title: The association of the human development index with global kidney cancer incidence and mortality.
abstract: OBJECTIVE
  We describe contemporary worldwide age standardized incidence and mortality rates for kidney cancer, and their association with social and economic development metrics.
  
  
  METHODS
  We obtained gender specific, age standardized incidence and mortality rates for 184 countries and 16 major world regions from the GLOBOCAN 2008 database. We compared the mortality-to-incidence ratio on the national and regional levels in males and females, and assessed the association with the development level of each country using the United Nations Human Development Index.
  
  
  RESULTS
  The age standardized incidence rate varied twentyfold worldwide with the highest rate in North America, and the lowest in Africa and South Central Asia (11.8 vs 1.2 and 1.0/100,000 individuals, respectively). The geographic distribution of the age standardized mortality rate was similar to that of the age standardized incidence rate with the highest rates in Europe and North America (3.1 and 2.6/100,000 individuals, respectively) and the lowest rates in Asian and African regions (0.6 to 1.5). Age standardized incidence and mortality rates were 4.5 and 2.8 times higher, respectively, in more developed countries than in developing countries. However, the mortality-to-incidence ratio was highest in Africa and Asia, and lowest in North America (0.6 to 0.8 vs 0.2/100,000 individuals). There was a strong inverse relationship between the Human Development Index and the mortality-to-incidence ratio (regression coefficient -0.79, p<0.0001).
  
  
  CONCLUSIONS
  Kidney cancer incidence and mortality rates vary widely throughout the world while the mortality-to-incidence ratio is highest in less developed nations. These observations suggest significant health care disparities and may reflect differences in risk factors, health care access, quality of care, diagnostic modalities and treatment options available. Future research should assess whether the mortality-to-incidence ratio decreases with increasing development.
authors.affiliation: Section of Urology and Department of Medicine, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
authors.forename: Sandip M
authors.initials: SM
authors.lastname: Prasad
authors.forename: Ya-Chen Tina
authors.initials: YC
authors.lastname: Shih
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
mesh_terms: D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D012959:Socioeconomic Factors