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      The gender difference and mortality-to-incidence ratio relate to health care disparities in bladder cancer: National estimates from 33 countries

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          Abstract

          The variation in the mortality-to-incidence ratio (MIR) between countries and genders reflects the complex etiology and intervention of bladder cancer. In this study, we investigated the MIR variation between genders and health care disparities among countries. Cancer incidence and mortality were obtained from the GLOBOCAN 2012 database. The ranking and the total expenditure on health of countries were obtained from the World Health Organization. Linear regression was used to estimate the significance between variables. We estimated the role of MIRs from 33 countries. Bladder cancer incidence and mortality rates were higher in more developed regions, Europe, and the Americas. The MIRs were higher in less developed regions. Analysis according to country revealed Germany to have the lowest MIR. High relative MIRs (female MIR/male MIR) for bladder cancer were noted in many developed countries. A correlation between MIR and health care disparities among countries was indicated by a significant association between the World Health Organization ranking and total expenditure on health/GDP with the MIR and relative MIR. Low bladder cancer MIR is prone to be more prevalent in countries with good health care system.

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          International variations in bladder cancer incidence and mortality.

          Previous studies have reported substantial worldwide regional variations in bladder cancer (BCa) incidence and mortality. To describe contemporary international variations in BCa incidence and mortality rates and trends using the most recent data from the International Agency for Research on Cancer (IARC). Estimated 2008 BCa incidence and mortality rates for each country by sex were obtained from GLOBOCAN. Recent trends in incidence for 43 countries and in mortality for 64 countries were assessed by join-point model using data from the IARC's Cancer Incidence in Five Continents and from the World Health Organisation's mortality database, respectively. The highest incidence rates for both men and women are found in Europe, the United States, and Egypt, and the lowest rates are found in sub-Saharan Africa, Asia, and South America. Mortality rates are highest in parts of Europe and northern Africa and lowest in Asia, Central America, and middle Africa. Incidence rates among men decreased in 11 of 43 countries (46 registries) (North America, western and northern Europe), remained stable in 20, and increased in 12 countries (southern, central, and eastern Europe). Among women, incidence rates decreased in 10 countries, stabilised in 22 countries, and increased in 12 countries. Mortality rates among men decreased in 32 of 65 countries (throughout all world regions except Central and South America), stabilised in 30 countries, and increased in 3 (Romania, Slovenia, and Cuba). Among women, mortality rates decreased in 24 countries, remained stable in 36 countries, and increased in 5 countries (central and eastern Europe). Incidence and mortality rates in general decreased in most Western countries but increased in some eastern European and developing countries. These patterns in part may reflect differences in the stage and extent of the tobacco epidemic, changes in coding practices, prevalence of schistosomiasis (Africa), and occupational exposure. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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            The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival.

            The complement of the cancer mortality to incidence ratio [1-(M/I)] has been suggested as a valid proxy for 5-year relative survival. Whether this suggestion holds true for all types of cancer has not yet been adequately evaluated. We used publicly available databases of cancer incidence, cancer mortality and relative survival to correlate relative survival estimates and 1-(M/I) estimates from Denmark, Finland, Iceland, Norway, Sweden, the USA and the Netherlands. We visually examined for which tumour sites 5-year relative survival cannot simply be predicted by the 1-(M/I) and evaluated similarities between countries. Country-specific linear regression analyses show that there is no systematic bias in predicting 5-year relative survival by 1-(M/I) in five countries. There is a small but significant systematic underestimation of survival from prognostically poor tumour sites in two countries. Furthermore, the 1-(M/I) overestimates survival from oral cavity and liver cancer with >10% in at least two of the seven countries. By contrast, the proxy underestimates survival from soft tissue, bone, breast, prostate and oesophageal cancer, multiple myeloma and leukaemia with >10% in at least two of the seven countries. The 1-(M/I) is a good approximation of the 5-year relative survival for most but not all tumour sites.
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              The colorectal cancer mortality-to-incidence ratio as an indicator of global cancer screening and care.

              Disparities in cancer screening, incidence, treatment, and survival are worsening globally. The mortality-to-incidence ratio (MIR) has been used previously to evaluate such disparities.
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                Author and article information

                Contributors
                cshy650@csh.org.tw
                chrcsmu@gmail.com
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                28 June 2017
                28 June 2017
                2017
                : 7
                : 4360
                Affiliations
                [1 ]ISNI 0000 0004 0638 9256, GRID grid.411645.3, Department of Urology, , Chung Shan Medical University Hospital, ; Taichung, Taiwan
                [2 ]ISNI 0000 0004 0532 2041, GRID grid.411641.7, School of Medicine, , Chung Shan Medical University, ; Taichung, Taiwan
                [3 ]ISNI 0000 0004 0532 2041, GRID grid.411641.7, Institute of Medicine, , Chung Shan Medical University, ; Taichung, Taiwan
                [4 ]ISNI 0000 0004 0638 9256, GRID grid.411645.3, Department of Medical Education, , Chung Shan Medical University Hospital, ; Taichung, Taiwan
                [5 ]Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
                [6 ]ISNI 0000 0004 0638 9256, GRID grid.411645.3, Division of Nephrology, , Department of Internal Medicine, Chung Shan Medical University Hospital, ; Taichung, Taiwan
                Article
                4083
                10.1038/s41598-017-04083-z
                5489533
                28659584
                125207a3-3d21-4cbb-baeb-d440fb15f5da
                © The Author(s) 2017

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 6 February 2017
                : 9 May 2017
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