Global incidence and mortality rates in pancreatic cancer and the association with the Human Development Index: decomposition approach

Objectives: Pancreatic cancer has a lower morbidity yet higher case fatality rates (CFRs) compared with other gastrointestinal cancers. The effects of socio-economic components on pancreatic cancer rates have been acknowledged; however, the effects of the Human Development Index (HDI) inequality are not. In this study, we aimed to determine the contribution of important socio-economic components on pancreatic cancer rates using a decomposition approach. Study design: Global ecological study. Methods: Incidence and mortality rates of pancreatic cancer were obtained for 172 countries from GLOBOCAN and the United Nations Development Program. The World Bank database was also used to obtain the HDI and its gradient for 169 countries. Inequality in pancreatic cancer age-specific incidence and mortality rates was calculated according to the HDI using the concentration index (CI). We decomposed the CI to determine main contributors of the inequality. Results: The CI for incidence and mortality of pancreatic cancer in both genders according to the HDI was 0.26 (95 confidence interval: 0.21-0.30) and 0.25 (95 confidence interval: 0.21-0.30), respectively, which indicated more concentrated inequality in advantaged countries. About 80 of the inequality sources were predicted by socio-economic component in both rates of pancreatic cancer. The main contributors to inequality were the mean years of schooling, life expectancy at birth, expected years of schooling, and urbanization. Conclusion: Global inequalities exist in pancreatic cancer incidence and mortality rates according to the HDI; in addition, inequality was more concentrated in countries with higher score of HDI. (c) 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved