1887
Volume 2023, Issue 4
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Cancer continues to be a significant worldwide health concern with substantial mortality. The cancer mortality-to-incidence ratio (MIR), a proxy measure of observed five-year survival, can serve as a valuable indicator of cancer management outcomes and healthcare disparities among countries. This study aims to determine the MIR trend for all cancers combined among Iraqi citizens during 2012-2020 for health expenditure percentages out of the gross domestic product (e/GDP (%)) and population growth rate.

Methods: The study used the Iraqi Cancer Registry annual reports for cancer data and World Bank data for health expenditure and population growth. Simple linear regression analysis examined the relationship between health expenditure, growth rate, and MIR, while joinpoint regression analysis examined the trend over time. The Ethics Committee of the College of Medicine at the University of Basrah approved the study.

Results: An increasing trend in crude incidence rates for all cancer types combined was seen with a decrease in mortality rates from 2012 to 2020 in both sexes. A non-statistically significant reduction in MIR was found with an average annual percent change (AAPC) of -3.1% (P = 0.100). The decrease in MIR was higher among females than males, with a statistically significant difference (P = 0.003). High health expenditure presented as e/GDP (%) was associated with a favorable cancer survival rate, but this was not statistically significant (R2 = 0.263, P = 0.158). In contrast, a low growth rate was significantly associated with cancer patients’ survival (R2 = 0.505, P = 0.032).

Conclusions: As indicated by the MIR and the MIR complement (1-MIR), the proxy five-year survival rate is improving in Iraq with time. Although not statistically significant, high health expenditure favorably affected overall cancer survival. A low growth rate, on the other hand, significantly improves cancer patients’ survival.

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2024-01-14
2024-07-13
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References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al.. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71::209–49. doi: 10.3322/caac.21660.
    [Google Scholar]
  2. Wang Z, Zhou C, Feng X, Mo M, Shen J, Zheng Y. Comparison of cancer incidence and mortality between China and the United States. Pecis Cancer Med. 2021;4::31. doi: 10.21037/pcm-21-25.
    [Google Scholar]
  3. Hussain AM, Lafta RK. Cancer trends in Iraq 2000-2016. Oman Med J. 2021; 36::e219. doi: 10.5001/omj.2021.18.
    [Google Scholar]
  4. Al-Asadi JN, Ibrahim SJ. Childhood cancer in Basrah, Iraq during 2012-2016: incidence and mortality. Asian Pac J Cancer Prev. 2018; 19::2337–41. doi: 10.22034/apjcp.2018.19.8.2337.
    [Google Scholar]
  5. Iraqi Cancer Board, Ministry of Health and Environment, Republic of Iraq, 2020 [Internet]. Annual Report, Iraqi Cancer Registry, c2020 [cited 2022 Nov 30]. Available from: https://moh.gov.iq/?page=46
    [Google Scholar]
  6. Habib OS, J. Al-Elwe WM. Pattern of cancer: Comparison of risk in Basrah with national pattern. Med J Babylon. 2018; 15::195–6. doi: 10.4103/MJBL.MJBL_41_18.
    [Google Scholar]
  7. Amirkhah R, Naderi-Meshkin H, Mirahmadi M, Allahyari A, Sharifi HR. Cancer statistics in Iran: Towards finding priority for prevention and treatment. Cancer Press. 2017; 3::27–38. doi: 10.15562/tcp.42
    [Google Scholar]
  8. Ellis L, Woods LM, Estève J, Eloranta S, Coleman MP, Rachet B. Cancer incidence, survival and mortality: explaining the concepts. Int J Cancer. 2014; 135::1774–82. doi: 10.1002/ijc.28990.
    [Google Scholar]
  9. Vostakolaei FA, Karim-Kos HE, Janssen-Heijnen MLG, Visser O, Verbeek AL, Kiemeney LA. The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival. Eur J Public Health. 2011:21::573–7. doi: 10.1093/eurpub/ckq120.
    [Google Scholar]
  10. World Health Organization [Internet] . Cancer Registration: Principles and Methods (IARC Scientific Publications No. 95), c1991 [cited 2022 Nov 30]. Available from: https://web.archive.org/web/20180514163527id_/https://www.iarc.fr/en/publications/pdfs-online/epi/sp95/SP95.pdf
    [Google Scholar]
  11. Sunkara V, Hébert JR. The colorectal cancer mortality-to-incidence ratio as an indicator of global cancer screening and care. Cancer. 2015; 121::1563–9.doi: 10.1002/cncr.29228.
    [Google Scholar]
  12. Stenning-Persivale K, Franco MJS, Cordero-Morales A, Cruzado-Burga J, Poquioma E, Nava ED, et al.. The mortality-incidence ratio as an indicator of five-year cancer survival in metropolitan Lima. Ecancermedicalscience. 2018;12::799. doi: 10.3332/ecancer.
    [Google Scholar]
  13. Ellis L, Belot A, Rachet B, Coleman MP. The mortality-to-incidence ratio is not a valid proxy for cancer survival. J Glob Oncol. 2019; 5::1–9. doi: 10.1200/JGO.19.00038.
    [Google Scholar]
  14. World Health Organization [Internet]. Guide to early cancer diagnosis, c2017 [cited 2022 Dec 12]. Available from: https://www.who.int/publications/i/item/9789241511940.
    [Google Scholar]
  15. Chen J, O’Brien MJ, Mennis J, Alos VA, Grande DT, Roby DH, et al.. Latino Population Growth and Hospital Uncompensated Care in California. Am J Public Health. 2015;105::1710-7. doi: 10.2105/AJPH.2015.302583.
    [Google Scholar]
  16. Wang SC, Chang NW, Chen WJ, Yang MH, Chen SL, Sung WW. Trends of testicular cancer mortality-to-incidence ratios in relation to health expenditure: An ecological study of 54 Countries. Int J Environ Res Public Health. 2021;18::1546. doi: 10.3390/ijerph18041546.
    [Google Scholar]
  17. Dong C, Fu JT, Wu HR, Chao YC, Chen YC, Sung WW, et al.. Mortality-to-incidence ratio for nasopharyngeal carcinoma is associated with health expenditure. Healthcare. 2022;10::1615. doi: 10.3390/healthcare10091615.
    [Google Scholar]
  18. Wang CC, Sung WW, Yan PY, Ko PY, Tsai MC. Favorable colorectal cancer mortality-to-incidence ratios in countries with high expenditures on health and development index: A study based on GLOBOCAN database. Medicine (Baltimore). 2021;100::e27414. doi: 10.1097/MD.0000000000027414.
    [Google Scholar]
  19. United Nations in Iraq [Internet] . Common Country Analysis, c2022 (Condensed version) [cited 2022 Dec 13]. Available from: https://iraq.un.org/sites/default/files/2022-07/CCA%20Iraq%20-%20Condensed.pdf.
    [Google Scholar]
  20. World Bank [Internet]. Current health expenditure per capita (current USD) – Iraq, c2003-2020 [cited 2022 Dec 14]. Available from: https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locations=IQ Accessed on April 20, 2023.
    [Google Scholar]
  21. World Bank. Current health expenditure (% of GDP) – Iraq, c2003-2020 [cited 2022 Dec 14]. Available from: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=IQ Accessed on April 20, 2023.
    [Google Scholar]
  22. World Bank [Internet]. Population growth (annual %) – Iraq, c1961-2022 [cited 2022 Dec 14]. Available from: https://data.worldbank.org/indicator/SP.POP.GROW?locations=IQ Accessed on April 20, 2023.
    [Google Scholar]
  23. Worldmeter [Internet]. What is GDP? [cited 2023 Oct 28]. Available from: https://www.worldometers.info/gdp/what-is-gdp/.
    [Google Scholar]
  24. Ades F, Senterre C, de Azambuja E, Sullivan R, Popescu R, Parent F, et al.. Discrepancies in cancer incidence and mortality and its relationship to health expenditure in the 27 European Union member states. Ann Oncol. 2013; 24::2897–902. doi: 10.1093/annonc/mdt352.
    [Google Scholar]
  25. World Health Organization [Internet]. The Global Health Observatory, Annual population growth rate [cited 2023 Oct 24]. Available from: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/1120.
    [Google Scholar]
  26. Statistical Research and Applications Branch, National Cancer Institute [Internet]. Joinpoint Regression Program, version 4.9.1.0. Statistical Research and Applications Branch, National Cancer Institute, c2022. Available from: https://surveillance.cancer.gov/joinpoint/
    [Google Scholar]
  27. de Souza Reis R, Scaff AJM. Cancer survival in Brazil: Estimate through the mortality to incidence ratio. J. Public Health Epidemiol 2018; 10::295–302. doi: 10.5897/JPHE2018.1027.
    [Google Scholar]
  28. More at Cancer Australia [Internet]. National cancer indicators: Mortality-to-incidence ratio for all cancers combined (1982-2019), c2022 [cited 2023 Sep 21]. Available from: https://ncci.canceraustralia.gov.au/outcomes/mortality-incidence-ratio/mortality-incidence-ratio.
    [Google Scholar]
  29. Williams AO. Assessment of the completeness of births and deaths registration in an urban Nigerian community. African population studies. 2014;27::263-72. doi 10.11564/27-2-473.
    [Google Scholar]
  30. Al Alwan NAS. General Oncology Care in Iraq. Al-Shamsi HO, Abu-Gheida IH, Iqbal F, Al-Awadhi A. Cancer in the Arab World. Springer, Singapore. 2022: pp 63–82. doi:10.1007/978-981-16-7945-2_5.
    [Google Scholar]
  31. Zhua Y, Shaob X, Wanga X, Liuc L, Liang H. Sex disparities in cancer. Cancer Letters. 2019; 466::35–8. doi: 10.1016/j.canlet.2019.08.017
    [Google Scholar]
  32. Jackson SS, Marks MA, Katki HA, Cook MB, Hyun N, Freedman ND, et al.. Sex disparities in the incidence of 21 cancer types: Quantification of the contribution of risk factors. Cancer. 2022;128::353-40. doi: 10.1002/cncr.34390
    [Google Scholar]
  33. Lee H, Peng C, Huang C, Wu S, Tsai M, Wang C, et al.. Is mortality-to-incidence ratio associated with health disparity in pancreatic cancer? A cross-sectional database analysis of 57 countries. BMJ Open. 2018;8::e020618. doi: 10.1136/bmjopen-2017-020618.
    [Google Scholar]
  34. Batouli A, Jahanshahi P, Gross CP, Makarov DV, Yu JB. The global cancer divide: relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries. J Epidemiol Glob Health. 2014;4::115-24. doi: 10.1016/j.jegh.2013.10.004.
    [Google Scholar]
  35. Jarzebski MP, Elmqvist T, Gasparatos A,Fukushi K, Eckersten S, Haase D, et al.. Ageing and population shrinking: implications for sustainability in the urban century. npj Urban Sustain. 2021;1::17. doi: 10.1038/s42949-021-00023-z.
    [Google Scholar]
  36. Needham SL. Toward priorities for aging research. Rejuvenation Res. 2014; 17::154–56. doi: 10.1089/rej.2013.1508.
    [Google Scholar]
  37. Hashim D, Carioli G, Malvezzi M, Bertuccio P, Waxman S, Negri E, et al.. Cancer mortality in the oldest old: a global overview. Aging (Albany NY). 2020;12::16744-58. doi: 10.18632/aging.103503.
    [Google Scholar]
  38. Carioli G, Malvezzi M, Bertuccio P, Hashim D, Waxman S, Negri E, et al.. Cancer mortality in the elderly in 11 countries worldwide, 1970-2015. Ann Oncol. 2019; 30::1344–55. doi: 10.1093/annonc/mdz178.
    [Google Scholar]
  39. Hébert JR, Daguise VG, Hurley DM, Wilkerson RC, Mosley CM, Adams SA, et al.. Mapping cancer mortality-to-incidence ratios to illustrate racial and sex disparities in a high-risk population. Cancer. 2009; 115::2539–52. doi: 10.1002/cncr.24270.
    [Google Scholar]
  40. Akbari A, Khayamzadeh M, Salmanian R, Ghanbari Motlagh A, Roshandel G, Nouri M, et al.. National Cancer Mortality-to-Incidence Ratio (MIR) in Iran (2005 - 2014). Int J Cancer Manag. 2019;12::e94145. doi: org/10.5812/ijcm.94145.
    [Google Scholar]
  41. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73::17-48. doi: 10.3322/caac.21763.
    [Google Scholar]
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  • Article Type: Research Article
Keyword(s): cancerIncidenceIraqmortalitymortality-to-incidence ratio and survival
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