Global Inequalities in Cervical Cancer Incidence and Mortality are Linked to Deprivation, Low Socioeconomic Status, and Human Development

Abstract

ObjectivesThis study examined global inequalities in cervical cancer incidence and mortality rates as a function of cross-national variations in the Human Development Index (HDI), socioeconomic factors, Gender Inequality Index (GII), and healthcare expenditure.MethodsAge-adjusted incidence and mortality rates were calculated for women in 184 countries using the 2008 GLOBOCAN database, and incidence and mortality trends were analyzed using the WHO cancer mortality database. Log-linear regression was used to model annual trends, while OLS and Poisson regression models were used to estimate the impact of socioeconomic and human development factors on incidence and mortality rates.ResultsCervical cancer incidence and mortality rates varied widely, with many African countries such as Guinea, Zambia, Comoros, Tanzania, and Malawi having at least 10-to-20-fold higher rates than several West Asian, Middle East, and European countries, including Iran, Saudi Arabia, Syria, Egypt, and Switzerland. HDI, GII, poverty rate, health expenditure per capita, urbanization, and literacy rate were all significantly related to cervical cancer incidence and mortality, with HDI and poverty rate each explaining >52% of the global variance in mortality. Both incidence and mortality rates increased in relation to lower human development and higher gender inequality levels. A 0.2 unit increase in HDI was associated with a 20% decrease in cervical cancer risk and a 33% decrease in cervical cancer mortality risk. The risk of a cervical cancer diagnosis increased by 24% and of cervical cancer death by 42% for a 0.2 unit increase in GII. Higher health expenditure levels were independently associated with decreased incidence and mortality risks.Conclusions and Public Health ImplicationsGlobal inequalities in cervical cancer are clearly linked to disparities in human development, social inequality, and living standards. Reductions in cervical cancer rates are achievable by reducing inequalities in socioeconomic conditions, availability of preventive health services, and women’s social status.

Comparison of cancer incidence and mortality in three GDP per capita levels in China, 2013

“…On the global scale, many researches agreed with our finding, pointing out that countries with higher levels of GDPPC reported low incidence and mortality rates of these cancers (17,26). Prevalence of stomach and liver cancers has always been high in East Asian countries compared with not only other continents but also other Asian countries (17,33). Furthermore, the age-standardized five-year net survival from liver cancer was generally low both in the developed and developing world (34).…”

“…In China, positive correlation between breast cancer mortality rate and GDPPC was found (16). Researches based on GLOBOCAN data showed that liver cancer incidence and mortality was negatively correlated with GDPPC (17), and cervical cancer incidence and mortality rates in developing countries were two-fold and three-fold higher respectively than women in developed countries (18). A study on women in the USA showed agreeable relation between poverty and cervical cancer incidence and mortality rates (19).…”

E6/E7 proteins are potential markers for the screening and diagnosis of cervical pre‑cancerous lesions and cervical cancer in a Chinese population

“…Approximately 565,000 new cases of CC occur in the world each year, and the incidence rate in developing countries is 3-fold higher than that in developed countries (24,25). Approximately 50% of all CC cases in the world were recorded in China and India (26).…”

Awareness and screening practices of cervical cancer among nursing staff working in tertiary care hospital

“…Cervical cancer has devastating effects with a very high human, social, and economic cost, affecting women in their prime. 3,4 The disproportionately high burden of cervical cancer in developing countries is largely due to a lack of screening that allows detection of precancerous and early stage cervical cancer. The most efficient and cost-effective screening techniques include visual inspection using either acetic acid or Lugol's iodine and DNA testing for human papilloma virus (HPV) DNA in cervical cell samples.…”