Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4749
Peer-review started: May 6, 2019
First decision: June 16, 2019
Revised: July 10, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 28, 2019
Liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide. Socioeconomic development, indicated by the Human Development Index (HDI), is closely interconnected with public health. But the manner in which social development and medical advances influenced liver cancer patients in the past decade is still unknown.
To investigate the influence of HDI on clinical outcomes for patients with existing liver cancer from 2008 to 2018.
The HDI values were obtained from the United Nations Development Programme, the age-standardized incidence and mortality rates of liver cancer were obtained from the GLOBOCAN database to calculate the mortality-to-incidence ratio, and the estimated 5-year net survival of patients with liver cancer was provided by the CONCORD-3 program. We then explored the association of mortality-to-incidence ratio and survival with HDI, with a focus on geographic variability across countries as well as temporal heterogeneity over the past decade.
From 2008 to 2018, the epidemiology of liver cancer had changed across countries. Liver cancer mortality-to-incidence ratios were negatively correlated and showed good fit with a modified “dose-to-inhibition response” pattern with HDI (r = -0.548, P < 0.0001 for 2018; r = -0.617, P < 0.0001 for 2008). Cancer survival was positively associated with HDI (r = 0.408, P < 0.01) and negatively associated with mortality-to-incidence ratio (r = -0.346, P < 0.05), solidly confirming the interrelation among liver cancer outcome indicators and socioeconomic factors. Notably, in the past decade, the HDI values in most countries have increased alongside a decreasing tendency of liver cancer mortality-to-incidence ratios (P < 0.0001), and survival outcomes have simultaneously improved (P < 0.001), with significant disparities across countries.
Socioeconomic factors have a significant influence on cancer outcomes. HDI values have increased along with improved cancer outcomes, with significant disparities among countries.
Core tip: This study identified the interrelation of area-specific development and liver cancer outcomes. We verified that the Human Development Index (HDI) correlated negatively with mortality-to-incidence ratio and positively with survival rates of liver cancer in a “dose-to-inhibition response” pattern. Analyzing epidemiological data of liver cancer from 2008 to 2018, it was found that HDI in most countries has increased, and the liver cancer outcomes have improved. Our findings provide strong evidence of healthcare disparities related to socioeconomic factors, and we provide a substantial summary of the development of liver cancer health care in the last decade.