Mortality-to-incidence Ratio Research Articles

Favorable cervical cancer mortality-to-incidence ratios of countries with good human development index rankings and high health expenditures

BackgroundCervical cancer is highly preventable. The mortality-to-incidence ratio (MIR) is a marker that reflects the available screening interventions and clinical outcomes of cancer treatments. The association between the MIR for cervical cancer and cancer screening disparities among countries is an interesting issue but rarely investigated. The present study sought to understand the association between the cervical cancer MIR and the Human Development Index (HDI).MethodsCancer incidence and mortality rates were obtained from the GLOBOCAN database. The MIR was defined as the ratio of the crude mortality rate to the incidence rate. We used linear regression to analyze the correlation of MIRs with the HDI and current health expenditure (CHE) in 61 countries selected based on data quality.ResultsThe results showed lower incidence and mortality rates and MIRs in more developed regions. In terms of regional categories, Africa had the highest incidence and mortality rates and MIRs. The incidence and mortality rates and MIRs were lowest in North America. Furthermore, favorable MIRs were correlated with a good HDI and high CHE as a percentage of gross domestic product (CHE/GDP) (both p < 0.0001).ConclusionsThe MIR variation for cervical cancer is associated with the ranking of the health system and health expenditure, which further supports the role of cancer screening and treatment disparities in clinical outcomes. The promotion of cancer screening programs can reduce the cervical cancer global incidence and mortality rates and MIRs.

The Global Macroeconomic Burden of Burn Injuries.

Standardized estimates of global economic losses from burn injuries are lacking. The primary objective of this study was to determine the global macroeconomic consequences of burn injuries and their geographic distribution. Using the Institute of Health Metrics and Evaluation database (2009 and 2019), mean and 95% uncertainty interval (UI) data on incidence, mortality, and disability-adjusted life-years (DALYs) from injuries caused by fire, heat, and hot substances were collected. Gross domestic product (GDP) data were analyzed together with DALYs to estimate macroeconomic losses globally using a value of lost welfare approach. There were 9 million global burn cases (95% UI, 6.8 to 11.2 million) and 111,000 deaths from burns (95% UI, 88,000 to 132,000 deaths) in 2019, representing a total of 7.5 million DALYs (95% UI, 5.8 to 9.5 million DALYs). This represented welfare losses of $112 billion (95% UI, $78 to $161 billion), or 0.09% of GDP (95% UI, 0.06% to 0.13%). Welfare losses as a share of GDP were highest in low- and middle-income countries (LMICs) of Oceania (0.24%; 95% UI, 0.09% to 0.42%) and Eastern Europe (0.24%; 95% UI, 0.19% to 0.30%) compared with high-income country regions such as Western Europe (0.06%; 95% UI, 0.04% to 0.09%). Mortality-incidence ratios were highest in LMIC regions, highlighting a lack of treatment access, with southern sub-Saharan Africa reporting a mortality-incidence ratio of 40.1 per 1000 people compared with 1.9 for Australasia. Burden of disease and resulting economic losses because of burn injuries are substantial worldwide and are disproportionately higher in LMICs. Possible effective solutions include targeted education, advocacy, and legislation to decrease incidence and investing in existing burn centers to improve treatment access.

Patterns of better breast cancer care in countries with higher human development index and healthcare expenditure: Insights from GLOBOCAN 2020.

The huge burden of breast cancer (BC) necessitates the profound and accurate knowledge of the most recent cancer epidemiology and quality of care provided. We aimed to evaluate BC epidemiology and quality of care and examine the effects of socioeconomic development and healthcare expenditure on disparities in BC care. The results from the GLOBOCAN 2020 study were utilized to extract data on female BC, including incidence and mortality numbers, crude rates, and age-standardized rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)]. The mortality-to-incidence ratio (MIR) was calculated for different locations and socioeconomic stratifications to examine disparities in BC care, with higher values reflecting poor quality of care and vice versa. In both descriptive and analytic approaches, the human development index (HDI) and the proportion of current healthcare expenditure (CHE) to gross domestic product (CHE/GDP%) were used to evaluate the values of MIR. Globally, 2,261,419 (95% uncertainty interval (UI): 2,244,260-2,278,710) new cases of female BC were diagnosed in 2020, with a crude rate of 58.5/100,000 population, and caused 684,996 (675,493-694,633) deaths, with a crude rate of 17.7. The WHO region with the highest BC ASIR (69.7) was Europe, and the WHO region with the highest ASMR (19.1) was Africa. The very high HDI category had the highest BC ASIR (75.6), and low HDI areas had the highest ASMR (20.1). The overall calculated value of female BC MIR in 2020 was 0.30, with Africa having the highest value (0.48) and the low HDI category (0.53). A strong statistically significant inverse correlation was observed between the MIR and HDI values for countries/territories (Pearson's coefficient = -0.850, p-value < 0.001). A significant moderate inverse correlation was observed between the MIR and CHE/GDP values (Pearson's coefficient = -0.431, p-value < 0.001). This study highlighted that MIR of BC was higher in less developed areas and less wealthy countries. MIR as an indicator of the quality of care showed that locations with higher healthcare expenditure had better BC care. More focused interventions in developing regions and in those with limited resources are needed to alleviate the burden of BC and resolve disparities in BC care.

Epidemiological landscape of esophageal cancer in Asia: Results from GLOBOCAN 2020.

Esophageal cancer (EC) is a global health problem. Asia represents a huge burden of EC globally, and incidence and mortality vary considerably across different Asian regions. Data on incidence, mortality, and preference were extracted from GLOBOCAN 2020. Age-standardized incidence and mortality rates were calculated overall by sex, age, country, region, and continent. The predicted burden of incidence and mortality in 2040 was calculated based on global demographic projections. It was estimated there were 481 552 new cases of and 434 363 deaths from EC in Asia in 2020, accounting for 79.7% and 79.8% of world EC cases and deaths, respectively. EC incidence and mortality in Asia ranked the highest among all continents. Eastern Asia represents the highest age-standardized world incidence rate (ASWIR) of 12.3 per 100 000 for all Asian regions. Western Asia represents the lowest ASWIR of 1.7 per 100 000, accounting for 0.7% of the globe. There exist obvious differences in epidemiological features in Asian countries, including incidence, mortality, prevalence, and mortality incidence ratio. There is forecast to be up to 781 000 new cases of EC in Asia by 2040, with increasing rates of 63% for incidence and 72% for mortality from 2020. Asia has an increasing number of EC cases and deaths. Strategies for targeting in high-incidence areas, the elderly, and survival should be prioritized to reduce the global EC burden, especially in low- and middle-income countries in Asia.

Trends and risk factors of global incidence, mortality, and disability of genitourinary cancers from 1990 to 2019: Systematic analysis for the Global Burden of Disease Study 2019.

The incidence of kidney, bladder, and prostate cancer ranked ninth, sixth, and third in male cancers respectively, meanwhile, the incidence of testicular cancer also increased gradually in the past 30 years. To study and present estimates of the incidence, mortality, and disability of kidney, bladder, prostate, and testicular cancer by location and age from 1990 to 2019 and reveal the mortality risk factors of them. The Global Burden of Diseases Study 2019 was used to obtain data for this research. The prediction of cancer mortality and incidence was based on mortality-to-incidence ratios (MIRs). The MIR data was processed by logistic regression and adjusted by Gaussian process regression. The association between the socio-demographic index and the incidence or disease burden was determined by Spearman's rank order correlation. Globally in 2019, there were 371,700 kidney cancer cases with an age-standardized incidence rate (ASIR) of 4.6 per 100,000, 524,300 bladder cancer cases, with an ASIR of 6.5 per 100,000, 1,410,500 prostate cancer cases with an ASIR of 4.6 per 100,000 and 109,300 testicular cancer incident cases with an ASIR of 1.4 per 100,000, the ASIR of these four cancers increased by 29.1, 4, 22, and 45.5% respectively. The incidence rate of the four cancers and the burden of kidney cancer were positively correlated with the socio-demographic index (SDI), regions with a higher SDI faced more of a burden attributable to these four cancers. High body-mass index has surpassed smoking to be the leading risk factor in the past thirty years for kidney cancer mortality. Smoking remained the leading risk factor for cancer-related mortality for bladder cancer and prostate cancer and the only risk factor for prostate cancer. However, the contribution of high fasting plasma glucose to bladder cancer mortality has been increasing. The incidence of bladder, kidney, prostate, and testicular cancer is ever-increasing. High-income regions face a greater burden attributable to the four cancers. In addition to smoking, metabolic risk factors may need more attention.

Favorable Mortality-to-Incidence Ratio Trends of Lung Cancer in Countries with High Computed Tomography Density

Background and Objectives: The prognoses of lung cancer deteriorate dramatically as the cancer progresses through its stages. Therefore, early screening using techniques such as low-dose computed tomography (LDCT) is critical. However, the epidemiology of the association between the popularization of CT and the prognosis for lung cancer is not known. Materials and Methods: Data were obtained from GLOBOCAN and the health data and statistics of the World Health Organization. Mortality-to-incidence ratios (MIRs) and the changes in MIR over time (δMIR; calculated as the difference between MIRs in 2018 and 2012) were used to evaluate the correlation with CT density disparities via Spearman's rank correlation coefficient. Results: Countries with zero CT density presented a relatively low incidence crude rate and a relatively high MIR in 2018 and a negative δMIR. Conversely, countries with a CT density over 30 had a positive δMIR. The CT density was significantly associated with the HDI score and MIR in 2018, whereas it demonstrated no association with MIR in 2012. The CT density and δMIR also showed a significant linear correlation. Conclusions: CT density was significantly associated with lung cancer MIR in 2018 and with δMIR, indicating favorable clinical outcomes in countries in which CT has become popularized.

Improved Trends in the Mortality-to-Incidence Ratios for Liver Cancer in Countries with High Development Index and Health Expenditures.

Primary liver cancer is one of the leading causes of death globally. Liver cancer has a unique geographical distribution, as its etiologies include chronic viral infections and aging. We hypothesize that the human development index (HDI), current health expenditure (CHE) per capita, and CHE-to-gross domestic product ratio (CHE/GDP) influence the incidence, mortality, and mortality-to-incidence ratios (MIRs) of liver cancer worldwide. Data were obtained from the Global Cancer Observatory (GLOBOCAN) database and the World Health Organization. MIRs and the changes in MIR over time (δMIR) were used to evaluate the correlation of expenditures on healthcare and the HDI disparities via Spearman's rank correlation coefficient. The crude incidence and mortality were significantly associated with HDI, CHE per capita, and CHE/GDP. Specifically, there were significant associations between δMIR and HDI, as well as between δMIR and CHE per capita. However, there were no significant associations between δMIR and CHE/GDP. Evidently, a favorable liver cancer δMIR was not associated with CHE/GDP, although it had a significant association with HDI and CHE per capita. These results are worthy of the attention of public health systems in correlation to improved outcomes in liver cancer.

COMPARISON OF TEMPORAL TRENDS IN THE GLOBAL BURDEN OF TRACHEA, BRONCHIAL, AND LUNG CANCER

Trachea, bronchial, and lung (TBL) cancers are significant public health problems among the leading causes of death in Turkey and the world. In this study, it was aimed to determine and evaluate the temporal trends of incidence, mortality, and DALY rates of TBA cancers between 1990 and 2019. Mortality-Incidence Ratio (MIR) and Joinpoint Regression Analysis (JRA) methods were used in this study. Incidence, mortality, and disability-adjusted life-years were used as variables in the study. The temporal trends of TBL cancers were compared between the global, Turkey, and Socio-Demographic Index (SDI) groups. In this study, it was determined that the age-standardized global burden of TBL cancers tended to decrease between 1990 and 2019. While the burden of TBL cancers tended to decline in high SDI countries during this period, it tended to increase in low SDI countries. In Turkey, while the TBL cancers burden decreased until 2005, it increased after 2006. While the global cancer burden of TBL tended to decline in men, it tended to increase in women during this period. According to the data obtained from the research findings, the burden of TBL cancers tends to decrease globally. However, it tends to increase in low and low-middle SDI group countries. To reduce the TBL global cancer burden, it is recommended that health policies should be developed in both Turkey and international health systems for fair access to cancer treatment.

Trends of kidney cancer burden from 1990 to 2019 in European Union 15 + countries and World Health Organization regions

In recent decades, variability in the incidence and mortality of kidney cancer (KC) has been reported. This study aimed to compare trends in incidence, mortality, and disability-adjusted life years (DALY) of KC between the European Union (EU) 15 + countries and 6 World Health Organization (WHO) regions. The data of KC Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and age-standardized DALYs were extracted from the Global Burden of Disease database. Joinpoint regression was employed to examine trends. From 1990 to 2019, the ASIR increased in most countries except for Luxembourg (males), the USA (females) and Austria and Sweden (both sexes). ASIR increased across all 6 WHO regions for both sexes except for females in Americas. The ASMR increased in 10/19 countries for males and 9/19 for females as well across most WHO regions. The mortality-to-incidence ratio (MIR) decreased in all countries and WHO regions. Trends in DALYs were variable across countries and WHO regions. While the incidence and mortality from KC rose in most EU15 + countries and WHO regions from 1990 to 2019, the universal drop in MIR suggests an overall improvement in KC outcomes. This is likely multifactorial, including earlier detection of KC and improved treatments.

The Study on Cervical Cancer Burden in 127 Countries and Its Socioeconomic Influence Factors

ObjectivesTo explore the relationship between cervical cancer burden and HDI and other socioeconomic influence factors in 127 countries.MethodsDividing 127 countries into low-, medium-, high-, ultrahigh-HDI groups, and using statistical method to compare the prevalence trend of cervical cancer in different HDI country groups. Then selecting mortality-to-incidence ratio (MIR) to measure the cancer burden as the dependent variable, HDI and other socioeconomic factors selected from 2020 Human Development Report as independent variables, and using multi-regression model to analyze the correlation between variables.ResultsCountries with higher HDI were found to have lower prevalence and mortality of cervical cancer, and vice versa. Besides that, air and water pollution, government-coordinated spending, and the intimate partner of 15–49-year-old women and girls have positive correlation impact on cervical cancer burden.DiscussionThe cancer prevention and control policies in countries with high HDI have achieved relatively ideal implementation effects. Countries with relatively backward social and economic development level, cancer prevention and control policies had little effect, such as lower HPV vaccination coverage, poor regional health resource allocation, and week public education awareness. Therefore, cervical cancer control plan must be integrated into national strategies and implemented in people-oriented comprehensive health services.

Spatial and temporal patterns of colorectal cancer in Asia, 1990-2019.

Asia accounts for the largest burden of colorectal cancer (CRC) worldwide. This study examines the temporal patterns of CRC in Asia in the last three decades. The data pertaining to CRC burden measured by incidence, mortality, and disability-adjusted-life-years (DALYs) and its risk factors for 49 countries in the Asian continent were drawn from the Global Burden of Disease 2019 study between 1990 and 2019. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates. In Asia, incident cases more than tripled from 270,851 to 1.1 million, deaths tripled from 183,252 to 560,426, and DALYs more than doubled from 5 million to 13.4 million between 1990 and 2019. The age-standardized incidence rate (ASIR) increased from 14.0/100,000 to 23.9/100,000, age-standardized mortality rate (ASMR) increased from 10.1/100,000 to 12.5/100,000, and MIR decreased from 0.68 to 0.50 between 1990 and 2019. ASIR varied 10-folds across countries from 5.6/100,000 in Bangladesh to 62.0/100,000 in Taiwan in 2019 and ASMR from 4.9/1000 in Bangladesh to 30.3/100,000 in Brunei. In 2019, diet low in milk (18.7%) and whole grains (15.2%) and calcium (16.6%) were the major contributory risk factors in CRC DALYs in 2019. CRC is a fast-rising neoplasm in Asia and its burden can be curtailed by focusing on primary prevention (e.g., diet and physical activity) and secondary prevention through screening. The policy focus and resources must be directed towards capacity building, including cancer infrastructure and quality data availability from cancer registries.

Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9-21·3), as well as among the young (22·5, 19·9-24·7), working (17·2, 15·2-19·1), and post-working (15·1, 13·2-17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6-33·0) on average in low-SDI countries to 83·4 (82·4-84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4-89·0), working (33·8-82·8), and post-working (30·4-79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. Bill & Melinda Gates Foundation.

Epidemiology of Bladder Cancer in the Arab World: 2019 Global Burden of Disease Data.

Urinary bladder cancer (UBC) has unique epidemiology. It is well known that some Arab countries have higher incidence of UBC due to certain risk factors, including schistosomiasis and smoking. We systematically reviewed the Global Burden of Disease study (GBD) database for the year 2019. We queried GBD study database using results tool for UBC in the 22 Arab countries and compared the age-standardized incidence rate (ASIR), death rate (ASDR), mortality-to-incidence ratio (MIR) and Disability-Adjusted Life Years (ASDALYs) in Arab countries with global values. The Arab population represents 5.6% of the global population. There was an estimated number of 27,503 patients diagnosed with UBC in 2019 in the Arab world. The ASIR for developing UBC in the Arab countries was 9.9/100,000; which is higher than the average global ASIR (6.5/100,000). Specifically, the ASIR was higher than the global average in 11 out of the 22 Arab countries. Notably, the age-specific incidence in Egypt showed that younger individuals had higher incidence of UBC than other countries, reflecting unique epidemiology. It is estimated that 10,532 patients died of UBC in the Arab world in 2019. The average mortality-to-incidence ratio (MIR) was estimated to be 0.448. The burden of UBC as estimated by the number of DALYs in the Arab world was 272,976 years representing 4% of cancer burden in Arab countries and 6.2% of the global DALYs related to UBC. UBC has high incidence in many Arab countries, particularly in North Africa. Risk factors are known and are modifiable, making prevention the most optimal way to reduce disease burden. High MIR in many Arab countries reflects suboptimal management and a window for improvement.

Mortality-to-Incidence Ratio for Nasopharyngeal Carcinoma Is Associated with Health Expenditure.

Geographic and gender-specific disparity can be observed in nasopharyngeal carcinoma (NPC). While screening and more effective therapies, such as induction chemotherapy, could improve survival rates, they are costly. This study aims to explore the correlation between healthcare expenditure and the mortality-to-incidence ratio (MIR) in NPC. Data were obtained from the World Health Organization and the Global Cancer Observatory. The correlation was evaluated by Spearman’s rank correlation coefficient. Most new cases and deaths occur in Asia, and more males are affected than females. Our study shows that countries with higher MIRs have lower levels of health expenditure regardless of the NPC’s gender-specific incidence. Correspondingly, MIRs are all significantly negatively associated with current health expenditure (CHE) per capita and CHE as a percentage of gross domestic product (CHE/GDP) in both genders. CHE per capita and CHE/GDP have a significant impact on NPC outcomes. Moreover, economic status is a potential major factor in MIR differences between countries.

Global burden of gastric cancer in adolescents and young adults: estimates from GLOBOCAN 2020

ObjectivesGastric cancer in adolescents and young adults (GCAYA) has been ignored by both patients and physicians. We examined the disease burden of GCAYA and its secular trends in incidence and mortality. Study designA comprehensive analysis of the global burden of GCAYA based on data provided by GLOBOCAN 2020. MethodsGlobal, regional, sex, and country-specific data of the incidence and mortality of GCAYA were extracted from the GLOBOCAN, the Cancer in Five Continents Plus, and the World Health Organization mortality database, respectively. The associations between the Human Development Index (HDI) and GCAYA burden were also evaluated by Pearson correlation analysis. ResultsThe global incidence of GCAYA was 0.79 per 100,000, and the corresponding mortality was 0.45 per 100,000 in 2020. The mortality-to-incidence ratio (MIR) was lower in AYA (0.61) than in patients aged 40–64 years (0.65) and patients aged 65 years and older (0.75). The age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) were 0.84 and 0.53 per 100,000, respectively, in women, compared with 0.74 and 0.45 per 100,000, respectively, in men. The majority of new cases (17,934) and deaths (10,360) were estimated to occur in Asia. There has a significant negative correlation between the MIR of GCAYA and HDI level (R2 = 0.2707, P < 0.0001). There was a decreasing trend of incidence and mortality in most countries. ConclusionsThe MIR of GCAYA is lower than that among older patients and exhibit a positive association with socio-economic status. The incidence and mortality of GCAYA show a decreasing trend in most countries.

Diversity in HIV epidemic transitions in India: An application of HIV epidemiological metrices and benchmarks.

The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-prevalence ratio (IPR) and incidence-mortality ratio (IMR) to measure the progress in HIV epidemic control. In this paper, we describe the status of epidemic control in India and in various states in terms of UNAIDS's recommended metrices. The National AIDS Control Programme (NACP) of India spearheads work on mathematical modelling to estimate HIV burden based on periodically conducted sentinel surveillance for providing guidance to program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2019, IPR and IMR were calculated. National level IPR was 0.029 [0.022-0.037] in 2019 and ranged from 0.01 to 0.15 in various States and Union Territories (UTs). Corresponding Incidence-Mortality Ratio was at 0.881 [0.754-1.014] nationally and ranged between 0.20 and 12.90 across the States/UTs. Based on UNAIDS recommended indicators for HIV epidemic control, namely IPR and IMR; national AIDS response in India appears on track. However, the program success is not uniform and significant heterogeneity as well as expanding epidemic was observed at the level of States or UTs. Reinforcing States/UTs specific and focused HIV prevention, testing and treatment initiatives may help in the attainment of 2030 Sustainable Development Goals of ending AIDS as a public health threat by 2030.

Gastric cancer incidence, mortality and burden in adolescents and young adults: a time-trend analysis and comparison among China, South Korea, Japan and the USA

ObjectivesTo evaluate and compare the burden of gastric cancer in adolescents and young adults (GCAYA) among China, South Korea, Japan and the USA, four countries with similar or different rates...

Oral Cancer Incidence, Mortality, and Mortality-to-Incidence Ratio Are Associated with Human Development Index in China, 1990-2019.

The burden of oral cancer (OC) is closely related to economic development. We aimed to evaluate the burden of OC at different stages of economic development in China in terms of incidence, mortality, and mortality-to-incidence ratio (MIR) from 1990 to 2019. Data on cancer in China from 1990 to 2019 were obtained from the Global Burden of Disease 2019. Based on human development index (HDI), Chinese economic development was divided into three stages: low, medium, and high HDI stages. Mann–Whitney U-test was used to evaluate the differences in age-standardised incidence rates (ASIR), age-standardised mortality rates (ASMR), and MIR at various stages of HDI. Correlation and regression tests were conducted to examine the association amongst ASIR, ASMR, MIR, and HDI in OC. The estimated annual percentage changes (EAPCs) were calculated to assess the trend of ASIR, ASMR, and MIR. Significant differences were observed in terms of ASIR, ASMR, and MIR between groups (P < 0.001). The values of both sexes in the low HDI stage were lower than those of the medium and high HDI stages, except for MIR, in which the low HDI stage was the highest (P < 0.05). ASIR and ASMR of OC in males at the medium HDI stage showed the fastest growth rate with EAPC values of 5.64 (95% confidence interval, 95% CI, 5.20 to 6.08) and 4.42 (95% CI, 4.01 to 4.82), respectively. A strong positive correlation exists between HDI and ASIR (r = 0.96) and ASMR (r = 0.91) in both sexes from 1990 to 2019. During the high HDI stage, the ASIR and ASMR of OC were at a high level, but the ASIR halted the uptrend trend and ASMR showed a decreasing trend. Therefore, the HDI index has been positively correlated with the ASIR and ASMR of OC in China in the past 30 years, but this relationship may not be sustained as the economy develops. The health department should continue to allocate additional resources for the prevention and treatment of OC.

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 &lt;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.