Incidence, mortality and oral cancer disability-adjusted life years in 204 countries and territories before and after the adoption of FCTC/WHO: interrupted time series study.

Abstract

The development of oral cancer (OC) is strongly associated with tobacco products which is a significant risk factor. In 2003, the WHO recommended that countries adopt the Framework Convention on Tobacco Control (FCTC/WHO), an international treaty that includes a set of public policies for tobacco control. Studies show a reduction in the prevalence of tobacco product consumption in countries that have more strongly implemented WHO/FCTC actions. However, information on the relationship between these policies and the burden of neoplastic diseases, including OC, is still scarce. For this reason, the objective of this study was to analyse trends in incidence, mortality, and OC disability-adjusted life years (DALYs) in countries and territories that have joined FCTC/WHO. The analysis lasted from 1990 to 2019, and 2003 was the interruption year (FCTC/WHO implementation), characterising the interrupted time series. The control group (G1) was composed of the countries and territories that did not adhere to the FCTC/WHO; the countries and territories that joined FCTC/WHO were divided into two groups, according to their policy performance (G2A: lowest MPOWER score and G2B: highest MPOWER score). To analyse trends and slopes, generalised linear regression was used using the Prais-Winsten method, allowing the presentation by means of the annual percentage changes and their respective 95% CIs. The temporal pattern showed significant downward negative movements in the group of countries and territories with the highest performance of the policies established in the FCTC/WHO (G2B Group). The socioeconomic development of the countries and territories did not interfere with the impact on the OC rates. It is concluded that the effective implementation of public policies for tobacco control is capable of favourably modifying the trend of incidence, mortality and DALYs rates of OC.