Inequalities in cancer incidence and mortality across medium to highly developed countries in the twenty-first century
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Inequalities in the burden of cancer have been well documented, and a variety of measures exist to analyse disease disparities. While previous studies have focused on inequalities within countries, the aim of the present study was to quantify existing inequalities in cancer incidence and mortality between countries.
Data on total and site-specific cancer incidence and mortality in 2003–2007 were obtained for 43 countries with medium-to-high levels of human development via Cancer Incidence in Five Continents Vol. X and the WHO Mortality Database. We calculated the concentration index as a summary measure of socioeconomic-related inequality between countries.
Inequalities in cancer burden differed markedly by site; the concentration index for all sites combined was 0.03 for incidence and 0.02 for mortality, pointing towards a slightly higher burden in countries with higher levels of the human development index (HDI). For both incidence and mortality, this pattern was most pronounced for melanoma. In contrast, the burden of cervical cancer was disproportionally high in countries with lower HDI levels. Prostate, lung and breast cancer contributed most to inequalities in overall cancer incidence in countries with higher HDI levels, while for mortality these were mostly driven by lung cancer in higher HDI countries and stomach cancer in countries with lower HDI levels.
Global inequalities in the burden of cancer remain evident at the beginning of the twenty-first century: with a disproportionate burden of lifestyle-related cancers in countries classified as high HDI, while infection-related cancers continue to predominate in transitioning countries with lower levels of HDI.
KeywordsSocioeconomic inequalities Concentration curve Global Cancer incidence Cancer mortality
This study was conceived and designed by MA, TVO and IS. MA conducted the statistical analyses and wrote the first draft of the manuscript. All authors contributed to critical revisions of the manuscript and approved the final submitted version.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Ferlay J, Soerjomataram I, Ervik M et al (2013) GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC cancer base no. 11. International agency for research on cancer, LyonGoogle Scholar
- 2.Mackenbach JP, Bakker M (2002) Reducing inequalities in health: a European perspective. Routledge, New YorkGoogle Scholar
- 7.United Nations Development Programme (UNDP) (2007) Human development report 2007/2008. Fighting climate change: human solidarity in a divided world. In: UNDP (ed) United Nations Development Programme (UNDP), New York. http://hdr.undp.org/sites/default/files/reports/268/hdr_20072008_en_complete.pdf
- 8.Forman D, Bray F, Brewster DH et al (2013) Cancer incidence in five continents, vol 10. IARC, Lyon (electronic version) Google Scholar
- 9.World Health Organization. WHO Mortality Database. www.who.int/healthinfo/mortality_data/en/
- 11.Conway DI, Brenner DR, McMahon AD et al (2015) Estimating and explaining the effect of education and income on head and neck cancer risk: INHANCE consortium pooled analysis of 31 case-control studies from 27 countries. Int J Cancer 136(1125–39):17Google Scholar
- 13.United Nations, Department of Economic and Social Affairs, Population Division (2011) World population prospects: the 2010 revision. New YorkGoogle Scholar
- 14.O’Donnell O, Van Doorslaer E, Wagstaff A, Lindelow M (2008) Analyzing health equity using household survey data. A guide to techniques and their implementation. The World Bank, WashingtonGoogle Scholar
- 23.Clarke PM, Gerdtham UG, Connelly LB (2003) A note on the decomposition of the health concentration index. Health Econ 12(511–6):18Google Scholar
- 35.Allemani C, Storm H, Voogd AC et al (2010) Variation in ‘standard care’ for breast cancer across Europe: a EUROCARE-3 high resolution study. Eur J Cancer 46(1528–36):19Google Scholar
- 38.Harper S, Lynch J, Meersman SC, Breen N, Davis WW, Reichman ME (2008) An overview of methods for monitoring social disparities in cancer with an example using trends in lung cancer incidence by area-socioeconomic position and race-ethnicity, 1992–2004. Am J Epidemiol 167:889–899CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Harper S, Lynch J, Meersman SC, Breen N, Davis WW, Reichman MC (2009) Trends in area-socioeconomic and race-ethnic disparities in breast cancer incidence, stage at diagnosis, screening, mortality, and survival among women ages 50 years and over (1987–2005). Cancer Epidemiol Biomark Prev 18:121–131CrossRefGoogle Scholar