Cotache-Condor Cesia, Rice Hannah E, Schroeder Kristin, Staton Catherine, Majaliwa Esther, Tang Shenglan, Rice Henry E, Smith Emily R
Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, NC, USA; Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA.
Duke Primary Care, Duke University, Durham, NC, USA.
Lancet Glob Health. 2023 Apr;11(4):e505-e515. doi: 10.1016/S2214-109X(23)00053-0.
Early access to diagnosis and care is essential to improve rates of survival from childhood cancer, particularly in low-income and middle-income countries (LMICs). Composite indices are increasingly used to compare country performance in many health fields. We aimed to develop a composite vulnerability index of risk of mortality associated with delays in care for childhood cancer in LMICs, and to compare the vulnerability index scores across countries.
The composite vulnerability index was built in ten steps. A previous systematic review of determinants of delays in cancer care for children guided data selection. We collected exposure variables (determinants of delays in care) and outcome variables (childhood cancer-related mortality) from several large datasets. Data were analysed with regression models to identify determinants of delays in care that contribute to childhood cancer mortality. Significant indicators were aggregated into domains according to the socio-ecological model. We used geospatial tools to summarise and compare the composite vulnerability index scores across countries.
We found that life expectancy, maternal education, fertility rate, availability of pathology services, bone marrow transplantation capacity, availability of treatment services (chemotherapy, radiotherapy, or surgery), number of pharmacists per 10 000 population, country income level, and out-of-pocket health expenditure were significantly associated with cancer mortality for children in LMICs. The highest levels of vulnerability were found in sub-Saharan Africa.
Our composite vulnerability index can potentially serve as a valuable policy decision tool to help monitor country performance and guide interventions to reduce delays in care for children with cancer in LMICs.
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For the Chinese, Portuguese, Arabic, Spanish and Swahili translations of the abstract see Supplementary Materials section.
尽早获得诊断和治疗对于提高儿童癌症的生存率至关重要，尤其是在低收入和中等收入国家（LMICs）。综合指数越来越多地用于比较许多卫生领域的国家表现。我们旨在制定一个与LMICs儿童癌症治疗延误相关的死亡风险综合脆弱性指数，并比较各国的脆弱性指数得分。
综合脆弱性指数分十个步骤构建。先前对儿童癌症治疗延误决定因素的系统评价指导了数据选择。我们从几个大型数据集中收集了暴露变量（治疗延误的决定因素）和结果变量（儿童癌症相关死亡率）。使用回归模型分析数据，以确定导致儿童癌症死亡的治疗延误决定因素。根据社会生态模型，将重要指标汇总到各个领域。我们使用地理空间工具来汇总和比较各国的综合脆弱性指数得分。
我们发现，预期寿命、母亲教育程度、生育率、病理服务的可及性、骨髓移植能力、治疗服务（化疗、放疗或手术）的可及性、每万人口药剂师数量、国家收入水平和自付医疗费用与LMICs儿童的癌症死亡率显著相关。撒哈拉以南非洲的脆弱性水平最高。
我们的综合脆弱性指数有可能成为一个有价值的政策决策工具，以帮助监测国家表现，并指导采取干预措施，减少LMICs中患癌症儿童的治疗延误。
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摘要的中文、葡萄牙语、阿拉伯语、西班牙语和斯瓦希里语翻译见补充材料部分。
