Association between oral cancer mortality and public health expenditure in Colombia between 2012 and 2022: an ecological study
DOI:
https://doi.org/10.17533/udea.rfnsp.e356875Keywords:
oral neoplasms, mortality, health expenditures, cancerAbstract
Objective: To analyze the association between oral cancer mortality and public health expenditure in Colombia between 2012 and 2022.
Methods: An ecological study was conducted, analyzing age-adjusted mortality trends per 100,000 inhabitants. The association was explored using a multilevel model that incorporated per capita public health expenditure, year, and department as covariates.
Results: Per capita public health expenditure had a median of $26,279, a minimum of $9,576, and a maximum of $589,278. Nationally, the mortality rate for 2022 for men was 2.42 (95% CI: 2.21–2.63), and for women, 1.66 (95% CI: 1.49–1.84). The departments with the highest mortality rates for men were Santander, Tolima, and Meta; for women, Santander, Risaralda, and Bogotá. Increasing trends were observed for both sexes. The multilevel model showed an increasing mortality rate, with a mean per capita expenditure of 0.042 per million (95% CI: 0.000019–0.93; p = 0.04).
Conclusions: A positive association was observed between public health expenditure and mortality. In addition, an increasing rate of mortality from oral cancer was observed in Colombia.
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References
1. World Health Organization. GLOBOCAN [internet] s. f. [citado 2024 may. 11]. Disponible en: https://gco.iarc.fr
2. Herrera-Serna BY, Lara-Carrillo E, et al. Efecto de las políticas de control de factores de riesgo sobre la mortalidad por cáncer oral en América Latina. Rev Esp Salud Pública [internet]. 2019 [citado 2024 may. 11]; 93(e201907050). Disponible en: https://scielo.isciii.es/scielo.php?pid=S1135-57272019000100134&script=sci_arttext&tlng=es
3. Chen W, Xia C, Zheng R, et al. Disparities by province, age, and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China: A comparative risk assessment. Lancet Glob Health. 2019;7(2):e257-69. DOI: https://doi.org/10.1016/s2214-109x(18)30488-1
4. Gupta B, Bray F, et al. Associations between oral hygiene habits, diet, tobacco and alcohol and risk of oral cancer: A case-control study from India. Cancer Epidemiol. 2017;51:7-14. DOI: https://doi.org/10.1016/j.canep.2017.09.003
5. Masters R, Anwar E, Collins B, et al. Return on investment of public health interventions: A systematic review. J Epidemiol Community Health. 2017;71(8):827-34. DOI: https://doi.org/10.1136/jech-2016-208141
6. Kops NL, Horvath JDC, Bessel M, et al. The impact of socioeconomic status on HPV infection among young Brazilians in a nationwide multicenter study. Prev Med Rep. 2021;21:101301. DOI: https://doi.org/10.1016/j.pmedr.2020.101301
7. Cohen N, Fedewa S, Chen AY. Epidemiology and demographics of the head and neck cancer population. Oral Maxillofacial Surg Clin N Am. 2018;30:381-95. DOI: https://doi.org/10.1016/j.coms.2018.06.001
8. Tranby EP, Frantsve-Hawley J, Minter-Jordan M, et al. A cross-sectional analysis of oral health care spending over the life span in commercial− and Medicaid-insured populations. J Am Dent As. 2022;153(2):101-9.e11. DOI: https://doi.org/10.1016/j.adaj.2021.07.028
9. Fullman N, Yearwood J, Abay SM, et al. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016. The Lancet. 2018;391(10136):2236-71. DOI: https://doi.org/10.1016/S0140-6736(18)30994-2
10. OECD. Health Spending Projections to 2030: New results based on a revised OECD methodology. OECD Health Working Papers; vol. 110. Report No. 110; 2019. DOI: https://doi.org/10.1787/5667f23d-en
11. De Vries E, Buitrago G, Quitian H, et al. Access to cancer care in Colombia, a middle-income country with universal health coverage. J Cancer Policy. 2018;15:104-12. DOI: https://doi.org/10.1016/j.jcpo.2018.01.003
12. Ammi M, Arpin E, et al. Do expenditures on public health reduce preventable mortality in the long run? Evidence from the Canadian provinces. Soc Sci Med. 2024;345:116696. DOI: https://doi.org/10.1016/j.socscimed.2024.116696
13. Owen L, Fischer A. The cost-effectiveness of public health interventions examined by the National Institute for Health and Care Excellence from 2005 to 2018. Public Health. 2019;169:151-62. DOI: https://doi.org/10.1016/j.puhe.2019.02.011
14. Chow RD, Bradley EH, Gross CP. Comparison of cancer-related spending and mortality rates in the US vs 21 High-income countries. JAMA Health Forum. 2022;3(5):e221229. DOI: https://doi.org/10.1001/jamahealthforum.2022.1229
15. Ammi M, Arpin E, Allin S. Interpreting forty-three-year trends of expenditures on public health in Canada: Long-run trends, temporal periods, and data differences. Health Policy (New York). 2021;125(12):1557-64. DOI: https://doi.org/10.1016/j.healthpol.2021.10.004
16. Rao KD, Roberton T, Vecino Ortiz AI, et al. Future health expenditures and its determinants in Latin America and the Caribbean: A multi-country projection study. The Lancet Regional Health. 2025;44:100781. DOI: https://doi.org/10.1016/j.lana.2024.100781
17. White P, Skirrow H, et al. A systematic review of economic evaluations of local authority commissioned preventative public health interventions in overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation in the United Kingdom. J Public Health. 2018;40(4):e521-e530. DOI: https://doi.org/10.1093/pubmed/fdy026
18. Martin S, Lomas J, Claxton K. Is an ounce of prevention worth a pound of cure? A cross-sectional study of the impact of English public health grant on mortality and morbidity. BMJ Open. 2020;10(10). DOI: https://doi.org/10.1136/bmjopen-2019-036411
19. OCDE, Banco Mundial. Health at a Glance: Latin America and the Caribbean 2023 [internet]; 2023 [citado 2025 ene. 8]. Disponible en: https://www.oecd.org/en/publications/health-at-a-glance-latin-america-and-the-caribbean-2023_532b0e2d-en.html
20. Harris JA, Ritchie CA, Hanna GJ, et al. The inequitable global burden of lip and oral cancers: Widening disparities across countries. J Oral Maxill Sur. 2021;79(6):1364-72. DOI: https://doi.org/10.1016/j.joms.2020.12.035
21. Miranda-Filho A, Bray F. Global patterns and trends in cancers of the lip, tongue and mouth. Oral Oncol. 2020;102(104551). DOI: https://doi.org/10.1016/j.oraloncology.2019.104551
22. Organización Mundial de la Salud, Organización Panamericana de la Salud. Clasificación estadística internacional de enfermedades y problemas relacionados con la salud. Volumen 2. Manual de instrucciones. Décima revisión [internet]; 2003 [citado 2024 may. 11]. disponible: https://ais.paho.org/classifications/chapters/pdf/volume2.pdf
23. Ahmad OB, Boschi-Pinto C, Lopez Christopher AD, et al. Age standardization of rates: A new WHO standard. World Health Organization [internet]; 2001 [citado 2024 may. 20]. https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/gpe_discussion_paper_series_paper31_2001_age_standardization_rates.pdf
24. Kim HJ, Fay MP, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335-51. DOI: https://doi.org/10.1002/(SICI)1097-0258(20000215)19:3%3C335::AID-SIM336%3E3.0.CO;2-Z
25. Joinpoint Regression Program, Version 5.0.2 - May 2023; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute [internet]. 2023 [citado 2024 may. 4]. Disponible en: https://surveillance.cancer.gov/joinpoint/
26. StataCorp. 2023. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC.
27. Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med. 2015;12(10):e1001885. DOI: https://doi.org/10.1371/journal.pmed.1001885
28. Departamento Administrativo Nacional de Estadística (DANE). Diccionario de Datos. Estadísticas Vitales Colombia 2022 [Internet]. 2024 [citado 2024 nov. 4]. Disponible en: https://microdatos.dane.gov.co/index.php/catalog/807/data-dictionary
29. Departamento Nacional de Planeación. Sistema de información y consulta de distribuciones de recursos territoriales (SICODIS) [internet] [citado 2023 ene. 11] Disponible: https://sicodis.dnp.gov.co/logon.aspx?ReturnUrl=%2fReportesSGP%2fSGP_Historicos.aspx)
30. Kocarnik JM, Compton K, Dean FE, et al. Cancer incidence, mortality, years of life lost, years lived with disability, and disability−Adjusted life years for 29 cancer groups from 2010 to 2019. A systematic analysis for the global burden of disease study 2019. JAMA Oncol. 2022;8(3):420-44. DOI: https://doi.org/10.1001/jamaoncol.2021.6987
31. Bosetti C, Carioli G, Santucci C, et al. Global trends in oral and pharyngeal cancer incidence and mortality. Int J Cancer. 2020;147(4):1040-9. DOI: https://doi.org/10.1002/ijc.32871
32. Yete S, D’Souza W, Saranath D. High-risk human papillomavirus in oral cancer: Clinical implications. Oncology. 2018;94(3):133–41. DOI: https://doi.org/10.1159/000485322
33. Aragón N, Ordoñez D, Urrea MF, et al. Head and neck cancer in Cali, Colombia: Population-based study. Community Dent Oral Epidemiol. 2022;50(4):292-9. DOI: https://doi.org/10.1111/cdoe.12671
34. Bravo LE, García LS, Collazos P, et al. Cancer epidemiology in Cali, 60 years of experience. Colomb Méd. 2022;53(1), e2005050. DOI: https://doi.org/10.25100/cm.v53i1.5050
35. Mathur P, Sathishkumar K, Chaturvedi M, et al. Cancer statistics, 2020: Report From National Cancer Registry Programme, India. JCO Glob Oncol. 2020;(6):1063-75. DOI: https://doi.org/10.1200/go.20.00122
36. Duran-Romero AJ, Infante-Cossio P, Pereyra-Rodriguez JJ. Trends in mortality rates for oral and oropharyngeal cancer in Spain, 1979-2018. Oral Dis. 2022;28(2):336–44. DOI: https://doi.org/10.1111/odi.13754
37. Defossez G, Uhry Z, Delafosse P, et al. Cancer incidence and mortality trends in France over 1990-2018 for solid tumors: The sex gap is narrowing. BMC Cancer. 2021;21:726. DOI: https://doi.org/10.1186/s12885-021-08261-1
38. Farhadi K, Rojanaworarit C, Bhurosy T, et al. Trends in lip, oral cavity, and pharyngeal cancer mortality in the United States, 1999-2019. J Oral Pathol Med. 2022;51(9):763-70. DOI: https://doi.org/10.1111/jop.13345
39. Costa EM, Magalhães Rodrigues ES, Sousa FS de, et al. The Brazilian National Oral Health Policy and oral cancer mortality trends: An autoregressive integrated moving average (ARIMA) model. PLoS One. 2023;18(9):e0291609. DOI: https://doi.org/10.1371/journal.pone.0291609
40. Reitsma MB, Fullman N, Ng M, et al. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: A systematic analysis from the global burden of disease study 2015. The Lancet. 2017;389(10082):1885-906. DOI: https://doi.org/10.1016/s0140-6736(17)30819-x
41. Flor LS, Reitsma MB, Gupta V, et al. The effects of tobacco control policies on global smoking prevalence. Nat Med. 2021;27(2):239-43. DOI: https://doi.org/10.1038/s41591-020-01210-8
42. Aggarwal A, Han L, Van der Geest S, et al. Health service planning to assess the expected impact of centralising specialist cancer services on travel times, equity, and outcomes: A national population-based modelling study. Lancet Oncol. 2022;23(9):1211-20. DOI: https://doi.org/10.1016/s1470-2045(22)00398-9
43. Hone T, Mirelman AJ, Rasella D, et al. Effect of economic recession and impact of health and social protection expenditures on adult mortality: A longitudinal analysis of 5565 Brazilian municipalities. Lancet Glob Health [internet] 2019 [citado 2024 nov. 4]; 7(11):e1575-83. Disponible en: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)304097/fulltext
44. Maruthappu M, Watkins J, Noor AM, et al. Economic downturns, universal health coverage, and cancer mortality in high-income and middle-income countries, 1990-2010: A longitudinal analysis. The Lancet. 2016;388(10045):684-95. DOI: https://doi.org/10.1016/s0140-6736(16)00577-8
45. Couto MS de A, Firme V de AC, et al. Efeito da redistribuição das causas mal definidas de óbito sobre a taxa de mortalidade por câncer de mama no Brasil. Cien Saude Colet. 2019;24(9):3517-28. DOI: https://doi.org/10.1590/1413-81232018249.31402017
46. Ades F, Senterre C, De Azambuja E, et al. Discrepancies in cancer incidence and mortality and its relationship to health expenditure in the 27 European Union member states. Ann Oncol. 2013;24(11):2897-902. DOI: https://doi.org/10.1093/annonc/mdt35
47. Doherty MJ, Thom B, Gany F. Evidence of the feasibility and preliminary efficacy of oncology financial navigation: A scoping review. Cancer Epidemiol Biomarkers Prev. 2021;30(10):1778-84. DOI: https://doi.org/10.1158/1055-9965.EPI-20-1853
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