脆弱国家的癌症负担和癌症控制措施现状:31个国家的比较分析。

Isabel Mosquera, Andre Ilbawi, Richard Muwonge, Partha Basu, Andre L Carvalho
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引用次数: 0

摘要

背景:在脆弱国家,有关癌症统计和癌症控制政策的信息有限。本文介绍了这些国家的癌症负担和癌症控制措施的现状。方法:选取2006- 2020年间至少10年脆弱国家指数(FSI)得分在90·0以上(脆弱性预警)的脆弱国家进行对比分析。如果数据少于10年的国家在所有年份都处于脆弱性警报状态,则选择这些国家。收集了有关癌症负担、癌症危险因素流行率、人口归因比例以及政治承诺、卫生筹资和卫生系统能力的信息。癌症发病率和死亡率是根据基于人口的癌症登记处的数据计算的,并通过使用邻国癌症登记处得出的死亡率与发病率比率和发病率与死亡率比率或选定邻国发病率平均值的模型进行估计。为了进行统计比较,根据FSI的年变化百分比(APC)对脆弱状态进行分组,第1组脆弱性呈增加趋势(APC为0.2%或更高),第2组脆弱性呈相对稳定趋势(APC在0.2%至- 0.2%之间),第3组脆弱性呈下降趋势(APC为- 0.2%或更低)。研究结果:总体而言,除宫颈癌和前列腺癌外,31个选定的脆弱国家的估计癌症负担低于全球水平。癌症病例归因于感染(第1组为22.40%,第2组为21.20%,第3组为18.80%),脆弱国家的比例高于全球(13.0%)。第1组和第2组暴露于室内空气污染的程度明显更高(第1组为97.70%,第2组为94.90%),而从第1组到第3组,男性目前的烟草使用量有所增加,第3组的肺癌发病率和死亡率更高。然而,25个国家只执行了一项或没有执行烟草控制的MPOWER措施。各国的自付费用在第1组为48.72%,在第2组为42.68%,在第3组为51.07%,只有一半的国家有更新的癌症控制计划或癌症管理指南。解读:脆弱国家已开始流行病学转型,但仍未实施足够的癌症控制措施。有必要制定可靠的癌症控制计划和指导方针,并建立实施的财政机制。资金:没有。翻译:关于摘要的阿拉伯语和法语翻译,见补充材料部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Cancer burden and status of cancer control measures in fragile states: a comparative analysis of 31 countries.

Cancer burden and status of cancer control measures in fragile states: a comparative analysis of 31 countries.

Background: Information on cancer statistics and cancer control policies is limited in fragile states. This paper describes the cancer burden and status of cancer control measures in these countries.

Methods: In this comparative analysis, fragile states presenting with a Fragile States Index (FSI) score of 90·0 or more (alert for fragility) for at least 10 years during the 2006-20 period were selected. States with fewer than 10 years of data were selected if they were in alert for fragility during all years. Information on cancer burden, prevalence of cancer risk factors, population-attributable fraction, and on political commitment, health financing, and health system capacity was collected. Cancer incidence and mortality was calculated on the basis of data from population-based cancer registries, estimated with modelling that used mortality-to-incidence ratios and incidence-to-mortality ratios derived from cancer registries in neighbouring countries, or average of rates in selected neighbouring countries. For statistical comparison, fragile states were grouped according to the annual percent change (APC) of the FSI, with group 1 showing an increasing fragility trend (APC 0·2% or higher), group 2 a relatively stable fragility trend (APC between 0·2% and -0·2%), and group 3 a decreasing fragility trend (APC of -0·2% or lower).

Findings: Overall, the estimated cancer burden in the 31 selected fragile states was lower than worldwide rates, except for cervical and prostate cancer. Cancer cases were attributed to infections (22·40% in group 1, 21·20% in group 2, and 18·80% in group 3) at a higher proportion in fragile states than globally (13·0%). Group 1 and 2 showed a significantly higher exposure to household air pollution (97·70% in group 1 and 94·90% in group 2), whereas current tobacco use in men increased from group 1 to group 3, with lung cancer incidence and mortality being higher in group 3. However, 25 countries had implemented only one or no MPOWER measures for tobacco control. Countries showed an out-of-pocket expenditure of 48·72% in group 1, 42·68% in group 2, and 51·07% in group 3, and only half of the countries had an updated cancer control plan or cancer management guidelines.

Interpretation: Fragile states have started the epidemiological transition but are still not implementing enough cancer control measures. There is a need to develop reliable cancer control plans and guidelines, and to create financial mechanisms for implementation.

Funding: None.

Translations: For the Arabic and French translations of the abstract see Supplementary Materials section.

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