The burden of prostate cancer is associated with human development index: evidence from 87 countries, 1990-2016

Abstract

Aim: To examine the temporal patterns of the prostate cancer burden and its association with human development.

Subject and methods: The estimates of the incidence and mortality of prostate cancer for 87 countries were obtained from the Global Burden of Disease 2016 study for the period 1990 to 2016. The human development level of a country was measured using its human development index (HDI): a summary indicator of health, education, and income. The association between the burden of prostate cancer and the human development index (HDI) was measured using pairwise correlation and bivariate regression. Mortality-to-incidence ratio (MIR) was employed as a proxy for the survival rate of prostate cancer.

Results: Globally, 1.4 million new cases of prostate cancer arose in 2016 claiming 380,916 lives which more than doubled from 579,457 incident cases and 191,687 deaths in 1990. In 2016, the age-standardised incidence rate (ASIR) was the highest in very high-HDI countries led by Australia with ASIR of 174.1/100,000 and showed a strong positive association with HDI (r = 0.66); the age-standardised mortality rate (ASMR), however, was higher in low-HDI countries led by Zimbabwe with ASMR of 78.2/100,000 in 2016. Global MIR decreased from 0.33 in 1990 to 0.26 in 2016. Mortality-to-incidence ratio (MIR) exhibited a negative gradient (r = - 0.91) with human development index with tenfold variation globally with seven countries recording MIR in excess of 1 with the USA recording the minimum MIR of 0.10.

Conclusion: The high mortality and lower survival rates in less-developed countries demand all-inclusive solutions ranging from cost-effective early screening and detection to cost-effective cancer treatment. In tackling the rising burden of prostate cancer predictive, preventive and personalised medicine (PPPM) can play a useful role through prevention strategies, predicting PCa more precisely and accurately using a multiomic approach and risk-stratifying patients to provide personalised medicine.

Keywords: Human development index; Incidence; Mortality; Mortality-to-incidence ratio; Precision medicine; Predictive preventive personalised medicine; Prostate cancer.

Fig. 1

Temporal movement of global prostate cancer burden in terms of key indicators, 1990–2016: a incidence, b mortality, c ASIR, d ASMR, e MIR. Incidence, all-age incidence numbers; mortality, all-age deaths; ASIR, age-standardised incidence rate; ASMR, age-standardised mortality rate; MIR, mortality-to-incidence ratio. Data source: Global Burden of Disease 2016 study

Fig. 2

HDI-group wise annual percentage change of key indicators of prostate cancer burden over 1990–2016. Incidence, all-age incidence numbers; mortality, all-age deaths; ASIR, age-standardised incidence rate; ASMR, age-standardised mortality rate; MIR, mortality-to-incidence ratio. Data pertains to low HDI (15 countries), medium HDI (18 countries), high HDI (31 countries), and very high HDI (36 countries) for the period 1990 to 2016 and is procured from Global Burden of Disease study 2016. Countries were categorised into four groups as per HDI value in 2015: very high (HDI > 0.800), high (0.700 < HDI < 0.799), medium (0.550 < HDI < 0.669), and low (HDI < 0.550)

Fig. 3

Geographical distribution of MIR in sample countries a 1990 and b 2016. MIR, mortality-to-incidence ratio. MIR is calculated as the ratio of all-age crude mortality rate to all-age crude incidence rate which was procured from Global Burden of Disease study 2016

Fig. 4

Percentage share of HDI categories in prostate cancer burden a incidence and b mortality in 2016. Incidence, all-age incidence numbers; mortality, all-age deaths. Data pertains to low HDI (15 countries), medium HDI (18 countries), high HDI (31 countries), and very high HDI (36 countries) for the period 1990 to 2016 and is procured from Global Burden of Disease study 2016. Countries were categorised into four groups as per HDI value in 2015: very high (HDI > 0.800), high (0.700 < HDI < 0.799), medium (0.550 < HDI < 0.669), and low (HDI < 0.550)

Fig. 5

Prostate cancer burden versus the proportion of population aged 50 years and above in 2016. ASIR, age-standardised incidence rate; ASMR, age-standardised mortality rate; MIR, mortality-to-incidence ratio. Data pertains to low HDI (15 countries), medium HDI (18 countries), high HDI (31 countries), and very high HDI (36 countries) for the period 1990 to 2016. Countries were categorised into four groups as per HDI value in 2015: very high (HDI > 0.800), high (0.700 < HDI < 0.799), medium (0.550 < HDI < 0.669), and low (HDI < 0.550). Data source: ASIR, ASMR data is from Global Burden of Disease 2016 study; proportion of population aged 50 years and above is from World Development Indicators (WDI) database of World Bank

Fig. 6

Relation between prostate cancer mortality-to-incidence ratio (MIR) and country-specific healthcare parameters a MIR vs CHE, b MIR vs OOP, c MIR vs surgeon workforce, d MIR vs UHC. MIR, mortality-to-incidence ratio; CHE, current health expenditure as %age of GDP; OOP, out-of-pocket expenditure as %age of total health expenditure; surgeon workforce, number of specialist surgeons per 100,000 population; UHC, universal health coverage service index. The data corresponding to MIR, CHE, UHC, and OOP pertains to the year 2015. The data of the surgeon workforce pertains to years ranging from 2010 to 2015 depending upon country-level availability of data. All the data is procured from health nutrition and population statistics database of World Bank