColorectal cancer (CRC) disparities vary by country and population group, but often have spatial features. This study of the United States state of Virginia assessed CRC outcomes, and identified demographic, socioeconomic and healthcare access contributors to CRC disparities.MethodsCounty- and city-level cross-sectional data for 2011–2015 CRC incidence, mortality, and mortality-incidence ratio (MIR) were analyzed for geographically determined clusters (hotspots and cold spots) and their correlates. Spatial regression examined predictors including proportion of African American (AA) residents, rural-urban status, socioeconomic (SES) index, CRC screening rate, and densities of primary care providers (PCP) and gastroenterologists. Stationarity, which assesses spatial equality, was examined with geographically weighted regression.ResultsFor incidence, one CRC hotspot and two cold spots were identified, including one large hotspot for MIR in southwest Virginia. In the spatial distribution of mortality, no clusters were found. Rurality and AA population were most associated with incidence. SES index, rurality, and PCP density were associated with spatial distribution of mortality. SES index and rurality were associated with MIR. Local coefficients indicated stronger associations of predictor variables in the southwestern region.ConclusionsRurality, low SES, and racial distribution were important predictors of CRC incidence, mortality, and MIR. Regions with concentrations of one or more factors of disparities face additional hurdles to improving CRC outcomes. A large cluster of high MIR in southwest Virginia region requires further investigation to improve early cancer detection and support survivorship. Spatial analysis can identify high-disparity populations and be used to inform targeted cancer control programming.