title: The colorectal cancer mortality-to-incidence ratio as an indicator of global cancer screening and care.
abstract: BACKGROUND
  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.
  
  
  METHODS
  The MIR for colorectal cancer is calculated for all Organisation for Economic Cooperation and Development (OECD) countries using the 2012 GLOBOCAN incidence and mortality statistics. Health system rankings were obtained from the World Health Organization. Two linear regression models were fit with the MIR as the dependent variable and health system ranking as the independent variable; one included all countries and one model had the "divergents" removed.
  
  
  RESULTS
  The regression model for all countries explained 24% of the total variance in the MIR. Nine countries were found to have regression-calculated MIRs that differed from the actual MIR by >20%. Countries with lower-than-expected MIRs were found to have strong national health systems characterized by formal colorectal cancer screening programs. Conversely, countries with higher-than-expected MIRs lack screening programs. When these divergent points were removed from the data set, the recalculated regression model explained 60% of the total variance in the MIR.
  
  
  CONCLUSIONS
  The MIR proved useful for identifying disparities in cancer screening and treatment internationally. It has potential as an indicator of the long-term success of cancer surveillance programs and may be extended to other cancer types for these purposes.
authors.affiliation: Department of Economics, Harvard University, Cambridge, Massachusetts; Saint Vincent Hospital, Erie, Pennsylvania.
authors.forename: Vasu
authors.initials: V
authors.lastname: Sunkara
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D003695:Delivery of Health Care; D055088:Early Detection of Cancer; D005060:Europe / Q000453:epidemiology; D005260:Female; D014943:Global Health; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: clinical medicine; colorectal cancer; mass screening; public health