Department of Otolaryngology-Head and Neck Surgery, Royal Oak, Michigan.
Beaumont Health System, Royal Oak, Michigan.
Laryngoscope. 2019 Nov;129(11):2482-2486. doi: 10.1002/lary.27532. Epub 2019 Mar 19.
Nasopharyngeal carcinoma has a unique worldwide racial and geographic distribution. Our objective was to evaluate socioeconomic disparities in the burden of nasopharyngeal cancer (NPC) between endemic and nonendemic regions.
To demonstrate trends regarding societal burden of NPC and socioeconomic development, national disability-adjusted life year (DALY) rates and human development indices (HDI) between 1990 and 2015 were evaluated. Countries were divided based on the endemic versus nonendemic presence of NPC and further analyzed by HDI status as specified by the United Nations Development Program. Gini coefficients and concentration index were used to evaluate global equality in NPC burden over this period.
Age-standardized DALYs dropped from 36.1 in 1990 to 26.5 in 2015 (26.6% decline) (r = -0.991, P < 0.001). Lower socioeconomic countries harbored greater NPC burden upon controlling by endemic and nonendemic regions, as demonstrated by progressively negative concentration indexes. Health inequality was greater in nonendemic countries than in endemic countries (P < 0.01).
To our knowledge, this is the first study to investigate socioeconomic-related changes in NPC burden using statistical tools such as the Gini coefficient and concentration index. Although the burden of NPC has steadily decreased, there remain persistent inequalities associated with socioeconomic disparities. Nasopharyngeal cancer burden is more pronounced in countries with lower HDI. Our results reinforce the importance of increasing resources for developing countries and continuing inquiry into the screening, diagnosis, and management of NPC.
NA Laryngoscope, 129:2482-2486, 2019.
鼻咽癌在世界范围内具有独特的种族和地理分布。我们的目的是评估鼻咽癌（NPC）在流行地区和非流行地区之间的社会经济负担的差异。
为了展示 NPC 社会负担和社会经济发展的趋势，评估了 1990 年至 2015 年期间的国家伤残调整生命年（DALY）率和人类发展指数（HDI）。根据 NPC 的流行与非流行情况对国家进行了划分，并根据联合国开发计划署（UNDP）的规定，按照 HDI 状况进一步进行了分析。基尼系数和集中指数用于评估在此期间 NPC 负担的全球平等状况。
年龄标准化 DALY 从 1990 年的 36.1 下降到 2015 年的 26.5（下降 26.6%）（r=-0.991，P<0.001）。通过控制流行地区和非流行地区，低社会经济国家的 NPC 负担更大，这表现为逐渐为负的集中指数。非流行国家的健康不平等程度高于流行国家（P<0.01）。
据我们所知，这是第一项使用基尼系数和集中指数等统计工具研究 NPC 负担与社会经济相关变化的研究。尽管 NPC 的负担稳步下降，但与社会经济差异相关的不平等现象仍然存在。NPC 负担在 HDI 较低的国家更为明显。我们的研究结果强调了为发展中国家增加资源以及继续研究 NPC 的筛查、诊断和管理的重要性。
无。喉镜，129：2482-2486，2019。
