Page 151 - GHES-2-2

Global Health Econ Sustain Disparities in cancer outcomes

2023). Conducting analyses of outcomes across countries services, number of dedicated public and private cancer
requires comparable data on patient characteristics, centers per 10,000 cancer patients, and availability of
encompassing age distribution, methods of detection pathology services (European Commission, 2022).
(screening or symptomatic), and pathological features, The highest estimates of age-standardized cancer
as well as information on health-care characteristics incidence rates (Table 1) were found in Anglo-EU
(European Commission, 2022; Lo et al., 2013). countries (372.80), Nordic EU countries (303.6), and
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2.2. Statistical analysis Continental EU countries (316.92) (and the Continental
European country, Switzerland [317.60]). In contrast,
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Data analysis was performed utilizing the Statistical Package the age-standardized cancer incidence rates were lower
for the Social Sciences (version 28.0). Descriptive statistics for Southeastern (267.00) and Southern EU countries
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for continuous variables involved the computation of means (266.27). Age-standardized mortality rates were higher
and standard deviations (SDs), while categorical variables in Central Eastern EU countries (129.98), Southeastern
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were characterized by frequencies and proportions. Simple EU countries (128.30), and Baltic EU countries (120.97).
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regression analyses were conducted to investigate the Spearman rank correlations revealed a coefficient of
relationship between the outcome variable (cancer age- R = 0.159 (p = 0.419) between age-standardized cancer
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standardized mortality rate) and the exposure variables, incidence rates and age-standardized cancer mortality
including current health expenditure, UHC service, rates, indicating no significant association between cancer
allocated funding for early cancer detection programs, and incidence and mortality. Conversely, a positive correlation
the number of dedicated public and private cancer centers was observed between prevalence and cancer incidence,
per 10,000 individuals diagnosed with cancer. with a coefficient of R = 0.792 (p < 0.001), as anticipated.
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The impact of independent variables on the outcomes Table 2 displays descriptive findings for continuous
of estimated age-standardized cancer incidence, mortality, independent variables, concerning health expenditure
and the estimated number of prevalent cases over a 5-year as a percentage of GDP, the provision of UHC services,
period in 2020 was evaluated using univariate linear allocated funding for early detection programs, and the
regressions. Coefficients were estimated using the ordinary presence of both public and private cancer centers. The
least squares method, and the explained variance was mean health expenditure for the assessed countries was
determined by calculating R-squared (R ) values. Linear 9.20% of GDP (SD = 1.96). UHC service had a mean
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regressions were assessed for adherence to assumptions and of 82.32 units (Euros) (SD = 3.98), ranging from 73.00
diagnostic tests. The normality of residuals was assessed to 88.00 units (Euros). Dedicated funding for the early
and validated through histograms and Kolmogorov– detection program had a mean of 2.61 units (Euros)
Smirnov tests. Examination of standardized residuals (SD = 1.40), with a minimum of 0.00 units (Euros) and a
revealed the absence of outliers, as all residuals fell within maximum of 4.00 units (Euros). Public and private cancer
the [−3; 3] interval. Homoscedasticity was evaluated by centers ranged from 0.30 to 21.50 units, with a mean of
plotting standardized residuals against predicted values, 4.60 units (SD = 4.59).
indicating a random distribution of points with no Table 3 displays descriptive results for categorical
discernible trend, thereby confirming this assumption. independent variables of 27 EU countries and Switzerland.

3. Results From the unadjusted analyses, the categorical independent
variables were notably more implicated in high-income
3.1. Association between estimated age- countries compared to low-income countries. Most of
standardized incidence and mortality rates and the the countries under study were categorized by the World
number of prevalent cases based on continuous and Bank as high-income countries (92.9%). Approximately
categorical independent variables 75% of countries lacked early detection programs, 67.9%
possessed referral systems, and 82.1% had operational
Among the 28 European countries with comprehensive
health system data, various indicators displayed a NCD cancer plans.
significant increase across the spectrum from low-income 2 Ireland
to high-income countries. These indicators include the 3 Denmark, Finland, and Sweden
UHC Index, current health expenditure as a percentage 4 Austria, Belgium, France, Germany, Luxembourg, and the Netherlands
of GDP (p = 0.0002), allocated funding for early detection 5 6 Switzerland
initiatives, existence of early cancer detection guidelines, 7 Bulgaria, Croatia, and Romania
Cyprus, Greece, Italy, Malta, Portugal, and Spain
availability of national cancer plans, presence of cancer 8 Czechia, Hungary, Poland, Slovakia, and Slovenia
referral systems, availability of early cancer detection 9 Estonia, Latvia, and Lithuania

Volume 2 Issue 2 (2024) 3 https://doi.org/10.36922/ghes.3216