探讨泛美地区根据人类发展指数乳腺癌和妇科癌症发病率和死亡率的差异。

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

机构信息

IMED, School of Medicine, Passo Fundo, RS, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.

Latin American Cooperative Oncology Group (LACOG), Porto Alegre, RS, Brazil.

出版信息

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

DOI:10.1016/j.puhe.2017.04.017

PMID:28577441

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.

摘要

目的

评估一个国家的人类发展指数（HDI）是否有助于解释泛美地区乳腺癌和妇科癌症发病率和死亡率的差异。

研究设计

生态分析。

方法

纳入了在 GLOBOCAN 2012 和联合国发展报告 2012 中均有公开数据的泛美地区国家（n=28）。使用自然对数转换了乳腺癌、卵巢癌、子宫癌和宫颈癌的每 100,000 人标准化发病率和死亡率。计算了每个部位的死亡率与发病率比（MIR）。进行了 Pearson 相关检验和简单线性回归。

结果

HDI 与乳腺癌和卵巢癌的发病率和死亡率呈正相关，与宫颈癌的发病率和死亡率呈负相关。HDI 与子宫癌无关联。除卵巢癌外，MIR 与 HDI 呈负相关。HDI 每增加 1 个单位，癌症发生率就会发生变化：乳腺癌发病率β=4.03（95%置信区间[CI] 2.61；5.45）P<0.001，乳腺癌死亡率β=1.76（95%CI 0.32；3.21）P=0.019，乳腺癌-MIRβ=-0.705（95%CI 0.704；0.706）P<0.001；宫颈癌发病率β=-3.28（95%CI -4.78；-1.78）P<0.001，宫颈癌死亡率β=-4.63（95%CI -6.10；-3.17）P<0.001，宫颈癌-MIRβ=-1.35（95%CI -1.83；-0.87）P<0.001；卵巢癌发病率β=3.26（95%CI 1.78；4.75）P<0.001，卵巢癌死亡率β=1.82（95%CI 0.44；3.20）P=0.012，卵巢癌-MIRβ=5.10（95%CI 3.22；6.97）P<0.001；子宫癌发病率β=2.37（95%CI -0.33；5.06）P=0.83，子宫癌死亡率β=0.68（95%CI -2.68；2.82）P=0.96，子宫癌-MIRβ=-2.30（95%CI -3.19；-1.40）P<0.001。