The global cancer divide: Relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries

Ali Batouli; Pooya Jahanshahi; Cary P. Gross; Danil V. Makarov; James B. Yu

doi:10.1016/j.jegh.2013.10.004

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Volume 4, Issue 2, June 2014, Pages 115 - 124

The global cancer divide: Relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries

Authors

Ali Batouli^a, Pooya Jahanshahi^b, Cary P. Gross^a^{, d}, Danil V. Makarov^c, James B. Yu^a^{, d}^{, *}^,james.b.yu@yale.edu

^aYale School of Medicine, New Haven, CT, USA

^bVirginia Commonwealth University School of Medicine, Richmond, VA, USA

^cUnited States Department of Veterans Affairs, Department of Urology, NYU Cancer Institute, New York University School of Medicine, New York, NY, USA

^dCancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center at Yale, New Haven, CT, USA

^*Corresponding author at: Department of Therapeutic Radiology, Yale School of Medicine, 333 Cedar St., New Haven, CT 06520, USA. Tel.: +1 203 785 5703; fax: +1 203 785 4622.

Corresponding Author

James B. Yujames.b.yu@yale.edu

Received 23 July 2013, Revised 29 September 2013, Accepted 30 October 2013, Available Online 28 December 2013.

DOI: 10.1016/j.jegh.2013.10.004 How to use a DOI?
Keywords: Cancer; Cancer mortality; Cancer incidence; Healthcare expenditure; Healthcare infrastructure; Global cancer mortality
Abstract: Background: Cancer continues to rise as a contributor to premature death in the developing world. Despite this, little is known about whether cancer outcomes are related to a country’s income level, and what aspects of national healthcare systems are associated with improved cancer outcomes.

Methods: The most recent estimates of cancer incidence and mortality were used to calculate mortality-to-incidence ratio (MIR) for the 85 countries with reliable data. Countries were categorized according to high-income (Gross Domestic Product (GDP) > $15,000) or middle/low-income (GDP < $15,000), and a multivariate linear regression model was used to determine the association between healthcare system indicators and cancer MIR. Indicators study included per capita GDP, overall total healthcare expenditure (THE), THE as a proportion of GDP, total external beam radiotherapy devices (TEBD) per capita, physician density, and the year 2000 WHO healthcare system rankings.

Results: Cancer MIR in high-income countries (0.47) was significantly lower than that of middle/low-income countries (0.64), with a p < 0.001. In high-income countries, GDP, health expenditure and TEBD showed significant inverse correlations with overall cancer MIR. A $3040 increase in GDP (p = 0.004), a $379 increase in THE (p < 0.001), or an increase of 0.59 TEBD per 100,000 population (p = 0.027) were all associated with a 0.01 decrease in cancer MIR. In middle/low-income countries, only WHO scores correlated with decreased cancer MIR (p = 0.022); 12 specific cancer types also showed similar significant correlations (p < 0.05) as overall cancer MIR.

Conclusions: The analysis of this study suggested that cancer MIR is greater in middle/low-income countries. Furthermore, the WHO healthcare score was associated with improved cancer outcomes in middle/low-income countries while absolute levels of financial resources and infrastructure played a more important role in high-income countries.
Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Journal: Journal of Epidemiology and Global Health
Volume-Issue: 4 - 2
Pages: 115 - 124
Publication Date: 2013/12/28
ISSN (Online): 2210-6014
ISSN (Print): 2210-6006
DOI: 10.1016/j.jegh.2013.10.004 How to use a DOI?
Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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ris enw bib

TY  - JOUR
AU  - Ali Batouli
AU  - Pooya Jahanshahi
AU  - Cary P. Gross
AU  - Danil V. Makarov
AU  - James B. Yu
PY  - 2013
DA  - 2013/12/28
TI  - The global cancer divide: Relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries
JO  - Journal of Epidemiology and Global Health
SP  - 115
EP  - 124
VL  - 4
IS  - 2
SN  - 2210-6014
UR  - https://doi.org/10.1016/j.jegh.2013.10.004
DO  - 10.1016/j.jegh.2013.10.004
ID  - Batouli2013
ER  -

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