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Public Health. 2017 Aug;149:81-88. doi: 10.1016/j.puhe.2017.04.017. Epub 2017 Jun 1.

Exploring disparities in incidence and mortality rates of breast and gynecologic cancers according to the Human Development Index in the Pan-American region.

Author information

1
IMED, School of Medicine, Passo Fundo, RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil. Electronic address: jeovanymm@gmail.com.
2
Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.
3
Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Univ. Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.
4
Clínica AMO, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.
5
Instituto de Investigaciones Biomédicas UNAM, Mexico; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.
6
Hospital Zenon Santillan, Tucuman, Argentina; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.
7
Intituto do Cancer do Estado de Sao Paulo (ICESP), University of São Paulo (USP), Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.
8
Instituto Nacional de Cancerología, Mexico; Centro de Mama, Tecnológico de Monterrey, Mexico; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.
9
Instituto Nacional de Enfermedades Neoplásicas, Peru; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.
10
Department of Medicine, PUCRS School of Medicine, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.

Abstract

OBJECTIVE:

To evaluate whether a country's Human Development Index (HDI) can help explain the differences in the country's breast cancer and gynecological cancer incidence and mortality rates in the Pan-American region.

STUDY DESIGN:

Ecological analysis.

METHODS:

Pan-American region countries with publicly available data both in GLOBOCAN 2012 and the United Nations Development Report 2012 were included (n = 28). Incidence and mortality rates age-standardized per 100,000 were natural log-transformed for breast cancer, ovarian cancer, corpus uteri cancer, and cervical cancer. The mortality-to-incidence ratio (MIR) was calculated for each site. Pearson's correlation test and a simple linear regression were performed.

RESULTS:

The HDI showed a positive correlation with breast cancer and ovarian cancer incidence and mortality rates, respectively, and a negative correlation with cervical cancer incidence and mortality rates. The HDI and corpus uteri cancer showed no association. MIR and the HDI showed a negative correlation for all tumor types except ovarian cancer. An increment in 1 HDI unit leads to changes in cancer rates: in breast cancer incidence β = 4.03 (95% confidence interval [CI] 2.61; 5.45) P < 0.001, breast cancer mortality β = 1.76 (95% CI 0.32; 3.21) P = 0.019, and breast cancer-MIR β = -0.705 (95% CI 0.704; 0.706) P < 0.001; in cervical cancer incidence β = -3.28 (95% CI -4.78; -1.78) P < 0.001, cervical cancer mortality β = -4.63 (95% CI -6.10; -3.17) P < 0.001, and cervical cancer-MIR β = -1.35 (95% CI -1.83; -0.87) P < 0.001; in ovarian cancer incidence β = 3.26 (95% CI 1.78; 4.75) P < 0.001, ovarian cancer mortality β = 1.82 (95% CI 0.44; 3.20) P = 0.012, and ovarian cancer-MIR β = 5.10 (95% CI 3.22; 6.97) P < 0.001; in corpus uteri cancer incidence β = 2.37 (95% CI -0.33; 5.06) P = 0.83, corpus uteri cancer mortality β = 0.68 (95% CI -2.68; 2.82) P = 0.96, and corpus uteri cancer-MIR β = -2.30 (95% CI -3.19; -1.40) P < 0.001.

CONCLUSIONS:

A country's HDI should be considered to understand disparities in breast cancer and gynecological cancer in the Pan-American region.

KEYWORDS:

Breast neoplasms; Epidemiology; Female; Genital neoplasm; Gynecology; Human Development Index; Incidence; Mortality

PMID:
28577441
DOI:
10.1016/j.puhe.2017.04.017
[Indexed for MEDLINE]

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