Arnold Melina, Rentería Elisenda, Conway David I, Bray Freddie, Van Ourti Tom, Soerjomataram Isabelle
Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France.
School of Medicine, Dentistry, and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
Cancer Causes Control. 2016 Aug;27(8):999-1007. doi: 10.1007/s10552-016-0777-7. Epub 2016 Jun 21.
Inequalities in the burden of cancer have been well documented, and a variety of measures exist to analyse disease disparities. While previous studies have focused on inequalities within countries, the aim of the present study was to quantify existing inequalities in cancer incidence and mortality between countries.
Data on total and site-specific cancer incidence and mortality in 2003-2007 were obtained for 43 countries with medium-to-high levels of human development via Cancer Incidence in Five Continents Vol. X and the WHO Mortality Database. We calculated the concentration index as a summary measure of socioeconomic-related inequality between countries.
Inequalities in cancer burden differed markedly by site; the concentration index for all sites combined was 0.03 for incidence and 0.02 for mortality, pointing towards a slightly higher burden in countries with higher levels of the human development index (HDI). For both incidence and mortality, this pattern was most pronounced for melanoma. In contrast, the burden of cervical cancer was disproportionally high in countries with lower HDI levels. Prostate, lung and breast cancer contributed most to inequalities in overall cancer incidence in countries with higher HDI levels, while for mortality these were mostly driven by lung cancer in higher HDI countries and stomach cancer in countries with lower HDI levels.
Global inequalities in the burden of cancer remain evident at the beginning of the twenty-first century: with a disproportionate burden of lifestyle-related cancers in countries classified as high HDI, while infection-related cancers continue to predominate in transitioning countries with lower levels of HDI.
癌症负担方面的不平等现象已有充分记录，并且存在多种分析疾病差异的方法。虽然先前的研究聚焦于国家内部的不平等，但本研究的目的是量化国家之间癌症发病率和死亡率方面现存的不平等。
通过《五大洲癌症发病率》第十卷和世界卫生组织死亡率数据库，获取了43个人类发展水平处于中高水平国家2003 - 2007年总体及特定部位癌症发病率和死亡率的数据。我们计算了集中指数，作为国家间社会经济相关不平等的综合衡量指标。
癌症负担的不平等在不同部位差异显著；所有部位综合的集中指数，发病率为0.03，死亡率为0.02，这表明人类发展指数（HDI）较高的国家负担略高。对于发病率和死亡率而言，这种模式在黑色素瘤方面最为明显。相比之下，宫颈癌负担在HDI水平较低的国家过高。在HDI较高的国家，前列腺癌、肺癌和乳腺癌对总体癌症发病率不平等的贡献最大，而对于死亡率，在HDI较高的国家主要由肺癌导致，在HDI较低的国家则主要由胃癌导致。
在21世纪初，全球癌症负担的不平等仍然明显：在被归类为高HDI的国家，与生活方式相关的癌症负担不成比例，而在HDI较低的转型国家，与感染相关的癌症仍然占主导地位。
