Kovács Nóra, Varga Orsolya
Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary.
Syreon Research Institute, 1142 Budapest, Hungary.
Cancers (Basel). 2025 Jun 21;17(13):2075. doi: 10.3390/cancers17132075.
Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide, posing a substantial health and economic burden. Despite advances in screening and treatment, significant socioeconomic and healthcare-related disparities persist across European Union (EU) member states. This study aims to identify trends and inequality in CRC burden over time and to explore the relationship between country-level socioeconomic and healthcare indicators and CRC burden across EU member states. Age-standardized mortality, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life years (DALY) rates were extracted from Global Burden of Diseases Study 2021 for 24 EU countries. Socioeconomic and healthcare indicators were extracted from Eurostat between 2005 and 2021. The Gini index was calculated to evaluate CRC-related health inequality, and generalized linear mixed models were used to assess the link between indicators and disease burden. The Gini index for age-standardized YLDs declined from 0.19 to 0.12 between 1990 and 2021, while inequality in YLL (from 0.11 to 0.16), DALY (from 0.11 to 0.15), and mortality rates (from 0.12 to 0.14) increased. The number of practicing physicians ( < 0.05) and higher levels of education ( < 0.001) were related to lower death, DALY, YLD, and YLL rates. Conversely, greater income inequality was linked to higher mortality, DALY, and YLL rates ( < 0.05). Our findings underscore that, in addition to expanding organized screening programs, enhancing physician availability and addressing socioeconomic inequalities are essential for reducing the burden of CRC.
结直肠癌（CRC）是全球癌症相关发病和死亡的主要原因，带来了巨大的健康和经济负担。尽管在筛查和治疗方面取得了进展，但欧盟（EU）成员国之间在社会经济和医疗保健相关方面仍存在显著差距。本研究旨在确定CRC负担随时间的趋势和不平等情况，并探讨欧盟成员国国家层面的社会经济和医疗保健指标与CRC负担之间的关系。从《2021年全球疾病负担研究》中提取了24个欧盟国家的年龄标准化死亡率、残疾生活年数（YLD）、生命损失年数（YLL）和残疾调整生命年（DALY）率。社会经济和医疗保健指标取自2005年至2021年的欧盟统计局数据。计算基尼系数以评估与CRC相关的健康不平等情况，并使用广义线性混合模型评估指标与疾病负担之间的联系。1990年至2021年期间，年龄标准化YLD的基尼系数从0.19降至0.12，而YLL（从0.11升至0.16）、DALY（从0.11升至0.15）和死亡率（从0.12升至0.14）的不平等情况有所增加。执业医师数量（<0.05）和较高的教育水平（<0.001）与较低的死亡、DALY、YLD和YLL率相关。相反，更大的收入不平等与较高的死亡率、DALY和YLL率相关（<0.05）。我们的研究结果强调，除了扩大有组织的筛查项目外，增加医生供应和解决社会经济不平等对于减轻CRC负担至关重要。
