title: Trends in childhood cancer mortality as indicators of the quality of medical care in the developed world.
abstract: BACKGROUND
  Mortality from childhood cancer in general and childhood leukemia in particular has sharply declined in economically developed countries over the last 30 years, whereas the incidence of these diseases has remained essentially unaltered. Therefore, childhood malignancies can be used as tracers of accessibility to and effectiveness of medical care. The objective of this study was to compare the reduction of mortality from childhood cancer in general, and childhood leukemia in particular, in four economically developed areas of the world, to assess accessibility to and effectiveness of technologically advanced medical care.
  
  
  METHODS
  The authors used data from the World Health Organization to compare the evolution over time of gender specific, age-adjusted mortality from childhood cancer in general and childhood leukemia in particular in the childhood (birth to age 14 years) populations of North America, western Europe, Japan, and Australia and New Zealand during the period 1960-1993. They assessed the evolution over time and the cumulative percentage representing the decline in mortality from childhood cancer and childhood leukemia in the four aforementioned areas of the world.
  
  
  RESULTS
  The decline in mortality from both the disease entities considered and for both genders has been more pronounced in North America than in other economically developed areas of the world.
  
  
  CONCLUSIONS
  When disease control depends on technologically advanced medical care, as in the case of cancer, the North American population is benefited by earlier and effective introduction of new therapeutic approaches. This conclusion does not apply to other childhood diseases, the incidence of which is higher among low-income groups and control of which depends on prevention rather than treatment.
authors.affiliation: Istituto di Statistica Medica e Biometria, Universita di Milano, Italy.
authors.forename: C
authors.initials: C
authors.lastname: La Vecchia
authors.forename: F
authors.initials: F
authors.lastname: Levi
authors.forename: F
authors.initials: F
authors.lastname: Lucchini
authors.forename: P
authors.initials: P
authors.lastname: Lagiou
authors.forename: D
authors.initials: D
authors.lastname: Trichopoulos
authors.forename: E
authors.initials: E
authors.lastname: Negri
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D019049:Developed Countries / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D007938:Leukemia / Q000401:mortality / Q000628:therapy; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy; D009520:New Zealand / Q000453:epidemiology; D011787:Quality of Health Care / Q000592:standards*; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology