title: The Outcome of Breast Cancer Is Associated with National Human Development Index and Health System Attainment.
abstract: Breast cancer is a worldwide threat to female health with patient outcomes varying widely. The exact correlation between global outcomes of breast cancer and the national socioeconomic status is still undetermined. Mortality-to-incidence ratio (MIR) of breast cancer was calculated with the contemporary age standardized incidence and mortality rates for countries with data available at GLOBOCAN 2012 database. The MIR matched national human development indexes (HDIs) and health system attainments were respectively obtained from Human Development Report and World Health Report. Correlation analysis, regression analysis, and Tukey-Kramer post hoc test were used to explore the effects of HDI and health system attainment on breast cancer MIR. Our results demonstrated that breast cancer MIR was inversely correlated with national HDI (r = -.950; P < .001) and health system attainment (r = -.898; P < .001). Countries with very high HDI had significantly lower MIRs than those with high, medium and low HDI (P < .001). Liner regression model by ordinary least squares also indicated negative effects of both HDI (adjusted R2 = .903, standardize β = -.699, P < .001) and health system attainment (adjusted R2 =. 805, standardized β = -.009; P < .001), with greater effects in developing countries identified by quantile regression analysis. It is noteworthy that significant health care disparities exist among countries in accordance with the discrepancy of HDI. Policies should be made in less developed countries, which are more likely to obtain worse outcomes in female breast cancer, that in order to improve their comprehensive economic strength and optimize their health system performance.
authors.affiliation: Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Kaimin
authors.initials: K
authors.lastname: Hu
authors.affiliation: Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Lixia
authors.initials: L
authors.lastname: Lou
authors.affiliation: Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Tian
authors.affiliation: Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Pan
authors.affiliation: Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Ye
authors.affiliation: Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Suzhan
authors.initials: S
authors.lastname: Zhang
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000628:therapy; D016208:Databases, Factual; D003695:Delivery of Health Care; D003906:Developing Countries; D005260:Female; D006803:Human Development; D006801:Humans; D012959:Socioeconomic Factors