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. 2021 Dec:7:1659-1667.
doi: 10.1200/GO.21.00307.

International Socioeconomic Predictors of Colon and Rectal Cancer Mortality: Is Colorectal Cancer a First World Problem?

Christina L Cui  1 , Anna M Dornisch  2 , Anya E Umlauf  3 , Raphael E Cuomo  4 , James D Murphy  5 , Nicole E Lopez  6
Affiliations

International Socioeconomic Predictors of Colon and Rectal Cancer Mortality: Is Colorectal Cancer a First World Problem?

Christina L Cui et al. JCO Glob Oncol. 2021 Dec.

Abstract

Purpose: Colorectal cancer (CRC) is a leading cause of international morbidity and is the second highest cause of cancer-related mortality in the world. The purpose of this study was to investigate the relationship between international health care spending on CRC mortality over time.

Methods: This is a retrospective study using a publicly available data from the WHO Global Health Observatory database. General estimating equations were used to analyze the relationship between total health care expenditure per capita (THEpc) and CRC mortality at the country level. The primary predictors of interest were quartiles of THEpc. Other exposure variables included gross domestic product per capita (GDPpc), smoking (% of adult population smoking), physician density (per 10,000), and time.

Results: Mortality decreased significantly from 2000 to 2016 (coefficient [95% CI], -2.2 [-3.3 to -1.1]; P < .001). THEpc, GDPpc, time, and percentage of adult population smoking were significant predictors of CRC mortality. Patients in the top two quartiles of THEpc had 3% higher rates of CRC mortality compared with countries in Q1 THEpc (Q3: 3.4 [1.9-4.8], P < .001; Q4: 3.2 [1.4-5.0], P = .001). Similar trends were seen in GDPpc (Q4: 3.2 [1.4-5.0], P = .001; Q3: 3.4 [1.9-4.8], P < .001; Q2: 1.7 [0.7-2.6], P < .001; Q1: reference).

Conclusion: Overall, mortality decreased significantly over the study period. Countries with higher health expenditures and higher gross domestic products experienced higher rates of CRC mortality. Further research will be necessary to determine the cause for this, but we postulate that it may be a result of more robust diagnostic and follow-up methods in countries with more resources.

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Conflict of interest statement

James D. MurphyConsulting or Advisory Role: Boston Consulting GroupResearch Funding: eContourNo other potential conflicts of interest were reported.

Figures

FIG 1
FIG 1
Mean CRC mortality rate (per 100,000) over time grouped by (A) GPDpc quartiles and (B) THEpc quartiles. CRC, colorectal cancer; GDPpc, gross domestic product per capita; THEpc, total health care expenditures per capita.
See this image and copyright information in PMC

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