Background

Background: Breast cancer is the most common cancer accounting for about one-fourth of total cancer cases and 15% of all cancer deaths among women worldwide. It is important to determine its trend across the regions in the world to find the high-focus regions. Hence, the current study was done to assess the global trends and deviations in the incidence of breast cancer. Materials and Methods: A descriptive trend analysis was done using the data on breast cancer incidence from the WHO Cancer Incidence Data of Five Continents plus database. Joinpoint regression was performed to determine the average annual percent change (AAPC), and age-period-cohort analysis was done to obtain age-, period-, and cohort-specific deviations and rate ratio. Results: All the regions showed an increasing trend in breast cancer incidence, with an exception of America. Maximum increase was observed in Asia (AAPC = 2.6%; 95% confidence interval [CI]: 2.4%–2.9%) followed by Europe (AAPC = 0.7%; 95% CI: 0.5%–1%). There was consistent rise in the breast cancer incidence across the age groups in all the four continents with maximum burden in elderly ( P < 0.001). Except in America, all other regions showed consistent rise in the incidence of breast cancer through the periods 1998–2002 to 2007–2012 ( P < 0.001). There was consistent increase across the cohorts from 1923–1927 to 1978–1982 in continents such as Asia and Oceania ( P < 0.001). Conclusion: To summarize, the incidence of breast cancer shows an increasing trend globally with a maximum increase in the Asian region. This makes a strong need for newer strategies irrespective of current prevention and control interventions.

National Nutritional Monitoring Bureau survey (2017) has found that more than half of the adults in India were overweight and obese. To halt this rising epidemic, development of various policy measures has been suggested in National action plan for prevention and control of noncommunicable diseases. One such measure is the introduction of fat tax which is a surcharge or tax placed on food and beverages containing high amounts of fat. Government of India has made various direct budgetary initiatives for boosting the sectors related to the production of items rich in fat, sugars and salt without realizing the potential public health consequences. Hence, increasing the taxes for unhealthy junk foods should encourage the people to take healthier food options which in turn lead to positive impact on health. However, fat taxation faced several challenges during implementation in countries like Denmark, Hungary, France and United States. Major challenges were the taxation debate, setting tax limit and encroaching into the autonomy rights of people. Evidences have shown that taxation alone cannot bring down the burden of non-communicable diseases but should be combined with measures like subsidies and access to healthy food items, public health education campaigns and programmes.

Introduction Tobacco use has been steadily increasing among the females in developing countries. It has led to rise in tobacco-related morbidity and mortality among females. Knowing the geographic distribution of the habit is essential to identify high priority areas and direct the healthcare intervention. Hence, this study was done to assess the spatial patterns and determinants of tobacco consumption among females in India. Methods Univariate and Bivariate Moran’s I statistic and local indicators for spatial association (LISA) maps were generated to determine the spatial clustering of tobacco consumption (smoked and smokeless form). Ordinary least-square regression, spatial-lag and spatial-error models were performed to assess the determinants. Poverty (belonging to poorest and poorer quintile of wealth index), illiteracy (no formal education), marital status, ST population, tobacco use by family members and alcohol use were the explanatory variables. Results Univariate Moran’s I was 0.691 suggesting positive spatial autocorrelation. High-prevalence clustering (hot-spots) was maximum in the Central, Eastern and North-Eastern states such as Chhattisgarh, Madhya Pradesh, Odisha, Bihar, Manipur, Tripura, Meghalaya, Mizoram and Assam. This pattern was similar for both smokeless and smoked form. Results of spatial-lag and spatial-error model suggested that alcohol use, scheduled tribes, illiteracy, poverty, marital status and tobacco use by family members were significant determinants of female tobacco consumption. The coefficient of spatial association was maximum for alcohol use (β=0.20, p&lt;0.001) followed by widowed/separated/divorced (β=0.12, p&lt;0.001). Conclusion Tobacco consumption among females in India is spatially clustered. Multisectoral coordination and targeted interventions are required in the geographical hotspots of tobacco consumption. Implications This is the first study to explore the geospatial pattern of tobacco consumption among females in India. We found that the pattern of tobacco use among females is spatially clustered in India. Clustering was predominantly found in Central, Eastern and North-Eastern regions of the country. Tribal population in these areas and complementarities between alcohol and tobacco use contributed significantly to the high prevalence clustering. These findings will be helpful for policymakers and planners to devise specific intervention package targeting the high-risk regions.

In India, out-of-pocket (OOP) expenditure on health care services has been showing an increasing trend. The cost and willingness to pay determines the use of facility-based maternal health services. Hence, the current study was done to find the costs and determinants of OOP payments on childbirth care in India. We analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from the Demographic Health Survey (DHS) program. Stratification and clustering in the sample design were accounted for by using the "svyset" command. Out of 43 507 women, 26 916 (61.9%) had incurred OOP expenditure during their most recent institutional delivery. The average OOP expenditure for delivery care was INR 5985 ($93.3) with median cost being INR 1000 ($15.6). About 80% of women who had OOP expenditure reported that they handled the financial situation by utilizing the money in their bank/savings account. Determinants of OOP expenses were the age of mother, education, religion, state of residence, number of antenatal visits place of delivery, and mode of delivery (P < .05). Out-of-pocket expenditure for accessing care is one of the key determinants of service utilization which, if not