Health Determinants in Association with Cancer Mortality from a Health Ecological Perspective

Abstract

Objective: To explore the health determinants of all-cancer mortality from a health-ecological perspective.

Methods: Using the health-ecological model, we identified 15 health determinants across five domains: personal innate, behavioral, interpersonal network, socioeconomic, and macroenvironmental characteristics. Data on cancer outcomes and health determinants from 185 countries, classified using the Human Development Index (HDI), were extracted from GLOBOCAN 2022, the World Health Organization Global Health Observatory, the Global Burden of Disease Study 2021, the United Nations, and the World Bank. A multivariate linear regression model was used to estimate the association between health determinants and cancer outcomes.

Results: A total of 153 countries with complete information on cancer outcomes and health determinants were enrolled in the study. A higher all-cancer age-standardized mortality rate (ASMR) was associated with current tobacco use, alcohol consumption, obesity, agricultural employment, and lag-distributed income. In women aged 15-49 years, being married or in a union was associated with a lower ASMR. Early-onset ASMR was positively associated with agricultural employment, lag-distributed income, and unsafe sanitation. Notable sex differences were observed, although tobacco use and obesity were identified as risk factors in both sexes.

Conclusion: We underscore the crucial need to incorporate cross-sectoral interventions within a resilient healthcare system to effectively mitigate the cancer mortality burden.

Keywords: Cancer mortality; Dominance analysis; Health determinants; Health ecological model.