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Disparities in Surgical Oncologic Care

E137: Factors associated with disparities in global colorectal cancer mortality

Introduction: In 2020, there were about 935,000 deaths worldwide attributed to colorectal cancer (CRC). The difference in cancer-specific Mortality to Incidence Ratios (dMIRs) between a country and the “highest performing” country is a quantitative metric that can be used to understand cancer outcome disparities between countries. The objective of this study was to explore associations of country level factors with disparities in mortality outcomes for CRC.

Methods: Epidemiological and country-level metadata for 185 countries was collected from the World Health Organization’s (WHO) International Agency for Research on Cancer (IARC) Global Cancer Observatory database, World Bank, and UNDP databases. Colorectal cancer incidence and mortality data was extracted from GLOBOCAN 2020 database. Using a previously developed metric -the dMIR- we described disparities in mortality related to colorectal cancer across 185 countries. Linear regression was used to assess association between dMIR and country level characteristics. A multivariable linear regression model was created using variables with P-value < 0.1 in univariate regression to test for associations between country level factors and dMIR. Missing data was imputed via multiple imputation using the PROC MI SAS procedure.

Results: Of the 185 countries, the Republic of Korea had the lowest MIR at 0.342, thus was designated as “highest performing”. The highest dMIRs were from Belize (0.607), Vanuatu (0.547), and Somalia (0.474). On univariate analysis a number of country level variables were significantly associated with mortality disparity, including Income Index (R-square = 0.601), life expectancy index (R-square = 0.545) and internet users (R-square = 0.532). Only life expectancy index (P-value < 0.001) and internet users (P-value < 0.001) remained significant on multivariable analysis.

Conclusions: In this study we assessed associations between country level factors and dMIR. Life expectancy index, a surrogate of healthcare infrastructure, and internet users, a surrogate for access to health information, were found to be independently associated with disparity in CRC mortality. Findings from this study can be utilized to understand the broader implications of how country level socioeconomic factors effect colorectal cancer outcomes.

Learning Objectives:

  • Data from global databases like the WHO's International Agency for Research on Cancer and GLOBOCAN can be used for evaluating associations between country-level characteristics and colorectal cancer outcomes.
  • The difference in mortality to incidence ratio (dMIR) can be utilized as a metric of disparity in cancer care worldwide.
  • Life expectancy index, a surrogate of healthcare infrastructure, and internet users, a surrogate for access to health information, are independently associated with dMIR.