Expansion of the quality of care index on breast cancer and its risk factors using the Global Burden of Disease Study 2019
Breast cancer (BC), as the top neoplasm in prevalence and mortality in females, imposes a heavy burden on health systems. Evaluation of quality of care and management of patients with BC and its responsible risk factors was the aim of this study.
Abstract
Background
Breast cancer (BC), as the top neoplasm in prevalence and mortality in females, imposes a heavy burden on health systems. Evaluation of quality of care and management of patients with BC and its responsible risk factors was the aim of this study.
Methods
We retrieved epidemiologic data of BC from the Global Burden of Disease (GBD) 1990–2019 database. Epidemiology and burden of BC and its risk factors were explored besides the Quality of Care Index (QCI) introduced before, to assess the provided care for patients with BC in various scales. Provided care for BC risk factors was investigated by their impact on years of life lost and years lived with disability by a novel risk factor quality index (rQCI). We used the socio-demographic index (SDI) to compare results in different socio-economic levels.
Results
In 2019, 1,977,212 (95% UI: 1,807,615–2,145,215) new cases of BC in females and 25,143 (22,231–27,786) in males was diagnosed and this major cancer caused 688,562 (635,323–739,571) deaths in females and 12,098 (10,693–13,322) deaths in males, globally. The all-age number of deaths and disability-adjusted life years attributed to BC risk factors in females had an increasing pattern, with a more prominent pattern in metabolic risks. The global estimated age-standardized QCI for BC in females in 2019 was 78.7. The estimated QCI was highest in high SDI regions (95.7). The top countries with the highest calculated QCI in 2019 were Iceland (100), Japan (99.8), and Finland (98.8), and the bottom countries were Mozambique (16.0), Somalia (8.2), and Central African Republic (5.3). The global estimated age-standardized rQCI for females was 82.2 in 2019.
Conclusion
In spite of the partially restrained burden of BC in recent years, the attributable burden to risk factors has increased remarkably. Countries with higher SDI provided better care regarding both the condition and its responsible risk factors.
1 INTRODUCTION
Breast cancer (BC) is the most common diagnosed cancer and cause of death due to cancers in women globally.1, 2 Various regions and countries have experienced different patterns of BC epidemiology; however, this cancer and the imposed burden remain the major public health concern among the female population.3, 4 BC occurrence is proved to be linked with two groups of inherent risk factors—including age, sex, ethnicity, genetic, and other intrinsic factors—which are not simply modifiable, and extrinsic factors—including lifestyle, diet, metabolic, and hormonal therapies—which are modifiable and could be altered by interventions.2, 5 Since the exposure to major extrinsic BC risk factors is growing, the significant share of the attributable burden to the risk factors is one of the major obstacles in the management of the BC pandemic.6 Also, BC in males as a distinct cause of cancer, had different epidemiological patterns and need more investigation.7, 8
Besides the importance of the general concept of quality of care in providing healthcare services to patients, ensuring the quality of cancer care plays a major role in the management of patients diagnosed with various cancers to reach the desired outcomes.9 Due to various clinical and socio-economic underlying causes, the quality of cancer care has faced many gaps and has yet to be improved in some regions and countries worldwide, especially in developing countries and those with limited resources, leading to delayed presentation and diagnosis of this cancer.10-13 In this regard, BC patients, as a major group of patients with cancers, showed to be vulnerable in perceived quality of care and exposed to poor quality in terms of too much unnecessary care, too little care, or the wrong received care and with considerable disparities in some areas.14-16 Besides, variations in different aspects of BC care exist, including screening, diagnosis, treatment, and follow-up stages of the disease management.17 Therefore, providing evidence-based information on BC quality of care, especially through large-scale population-based studies, could help BC care.
To provide an insightful vision on the global, regional, and national burden and quality of care of BC and its major risk factors, we aimed to conduct this study using the recent Global Burden of Disease (GBD) 2019 data and the developed measures for quality of care assessment. The beneficial results of this study potentially provide health authorities and clinicians worldwide with the essential data on how to re-allocate resources to curb the heavy burden of this cancer through appropriate measures.
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