ABSTRACT
Cancer continues to rise as a contributor to premature death in the developing world. Despite this, little is known about whether cancer outcomes are related to a country's income level, and what aspects of national healthcare systems are associated with improved cancer outcomes. The most recent estimates of cancer incidence and mortality were used to calculate mortality-to-incidence ratio [MIR] for the 85 countries with reliable data. Countries were categorized according to high-income [Gross Domestic Product [GDP] > [dollar sign]15,000] or middle/low-income [GDP < [dollar sign]15,000], and a multivariate linear regression model was used to determine the association between healthcare system indicators and cancer MIR. Indicators study included per capita GDP, overall total healthcare expenditure [THE], THE as a proportion of GDP, total external beam radiotherapy devices [TEBD] per capita, physician density, and the year 2000 WHO healthcare system rankings. Cancer MIR in high-income countries [0.47] was significantly lower than that of middle/low-income countries [0.64], with a p < 0.001. In high-income countries, GDP, health expenditure and TEBD showed significant inverse correlations with overall cancer MIR. A [dollar sign]3040 increase in GDP [p = 0.004], a [dollar sign]379 increase in THE [p < 0.001], or an increase of 0.59 TEBD per 100,000 population [p = 0.027] were all associated with a 0.01 decrease in cancer MIR. In middle/low-income countries, only WHO scores correlated with decreased cancer MIR [p = 0.022]; 12 specific cancer types also showed similar significant correlations [p < 0.05] as overall cancer MIR. The analysis of this study suggested that cancer MIR is greater in middle/low-income countries. Furthermore, the WHO healthcare score was associated with improved cancer outcomes in middle/low-income countries while absolute levels of financial resources and infrastructure played a more important role in high-income countries