National health system characteristics, breast cancer stage at diagnosis, and breast cancer mortality: a population-based analysis
National health system characteristics, breast cancer stage at diagnosis, and breast cancer mortality: a population-based analysis
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DOI：
10.1016/s1470-2045(21)00462-9
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发表时间：
2021-11-01
期刊：
影响因子：
51.1
通讯作者：
Anderson, Benjamin O.
中科院分区：
文献类型：
--
作者：
Duggan, Catherine;Trapani, Dario;Anderson, Benjamin O.
背景：自20世纪90年代以来，在一些国家，乳腺癌年龄标化死亡率每年下降2-4%，但其他国家尚未达到这一结果。在这项研究中，我们旨在描述国家卫生系统特征与乳腺癌年龄标化死亡率以及乳腺癌降级程度与国家年龄标化死亡率降低之间的关联。方法在这项基于人口的研究中，从GLOBOCAN 2020获得的69岁及以下妇女的国家年龄标化死亡率估计与世界卫生组织2020年癌症国家概况中报告的一系列标准化国家卫生系统数据相关联。这些医疗系统特征包括医疗支出、全民健康覆盖服务覆盖指数(UHC指数)、早期发现计划的专项资金、乳腺癌早期发现指南、转介系统、癌症计划、每10 000名癌症患者中有多少专门的公立和私营癌症中心，以及病理服务。我们使用非参数Kruskal-Wallis检验检验连续变量之间的差异，并使用Pearson chi(2)检验检验分类变量之间的差异。简单和多元线性回归分析适用于确定卫生系统特征和年龄标准化乳腺癌死亡率之间的联系。关于诊断时TNM分期的数据来自国家或国家以下癌症登记机构，并补充了2010-2020年PubMed的文献综述。使用世卫组织癌症死亡率数据库评估了1950至2016年的死亡率趋势。显着性的阈值被设定在p值0.05或更低。发现148个国家拥有完整的卫生系统数据。在未经调整的分析中，以下变量在高收入国家显著高于低收入国家：卫生支出(p=0.0002)、超额医疗费用指数(p
Background In some countries, breast cancer age-standardised mortality rates have decreased by 2-4% per year since the 1990s, but others have yet to achieve this outcome. In this study, we aimed to characterise the associations between national health system characteristics and breast cancer age-standardised mortality rate, and the degree of breast cancer downstaging correlating with national age-standardised mortality rate reductions.Methods In this population-based study, national age-standardised mortality rate estimates for women aged 69 years or younger obtained from GLOBOCAN 2020 were correlated with a broad panel of standardised national health system data as reported in the WHO Cancer Country Profiles 2020. These health system characteristics include health expenditure, the Universal Health Coverage Service Coverage Index (UHC Index), dedicated funding for early detection programmes, breast cancer early detection guidelines, referral systems, cancer plans, number of dedicated public and private cancer centres per 10 000 patients with cancer, and pathology services. We tested for differences between continuous variables using the non-parametric Kruskal-Wallis test, and for categorical variables using the Pearson chi(2) test. Simple and multiple linear regression analyses were fitted to identify associations between health system characteristics and age-standardised breast cancer mortality rates. Data on TNM stage at diagnosis were obtained from national or subnational cancer registries, supplemented by a literature review of PubMed from 2010 to 2020. Mortality trends from 1950 to 2016 were assessed using the WHO Cancer Mortality Database. The threshold for significance was set at a p value of 0.05 or less.Findings 148 countries had complete health system data. The following variables were significantly higher in high income countries than in low-income countries in unadjusted analyses: health expenditure (p=0.0002), UHC Index (p