La Vecchia C, Levi F, Lucchini F, Lagiou P, Trichopoulos D, Negri E
Istituto di Statistica Medica e Biometria, Universita di Milano, Italy.
Cancer. 1998 Nov 15;83(10):2223-7.
Mortality from childhood cancer in general and childhood leukemia in particular has sharply declined in economically developed countries over the last 30 years, whereas the incidence of these diseases has remained essentially unaltered. Therefore, childhood malignancies can be used as tracers of accessibility to and effectiveness of medical care. The objective of this study was to compare the reduction of mortality from childhood cancer in general, and childhood leukemia in particular, in four economically developed areas of the world, to assess accessibility to and effectiveness of technologically advanced medical care.
The authors used data from the World Health Organization to compare the evolution over time of gender specific, age-adjusted mortality from childhood cancer in general and childhood leukemia in particular in the childhood (birth to age 14 years) populations of North America, western Europe, Japan, and Australia and New Zealand during the period 1960-1993. They assessed the evolution over time and the cumulative percentage representing the decline in mortality from childhood cancer and childhood leukemia in the four aforementioned areas of the world.
The decline in mortality from both the disease entities considered and for both genders has been more pronounced in North America than in other economically developed areas of the world.
When disease control depends on technologically advanced medical care, as in the case of cancer, the North American population is benefited by earlier and effective introduction of new therapeutic approaches. This conclusion does not apply to other childhood diseases, the incidence of which is higher among low-income groups and control of which depends on prevention rather than treatment.
在过去30年中，经济发达国家儿童癌症总体死亡率，尤其是儿童白血病死亡率急剧下降，而这些疾病的发病率基本保持不变。因此，儿童恶性肿瘤可作为医疗可及性和有效性的追踪指标。本研究的目的是比较世界四个经济发达地区儿童癌症总体死亡率，尤其是儿童白血病死亡率的下降情况，以评估先进医疗技术的可及性和有效性。
作者使用世界卫生组织的数据，比较了1960年至1993年期间北美、西欧、日本以及澳大利亚和新西兰儿童（出生至14岁）总体中儿童癌症尤其是儿童白血病按性别和年龄调整后的死亡率随时间的变化。他们评估了上述四个世界地区儿童癌症和儿童白血病死亡率随时间的变化以及死亡率下降的累积百分比。
在北美，所考虑的两种疾病实体以及两性的死亡率下降比世界其他经济发达地区更为明显。
当疾病控制依赖于先进医疗技术时，如癌症的情况，北美人群因新治疗方法的早期有效引入而受益。这一结论不适用于其他儿童疾病，这些疾病在低收入群体中发病率较高，其控制依赖于预防而非治疗。
