Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels.
Ann Oncol. 2013 Nov;24(11):2897-902. doi: 10.1093/annonc/mdt352. Epub 2013 Sep 28.
The European Union (EU) is a confederation of 27 member states, the institutions of which work according to negotiated decisions. The EU has implemented similar legislation and a common market, and has adopted the same currency in most of its member states. Although financing health systems is a responsibility of the national governments, the EU has enacted the Charter of Fundamental Rights to standardize public health policies. However, for historical reasons, health policy and health expenditure is not uniform across the 27 EU member states (EU-27).
We hypothesized that increased health expenditure would be associated with better cancer outcome and that this would be most apparent in breast cancer, because of the availability of effective screening methods and treatments. Using publically available data from the World Health Organization, the International Monetary Fund, and the World Bank, we assessed associations between cancer indicators and wealth and health indicators. To do so, we constructed scatter plots and used the Spearman's rank correlation coefficient.
A marked difference in wealth and health expenditure indicators was observed between Eastern and Western European countries, with Western European being the higher. Higher wealth and higher health expenditures were associated both with increased cancer incidence and decreased cancer mortality. In breast cancer, the association with incidence was stronger. We created mortality/incidence ratios and observed that the more spent on health, the fewer the deaths after a cancer diagnosis.
Despite the initiatives to standardize public health policies of the EU-27, health expenditure continues to be higher in Western European countries and this is associated with better cancer outcome in these countries.
欧盟（EU）是由 27 个成员国组成的联盟，其机构根据协商一致的决定运作。欧盟实施了类似的立法和共同市场，并在其大多数成员国中采用了相同的货币。尽管为成员国提供资金是各国政府的责任，但欧盟已颁布《基本权利宪章》以规范公共卫生政策。然而，由于历史原因，27 个欧盟成员国（EU-27）的卫生政策和卫生支出并不统一。
我们假设增加卫生支出将与更好的癌症结果相关，并且由于有效的筛查方法和治疗方法的存在，这种相关性在乳腺癌中最为明显。使用世界卫生组织、国际货币基金组织和世界银行提供的公开数据，我们评估了癌症指标与财富和健康指标之间的关联。为此，我们构建了散点图并使用 Spearman 秩相关系数。
东欧和西欧国家的财富和卫生支出指标存在显著差异，西欧国家更高。更高的财富和更高的卫生支出都与癌症发病率的增加和癌症死亡率的降低有关。在乳腺癌中，与发病率的关联更强。我们创建了死亡率/发病率比，观察到在卫生支出越高的情况下，癌症诊断后的死亡人数越少。
尽管欧盟 27 国采取了标准化公共卫生政策的举措，但西欧国家的卫生支出仍然较高，这与这些国家更好的癌症结果相关。
