Accepted Manuscript The incidence and mortality of Nasopharynx cancer and their relationship with the Human Development Index in Asia Neda Mahdavifar, Mahshid Ghoncheh, Abdollah Mohammadian-Hafshejani, Bahman Khosravi, Hamid Salehiniya PII:
S2210-9099(16)30153-9
DOI:
10.1016/j.phrp.2016.11.002
Reference:
PHRP 374
To appear in:
Osong Public Health and Research Perspectives
Received Date: 12 August 2016 Revised Date:
21 September 2016
Accepted Date: 7 November 2016
Please cite this article as: Mahdavifar N, Ghoncheh M, Mohammadian-Hafshejani A, Khosravi B, Salehiniya H, The incidence and mortality of Nasopharynx cancer and their relationship with the Human Development Index in Asia, Osong Public Health And Research Perspectives (2016), doi: 10.1016/ j.phrp.2016.11.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Epidemiology and Inequality in the Incidence and Mortality of Nasopharynx Cancer in Asia Neda Mahdavifar (1), Mahshid Ghoncheh (2), Abdollah Mohammadian-Hafshejani (3), Bahman
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Khosravi(4) , Hamid Salehiniya(5,6)
Health promotion research center, Department of Epidemiology and Biostatistics, school of public Health, Zahedan University of Medical Sciences, Zahedan. 2) Department of Epidemiology & Biostatistics, School of public health, Hamadan University of medical sciences, Hamadan, Iran.
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1)
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3) Department of Social Medicine, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 4) Tehran University of Medical Sciences, Tehran, Iran. 5) Zabol university of Medical Sciences, Zabol, Iran
6) Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Corresponding Author: Hamid Salehiniya: E-mail:
[email protected]. Call number: +98 9357750428
ACCEPTED MANUSCRIPT The incidence and mortality of Nasopharynx cancer and their relationship with the Human Development Index in Asia Running tittle: Nasopharynx Cancer in Asia Abstract:
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Introduction: One of the most common head and neck cancers is nasopharynx cancer. Knowledge about the incidence and mortality of this disease and its distribution in terms of geographical areas is necessary for prevention for further study and better planning.
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Therefore, this study was done with the aim of determining incidence and mortality of nasopharynx cancer and its relationship with the Human Development in Asia in 2012.
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Method: This study was an ecologic study in Asia for assessment the correlation between age-specific incidence rate (ASIR) and age-specific incidence rate (ASMR) with HDI and its details that include: Life expectancy at birth, Mean years of schooling and Gross national income (GNI) per capita. Data about SIR and SMR for every Asian counter for year 2012 get
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from global cancer project. We use of correlation bivariate method for assessment the correlation between SIR and SMR with HDI and its components. Statistical significance was assumed if P< 0.05. All reported P-values are two-sided. Statistical analyses were performed
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using SPSS (Version 15.0, SPSS Inc.).
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Results: in total 68272 incidences (71.02% in males and 28.97%in females. Sex ratio was 2.45) and 40530 mortality (71.63% in males and 28.36% in females. The sex ratio was 2.52) recorded in Asian countries in 2012. Five countries with the highest ASIR of Nasopharynx cancer were Malaysia, Singapore, Indonesia, Viet Nam and Brunei and five countries with the highest ASMR were Indonesia, Viet Nam, Singapore, Malaysia and Brunei respectively. Correlation between HDI and ASIR was 0.097 (p = 0.520), in men 0.105 (p = 0.488) and in women 0.019 (p = 0.901).Also Correlation between HDI and ASMR -0.102 (p = 0.502) in men -0.072 (p = 0.633) and in women- 0.224 (p = 0.134).
ACCEPTED MANUSCRIPT Conclusion: nasopharynx cancer is the native cancer of Southeast Asia. So that the highest incidence and mortality are related to Southeast Asian countries including Malaysia, Singapore, Indonesia, Vietnam and Brunei. It was not seen a significant relation between the standardized incidence and mortality rate of nasopharynx cancer and the Human
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Development Index components. Further studies are recommended in Southeast Asian countries in order to find the etiology of cancer, diagnosis and treatment.
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Key words: Epidemiology, Incidence, Mortality, Nasopharynx Cancer, HDI, Asia
Introduction:Cancer was the leading cause of mortality and burden of disease and one of the major public health concerns at international level (1, 2). Head and neck malignancies are among relatively common cancers in humans that affect several anatomic sites of head and
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neck(3). One of the most common head and neck cancers is nasopharynx cancer(4, 5) with a very unique distribution pattern. Worldwide, about 86,500 cases of nasopharynx cancer and 50,000 deaths from it(6) are reported annually. According to the IARC report in 2008, more
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than 80% of patients with nasopharynx cancer are in Asia and only 5% of these cancers are related to Europe. 71% of new cases of nasopharynx cancer are related to East and South-
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East Asia and 29% to South and Central Asia and North and East Africa(7). Nasopharynx cancer is native to Southeast Asia with a prevalence of 15-50 cases per hundred thousand people(8). While in the United States and the rest of the world ,the incidence of less than 1 case per 100,000 people per year is reported(9). In addition to geographic diversity, it seems that some ethnic groups are prone to nasopharynx cancer. For example: Bidayuh in Borneo, Nagas in northern India and Inuit's in the North pole that have allocated the agestandardized incidence of over 16 per 100,000 people in men each year (10).
ACCEPTED MANUSCRIPT In terms of heterogeneous epidemiological patterns, in addition to non-environmental risk factors such as gender, ethnicity and family history(11) , other factors such as smoking(12), salted fish consumption, especially in childhood(12-18), Nitrosamine in some food items traditionally in southern China(19, 20) , use of traditional herbal medicines in the Asian
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population(12, 21-23) and non-food risk factors such as occupational exposures to formaldehyde, wood dust, smoke and chemicals(7, 12, 22, 24) may be involved in pathogenesis of nasopharynx carcinoma(25). Nasopharynx cancer, in comparison to other
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head and neck tumors, has different epidemiological, staging and treatment characteristics.
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Most patients come when they are in advanced stages (26, 27).
The Human Development Index (HDI), is a useful classification to compare the incidence and mortality of cancer in a global level (28-30) and is one of the indicators to check the status of illnesses and deaths between countries. In fact, this index is in relationship with lots of diseases incidence and mortality and is a good index to get inform of the status of
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countries in terms of a specific disease. The Human Development Index is composed of three basic dimensions: life expectancy at birth, adult literacy rate and Gross Domestic Product
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(GDP) capita. The relationship between HDI and some cancers is studied and investigating this relationship can lead to a more accurate understanding of cancer and its risk factors
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distribution (31) and it is suggested also to be done for other cancers. Although nutritional and communicable diseases are common causes of death in countries with a low HDI, but it is anticipated that by 2030, a common cause of death in these countries will be noncommunicable diseases such as cancer(32). Due to this point that awareness about nasopharynx cancer incidence and mortality can be useful for health programs and research activities and considering the possible role of the Human Development Index, this study was done with the aim of evaluating the incidence and mortality of nasopharynx carcinoma and its relationship with development index and its components in Asia in 2012.
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Methods: This study was an ecologic study in Asia for assessment the correlation between age-specific incidence and mortality rate (ASR) with Human Development Index (HDI) and its details that include: Life expectancy at birth, Mean years of schooling and Gross national
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income (GNI) per capita. Data about the age-specific incidence and mortality rate (ASR) for every Asian counter for year 2012 get from global cancer project that available in (http://globocan.iarc.fr/Default.aspx) (33) and Human Development Index (HDI) from
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Human Development Report 2013(34) that include information about HDI and its details for
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every country in the word for year 2012.
Method of estimate the age-specific Incidence and mortality rates in global cancer project by international agency for research on cancer
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Age-specific incidence rate estimate: The methods of estimation are country specific and the quality of the estimation depends upon the quality and on the amount of the information available for each country. In theory, there are as many methods as countries, and because of
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the variety and the complexity of these methods, an overall quality score for the incidence and mortality estimates combined is almost impossible to establish. However an
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alphanumeric scoring system which independently describes the availability of incidence and mortality data has been established at the country level. The combined score is presented together with the estimates for each country with an aim of providing a broad indication of the
robustness
of
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estimation.
The methods to estimate the sex- and age-specific incidence rates of cancer for a specific country fall into one of the following broad categories, in priority order:
ACCEPTED MANUSCRIPT 1- Rates projected to 2012 (38 countries)-2- Most recent rates applied to 2012 population (20 countries)-3-Estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in country-specific cancer registries (13 countries)-4- Estimated from national mortality estimates by modelling, using incidence mortality ratios derived from
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recorded data in local cancer registries in neighboring countries (9 European countries)-5Estimated from national mortality estimates using modelled survival (32 countries)-6Estimated as the weighted average of the local rates (16 countries)-7- One cancer registry
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covering part of a country is used as representative of the country profile (11 countries)-8Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of
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different cancers (by age and sex) (12 countries)-9- The rates are those of neighboring countries or registries in the same area (33 countries) (33, 35).
Age-specific mortality rate estimate: Depending of the degree of detail and accuracy of the
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national mortality data, six methods have been utilized in the following order of priority: 1-Rates projected to 2012 (69 countries)-2- Most recent rates applied to 2012 population (26 countries)-3- Estimated as the weighted average of regional rates (1 country)-4- Estimated
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from national incidence estimates by modelling, using country-specific survival (2 countries)-
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5-Estimated from national incidence estimates using modelled survival (83 countries)-6-The rates are those of neighboring countries or registries in the same area (3 countries) (33, 35). Human Development Index (HDI): Human Development Index (HDI), a composite measure of indicators along three dimensions: life expectancy, educational attainment and command over the resources needed for a decent living. All groups and regions have seen notable improvement in all HDI components, with faster progress in low and medium HDI countries. On this basis, the world is becoming less unequal. Nevertheless, national averages hide large variations in human experience. Wide disparities remain within countries of both
ACCEPTED MANUSCRIPT the North and the South, and income inequality within and between many countries has been rising.(34)
Statistical analysis: In this study, we use of correlation bivariate method for assessment
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the correlation between age-specific incidence and mortality rate (ASR) with Human Development Index (HDI) and its details that include: Life expectancy at birth, Mean years of schooling and Gross national income (GNI) per capita. Statistical significance was assumed if
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P< 0.05. All reported P-values are two-sided. Statistical analyses were performed using SPSS
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(Version 15.0, SPSS Inc.).
Result: In general, a number of 68272 nasopharynx cancer cases were recorded in Asian countries in 2012 that 48492 cases (2/71%) were in men and 19,780 cases (97/28%) were in women. The sex ratio (man to woman) is 45/2. Five countries with the highest number of new
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cases of nasopharynx cancer are as follows, respectively: 1. China with 33198 cases, 2. Indonesia with 13084 cases, 3. Vietnam with 4931 cases, 4.India with 3947 cases, 5. Malaysia with 2030 cases that these five countries have allocated a total of 57190 cases
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(76/83%) of all cases in Asia. In Asian countries, five countries with the highest standardized incidence of nasopharynx cancer are as follows, respectively: 1. Malaysia with the
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standardized rate of 7.2 per one hundred thousand people, 2. Singapore with the rate of 6.4 per one hundred thousand people, 3.Indonesia with the rate of 5.6 per one hundred thousand people, 4.Vietnam with the rate of 5.4 per one hundred thousand people, 5. Brunei Vietnam with the rate of 5 per one hundred thousand people. Similarly, five countries with the lowest standardized incidence of nasopharynx cancer are as follows: 1. Maldives with the rate of 0 per one hundred thousand people, 2. Tajikistan with the rate of 0.1 per one hundred thousand people, 3. Japan with the rate of 0.2 per one hundred thousand people, 4. Bahrain with the rate of 0.2 per one hundred thousand people, 5. Uzbekistan with the rate of 0.3 per one
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10.6 9.7 8.3 7.7 7.6 3.5 3.3 3.2 3.2 2.7 2.5 2.5 1.9 1.8
244
2.0
1.8
212 46
1.3 2.3
1.7 1.7
Turkey
779
1.0
1.0
Nepal
178
1.2
1.6
Nepal Georgia Syrian Arab Republic United Arab Emirates
233 57 138
0.8 1.3 0.7
1.0 0.9 0.8
Turkey Jordan Armenia
588 32 19
1.6 1.0 1.3
0.8
Kyrgyzstan
25
0.7
Syrian Arab Republic
87
1.3
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1.2 1.1
36
139
0.4 0.4
ASR (W)
0.8 0.8
Crude Rate
1.6
9 51
Numbers
10.0 13.3 7.7 7.4 5.8 3.3 2.2 2.5 3.9 3.3 2.0 1.7 1.2 0.9
POPULATION
1487 353 9355 3301 12 789 159 1199 1328 23581 8 55 7 121
Malaysia Singapore Indonesia Viet Nam Brunei Myanmar Cambodia Philippines Thailand China Bhutan Lao PDR Timor-Leste Yemen Korea, Democratic Republic of Saudi Arabia Georgia
Nasopharynx- Estimated incidence, all ages: female
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383
Iraq
Crude Rate
7.2 6.4 5.6 5.4 5.0 2.4 2.2 2.2 2.1 1.9 1.9 1.7 1.5 1.3
Numbers
6.9 9.0 5.3 5.5 3.6 2.4 1.8 1.9 2.7 2.4 1.5 1.3 0.8 1.0
543 1630 120 3729 6 3 359 539 539 9617 96 26 61 83
3.8 3.6 4.6 3.0 1.7 1.5 1.5 1.1 1.5 1.5 0.8 0.8 0.8 0.6
3.9 3.4 3.2 3.0 1.9 1.5 1.5 1.3 1.2 1.1 1.1 1.0 0.9 0.9
139
1.1
0.8
19 4
0.6 0.3
0.8 0.6
51
0.5
0.6
1.6 1.3 1.2
Malaysia Viet Nam Singapore Indonesia Bhutan Brunei Myanmar Philippines Thailand China Yemen Lao PDR Cambodia Saudi Arabia Korea, Democratic Republic of Jordan Kuwait Syrian Arab Republic Turkey Iraq Timor-Leste
191 56 2
0.5 0.3 0.3
0.5 0.5 0.5
0.9
1.1
Sri Lanka
50
0.5
0.4
0.8
1.1
Nepal
55
0.4
0.4
140
0.4
0.4
10
0.4
0.4
122
0.5
0.4
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ASR (W)
2030 473 13084 4931 15 1148 1738 14 1867 33198 220 81 217 295
POPULATION
Crude Rate
Malaysia Singapore Indonesia Viet Nam Brunei Myanmar Philippines Bhutan Thailand China Cambodia Lao PDR Yemen Saudi Arabia Korea, Democratic Republic of Timor-Leste Jordan
Nasopharynx- Estimated incidence, all ages: male
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Numbers
POPULATION
Nasopharynx- Estimated incidence, all ages: both sexes
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Table 1: number and amount of standardized and crude incidence of nasopharynx cancer in Asian countries in 2012 (sorted by age-standardized incidence rate of the highest value to the lowest value)
31
0.7
0.7
Korea, Republic of
320
1.3
1.0
Korea, Republic of Iran, Islamic Republic of
442
0.9
0.7
Israel
38
1.0
0.9
Iran, Islamic Republic of United Arab Emirates Korea, Republic of
418
0.6
0.6
Iraq
83
0.5
0.9
Lebanon
8
0.4
0.3
Israel
53
0.7
0.6
26
0.5
0.9
Pakistan
228
0.3
0.3
Kyrgyzstan
28
0.5
0.6
9
0.6
0.8
Israel
15
0.4
0.3
Armenia
22
0.7
0.6
278
0.7
0.8
Georgia
11
0.5
0.3
Pakistan Kuwait State of Palestine
795 11 14
0.4 0.4 0.3
0.6 0.5 0.5
10 567 34
0.5 0.6 0.7
0.8 0.8 0.7
Mongolia Kazakhstan Qatar
3 25 1
0.2 0.3 0.2
0.3 0.3 0.3
Qatar Lebanon
10
0.5
0.7
Lebanon
23
1.1
1.1
United Arab Emirates Qatar Iran, Islamic Republic of State of Palestine Pakistan Azerbaijan
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0.4 0.4 0.4 0.4 0.4 0.4 0.3 0.3 0.3 0.3 0.2 0.2 0.1 0.0
Kazakhstan India Bangladesh Oman Afghanistan Turkmenistan Mongolia Japan Sri Lanka Kuwait Uzbekistan Bahrain Tajikistan Maldives
50 2956 322 7 51 9 5 421 45 7 38 3 4 0
0.6 0.5 0.4 0.4 0.3 0.4 0.4 0.7 0.4 0.4 0.3 0.4 0.1 0.0
0.7 0.5 0.5 0.5 0.5 0.4 0.4 0.4 0.4 0.4 0.3 0.2 0.1 0.0
Uzbekistan Oman Bahrain Bangladesh India State of Palestine Azerbaijan Afghanistan Armenia Kyrgyzstan Turkmenistan Japan Maldives Tajikistan
26 2 1 112 991 4 8 15 3 3 2 132 0 0
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75 42 95 9 8 3947 434 66 11 64 4 553 4 0
0.2 0.2 0.2 0.1 0.2 0.2 0.2 0.1 0.2 0.1 0.1 0.2 0.0 0.0
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Kazakhstan Azerbaijan Sri Lanka Oman Mongolia India Bangladesh Afghanistan Turkmenistan Uzbekistan Bahrain Japan Tajikistan Maldives
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Map 1: distribution standardized incidence rate of nasopharynx cancer in Asia in 2012(extracted from GLOBALCAN)
On the other hand, the number of 40530 deaths occurred due to nasopharynx cancer in Asia in 2012, which about 29032 (63/71%) are in men and 11498 cases (36/28%) are in women. the sex ratio of mortality of nasopharynx cancer in Asian countries is 52/2. Of these, the most number of deaths occurred in China with the number of 20404 cases, Indonesia with 7391 cases, Vietnam with 2885 cases, India with 2836 cases and Thailand with 1114 cases. That a total of 34630 cases (44/85%) of deaths occurred in just these five countries.
0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.1 0.1 0.1 0.1 0.0 0.0
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Graph 1: the standardized incidence and mortality rate of nasopharynx cancer in Asia in 2012(extracted from GLOBALCAN)
In Asian countries, 5 countries with the highest standardized mortality rate of nasopharynx
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cancer are as follows, respectively: 1.Indinesia with the standardized rate of 3.3 per one hundred thousand people, 2. Vietnam with the rate of 3.3 per one hundred thousand people, 3. Singapore with the rate of 2.8 per one hundred thousand people, 4. Malaysia with the rate of 2.5 per one hundred thousand people, 5. Brunei with the rate of 2.1 per one hundred thousand people. Similarly, five countries with the lowest standardized mortality rate of nasopharynx cancer are as follows: Maldives and Tajikistan with the rate of 0 per hundred thousand people, Bahrain, Kuwait and Israel with the rate of 0.1 per hundred thousand people. The number and rate of standardized and crude mortality of this cancer is shown in table two due
ACCEPTED MANUSCRIPT to sex in Asian countries. Countries are arranged based on standardized rates from high to low in table two so that you can see countries with the highest and lowest standardized rates in each sex (table and map 2 and graph 1).
Numbers
Crude Rate
ASR (W)
2108 4 50 165 247 65 272 16 321 5686 39 9 2 38
1.7 1.1 1.9 1.1 1.0 0.5 0.6 0.5 0.9 0.9 0.5 0.3 0.3 0.3
1.8 1.5 1.3 1.2 1.1 0.9 0.7 0.7 0.7 0.6 0.6 0.5 0.5 0.5
1.2
1.1
Brunei
1
0.5
0.5
0.6
0.9
Syrian Arab Republic
29
0.3
0.4
67
0.5
0.4
39 32 97 150
0.2 0.2 0.3 0.2
0.3 0.3 0.3 0.2
3.3
Indonesia
5283
4.3
Viet Nam Singapore Malaysia Brunei Myanmar Bhutan Cambodia Philippines Thailand Lao PDR China Yemen Timor-Leste Nepal
2885 218 698 6 785 8 144 873 1114 51 20404 152 8 164
3.2 4.1 2.4 1.5 1.6 1.1 1.0 0.9 1.6 0.8 1.5 0.6 0.7 0.5
3.3 2.8 2.5 2.1 1.8 1.4 1.4 1.3 1.3 1.2 1.2 1.2 1.1 0.8
1931 168 533 5 538 105 793 601 35 6 14718 87 4 125
4.4 6.3 3.6 2.4 2.2 1.5 2.3 1.2 1.1 1.0 2.1 0.7 1.0 0.8
Saudi Arabia
136
0.5
0.7
Viet Nam Singapore Malaysia Brunei Myanmar Cambodia Thailand Philippines Lao PDR Timor-Leste China Yemen Bhutan Nepal Korea, Democratic Republic of
148
Korea, Democratic Republic of
215
0.9
0.7
Saudi Arabia
98
0.6
Turkey Syrian Arab Republic Iraq Qatar
397 77 82 4
0.5 0.4 0.2 0.2
0.5 0.5 0.5 0.4
Georgia
27
0.6
0.4
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Pakistan Kyrgyzstan United Arab Emirates Iran, Islamic Republic of Afghanistan State of Palestine
532 16 13 214 54 8
0.3 0.3 0.2 0.3 0.2 0.2
0.4 0.4 0.4 0.3 0.3 0.3
Lebanon
15
0.3
0.3
12 2836 288 185 36 22 4 49 6 5 35
0.4 0.2 0.2 0.4 0.2 0.2 0.1 0.2 0.1 0.2 0.1
0.3 0.3 0.3 0.3 0.2 0.2 0.2 0.2 0.2 0.2 0.2
Armenia India Bangladesh Korea, Republic of Kazakhstan Azerbaijan Oman Sri Lanka Turkmenistan Mongolia Uzbekistan
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0.3
Turkey
300
0.8
0.9
Georgia Kyrgyzstan Syrian Arab Republic Jordan
22 14 48 13
1.1 0.5 0.4 0.4
0.8 0.8 0.7 0.7
Korea, Democratic Republic of Nepal Iraq Turkey Pakistan
Iraq
50
0.3
0.6
Iran, Islamic Republic of
72
0.2
0.2
Armenia Qatar Pakistan Lebanon State of Palestine Afghanistan Iran, Islamic Republic of Korea, Republic of United Arab Emirates India Bangladesh Azerbaijan Kazakhstan Turkmenistan Mongolia Oman Israel Uzbekistan
10 4 382 12 6 42
0.7 0.3 0.4 0.6 0.3 0.2
0.6 0.6 0.6 0.5 0.5 0.5
Sri Lanka Afghanistan United Arab Emirates Oman Uzbekistan Bangladesh
26 12 3 1 14 74
0.2 0.1 0.1 0.1 0.1 0.1
0.2 0.2 0.2 0.1 0.1 0.1
142
0.4
0.4
Kazakhstan
12
0.1
0.1
145 10 2094 214 18 24 5 4 3 9 21
0.6 0.2 0.3 0.3 0.4 0.3 0.2 0.3 0.2 0.2 0.2
0.4 0.4 0.4 0.4 0.4 0.4 0.3 0.3 0.3 0.2 0.2
India Georgia Lebanon Korea, Republic of Azerbaijan State of Palestine Kyrgyzstan Armenia Turkmenistan Mongolia Japan
742 5 3 40 4 2 2 2 1 1 90
0.1 0.2 0.1 0.2 0.1 0.1 0.1 0.1 0.0 0.1 0.1
0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1
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22
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3.0
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7391
ASR (W)
Indonesia Bhutan Singapore Malaysia Myanmar Yemen Philippines Lao PDR Thailand China Cambodia Jordan Timor-Leste Saudi Arabia
Crude Rate
4.8 4.4 3.9 3.4 2.6 2.5 1.9 1.9 1.7 1.7 1.7 1.5 1.4 1.3
Numbers
2.0
POPULATION
2.1
ASR (W)
954
Crude Rate
Viet Nam
Numbers
5.0
Indonesia
Jordan
Nasopharynx- Estimated mortality, all ages: male
POPULATION
Nasopharynx- Estimated mortality, all ages: female
POPULATION
Nasopharynx- Estimated mortality, all ages: both sexes
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Table 2: number and amount of standardized and crude mortality of nasopharynx cancer in Asian countries in 2012 (sorted by age-standardized incidence rate of the highest value to the lowest value)
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0.3 0.1 0.1 0.1 0.0 0.0
0.1 0.1 0.1 0.1 0.0 0.0
Japan Sri Lanka Kuwait Bahrain Tajikistan Maldives
234 23 2 1 2 0
0.4 0.2 0.1 0.1 0.1 0.0
0.2 0.2 0.1 0.1 0.1 0.0
Israel Tajikistan Maldives Bahrain Qatar Kuwait
1 0 0 0 0 0
0.0 0.0 0.0 0.0 0.0 0.0
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Japan Israel Kuwait Bahrain Tajikistan Maldives
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Map 2: distribution standardized mortality rate of nasopharynx cancer in Asia in 2012(extracted from GLOBALCAN) In table three, values of the Human Development Index and its components for each of the
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Asian countries that are arranged based on HDI (Human Development Index) is shown. Thus, in Asia countries are classified in terms of Human Development Index in this way: three countries in very high category, four countries in top category, thirty-five countries in medium category, three countries in low category and a country in uncertain category. Table 3 Human Development Index and its components in Asian countries in 2012 POPULATION Very high human development
Japan Korea, Republic of Israel
Human Development Index(HDI) 0.912
Life expectancy at birth 83.6
Mean Year of schooling 11.6
Gross national income (GNI) per capita 32545
0.909
80.7
11.6
28231
0.9
81.9
11.9
26224
0.0 0.0 0.0 0.0 0.0 0.0
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Low human development
52613 45690 87478
0.818
76.7
8.9
42716
0.796 0.79 0.782 0.769 0.754 0.745 0.745
75.2 74.7 74.1 74.5 67.4 73.9 72.8
9.4 6.1 7.8 9.5 10.4 12.1 7.9
19154 52793 22616 13676 10451 5005 12364
0.742
73.2
7.8
0.734 0.731 0.729 0.722 0.715 0.7 0.699 0.698 0.69 0.688 0.675
70.9 73.2 74.4 74.2 75.1 73.5 73.7 65.2 74.3 77.1 68.8
11.2 5.5 10.8 6.5 9.3 8.6 7.5 9.9 6.6 5.8 8.3
0.648 0.629 0.622 0.622 0.617 0.59 0.576 0.554 0.543 0.543 0.538 0.515 0.515 0.498 0.463 0.458 0.374 -
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0.67
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10.1 8.6 7.3
0.654 0.654
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Other countries or territories
81.2 78.1 78.5
10695
8153 24092 5540 13710 5170 5272 7945 7782 7722 7478 4245
73
8
3359
69 68.6
8.9 10
3752 3201
76
5.7
4674
69.8 68 67.8 75.4 69.6 62.9 65.8 63.6 67.8 67.6 69.2 65.7 65.7 69.1 65.9 49.1
5.8 9.3 9.8 5.5 5.6 4.4 4.4 5.8 4.6 2.3 4.8 4.9 3.9 3.2 5.3 3.1
4154 2009 2119 2970 3557 5446 3285 2095 2435 5246 1785 2566 1 817 1137 928 1000
-
-
-
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Medium human development
0.895 0.855 0.834
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High human development
Singapore Brunei Qatar United Arab Emirates Bahrain Kuwait Saudi Arabia Malaysia Kazakhstan Georgia Lebanon Iran, Islamic Republic of Azerbaijan Oman Armenia Turkey Sri Lanka Jordan China Turkmenistan Thailand Maldives Mongolia State of Palestine Philippines Uzbekistan Syrian Arab Republic Indonesia Kyrgyzstan Tajikistan Viet Nam Iraq Timor-Leste India Cambodia Lao PDR Bhutan Bangladesh Pakistan Myanmar Nepal Yemen Afghanistan Korea, Democratic People’s Rep. of
Checking the relationship between standardized incidence rate and the Human Development Index It was seen a correlation of 0.097 between the standardized incidence rate of nasopharynx cancer and HDI and this relation was not statistically significant (p=0.520). Also it was seen a correlation between components of the Human Development Index and standardized rate so that we had a correlation of 0.174 between the standardized incidence rate and life
ACCEPTED MANUSCRIPT expectancy at birth (p=0.247), a negative correlation of 0.057 with the average years of schooling (p=0.705) and a correlation of 0.134 with the level of income per person of
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population (p=0.375). (Graph 2).
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Graph 2: correlation between the HDI and standardized incidence rate of nasopharynx cancer in Asia in 2012 Also in men it was observed a correlation of 0.105 between the standardized incidence rate of
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nasopharynx cancer and the Human Development Index that this relation was not statistically significant (p=0.488).
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Also it was seen a correlation between components of the Human Development Index and standardized incidence rate so that we had a correlation of 0.174 between the standardized incidence rate and life expectancy at birth (p=0.253), a negative correlation of 0.031 with the average years of schooling (p=0.836) and a correlation of 0.125 with the level of income per person of population (p=0.407). Also in women it was observed a correlation of 0.019 between the standardized incidence rate of nasopharynx cancer and the Human Development Index that this relation was not
ACCEPTED MANUSCRIPT statistically significant (p=0.901). Also it was seen a correlation between components of the Human Development Index and standardized incidence rate so that we had a correlation of 0.134 between the standardized incidence rate and life expectancy at birth (p=0.376), a negative correlation of 0.142 with the average years of schooling (p=0.346) and a correlation
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of 0.059 with the level of income per person of population (p=0.696).
Checking the relationship between standardized mortality rate and the Human
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Development Index
It was seen a negative correlation of 0.102 between the standardized mortality rate of
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nasopharynx cancer and HDI and this relation was not statistically significant (p=0.502). Also it was seen a correlation between components of the Human Development Index and standardized rate so that we had a correlation of 0.034 between the standardized incidence rate and life expectancy at birth (p=0.824), a negative correlation of 0.238 with the average
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years of schooling (p=0.112) and a correlation of 0.001 with the level of income per person
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of population (p=0.994). (Graph 3).
ACCEPTED MANUSCRIPT Graph 3: correlation between the HDI and standardized mortality rate of nasopharynx cancer in Asia in 2012
In men it was observed a correlation of 0.072 between the standardized mortality rate of nasopharynx cancer and the Human Development Index that this relation was not statistically
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significant (p=0.633). Also it was seen a correlation between components of the Human Development Index and standardized mortality rate so that we had a correlation of 0.040 between the standardized incidence rate and life expectancy at birth (p=0.792), a negative
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correlation of 0.188 with the average years of schooling (p=0.211) and a correlation of 0.014
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with the level of income per person of population (p=0.924).
In women it was observed a negative correlation of 0.224 between the standardized mortality rate of nasopharynx cancer and the Human Development Index that this relation was not statistically significant (p=0.134). Also it was seen a negative correlation between
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components of the Human Development Index and standardized rate so that we had a negative correlation of 0.044 between the standardized incidence rate and life expectancy at birth (p=0.773), a negative correlation of 0.345 with the average years of schooling (p=0.019)
(p=0.350).
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and a negative correlation of 0.014 with the level of income per person of population
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Discussion: Generally, a number of 68272 of new cases and 40530 deaths due to nasopharynx cancer were recorded in Asian countries in 2012 that the sex ratio (male to female) of catching disease is 2.45 and the sex ratio of nasopharynx cancer mortality is 2.52 The prevalence of nasopharynx cancer in developing countries is more and it is due to the higher exposure to a variety of risk factors related to this cancer and less budget allocations for health. So that with disease diagnosis in advanced stages and lack of access to treatment, the metastasis of nasopharynx cancer can be observed in these areas more (36, 37).
ACCEPTED MANUSCRIPT In this study it was not seen a significant relation between standardized incidence and mortality rate of nasopharynx cancer and the Human Development Index. Also it was not seen a significant positive relation between standardized incidence and mortality rate of nasopharynx cancer with proper income level (GDP) and level of education or knowledge
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(mean years of schooling). So that in other studies, the increase in life expectancy leads to an increase in global cancer burden and future changes in population growth and aging show that new cases of nasopharynx cancer and mortality in elderly people will increase and this
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increase will be noticeable in countries with low HDL compared to countries with high HDI (76% vs. 25%)(26, 28, 38, 39). Also according to other studies, people who have higher
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education typically have more healthy habits and behaviors than those with a low education level about cancer incidence and mortality are(40, 41). In studies done about nasopharynx cancer, the relationship between nasopharynx cancer with socioeconomic status, lifestyle and geographical positions is known (12). So that in Asian countries, increased incidence of
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nasopharynx cancer in lower economic classes is seen more among men and women(12). Also no difference was seen between the deaths of people living in rural areas with low socio
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- economic status and the people who live in urban areas(42, 43). In this study, Malaysia, Singapore, Indonesia, Vietnam and Brunei are the five states with the
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highest incidence. So that Singapore and Brunei are located in very high HDI countries in terms of Human Development Index, Malaysia in category of countries with a high HDI and Indonesia and Vietnam in the category of countries with medium HDI. According to previous studies in Singapore, nasopharynx cancer is the eighth most common cancer in men, with age standardized incidence of 9.5 per 100,000 per year(44). Also in Indonesia, almost high incidence is reported, and is at least 5.7 among men and 1.9 among women per 100,000 people, compared with incidence in the world is reported 1.9 among men and 0.8 among
ACCEPTED MANUSCRIPT women(45). It should be noted that the actual incidence of nasopharynx cancer in Indonesia is not known due to incomplete registration(11). Regardless of ethnicity, genetic plays an important part in pathogenesis of nasopharynx cancer. The incidence of nasopharynx cancer is 20-50 times higher in South China compared
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with western countries. It is notable that second and third generation of Chinese in South that emigrated to the United States of America (low prevalence area), are still at risk of high nasopharynx cancer despite cultural assimilation compared with resident population(46). In
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the present study, Indonesia, Vietnam, Singapore, Malaysia and Brunei were the five
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countries with the highest death rates from this cancer. Other studies have shown that one of the main causes of death in Indonesia is nasopharynx cancer and in early detection, 80% of patients are at an advanced stage of the disease. In Indonesia, primary health care is done generally by health centers named Puskesmas. Lack of knowledge of general practitioners working in these centers from the various aspects about nasopharynx cancer, may lead to a
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delay in diagnosis(11). So that only about 14 percent of patients who have metastasis at initial diagnosis and 29 percent of patients without metastasis, have response to therapy about 70-
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95% (36). In Singapore older patients diagnosed with stage 2 or stage 3 are at higher risk of recurrence and lower overall survival(47). 80% of patients are now at the stage of 3 or 4 of
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the disease that leads to lower survival and death (11). In the past two decades, the treatment of nasopharynx cancer is considerably enhanced by the usage of chemotherapy and radiotherapy at the same time. However, the overall incidence of patients with metastasis remains 25-34% and survival of these patients is low(48, 49). Conclusion: Countries are located in the category of very high, high and medium HDI in terms of Human Development Index. It was not seen a significant relation between the standardized incidence and mortality rate of nasopharynx cancer and components of the
ACCEPTED MANUSCRIPT Human Development Index (life expectancy at birth, mean years of schooling and income level).
Limitations of the study:
misleading and lack of relation of group results with individuals.
Acknowledgements
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Our study was an ecological study and special limitations of this study include ecological
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Hereby we appreciate of the cooperation of all employees involved in data collection in the
Conflict of interest statement
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GLOBOCAN project and World Bank.
References:
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The authors declare that they have no conflicts of interest for this work.
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