Neurosurgery Resident Medical College of Georgia North Augusta, SC, US
Introduction: Central nervous system (CNS) cancers comprise 2 percent of all diagnosed cancers, but contribute disproportionately to morbidity and mortality. Diagnosis and optimal treatment requires extensive workup including advanced neuroimaging and treatment including chemoradiation and neurosurgery necessitating a multidisciplinary team. The Global Burden of Disease (GBD) is an international collaboration and the largest comprehensive investigation of global health disease burden ever conducted. Due to the advanced health infrastructure required to diagnose and treat CNS cancers, we hypothesized that higher income nations would show greater morbidity and mortality burdens.
Methods: Using GBD data, we extracted mortality and prevalence of years lived with disability (YLD) for intracranial cancers for every country in the world. We abstracted additional data including GDP per capita, United Nations geoscheme region, Healthcare Access and Quality Index (HAQI), and neurosurgeons per capita where such data were available.
Results: 19/20 (95%) of the countries with the highest death burden were in the top 50% for GDP per capita, with 12/20 (60%) in the top 25%. All 20 countries were European, with 17/20 (85%) in Southern or Eastern Europe. 19/20 (95%) of the countries with the highest YLD burden were in the top 50% for GDP per capita, with 18/20 (90%) in the top 25%. 17/20 (85%) countries were European, with 13/20 (65%) in Northern or Western Europe. 10 of the 20 wealthiest countries on earth were in the top 20 countries for CNS cancer YLD.
Conclusion : Wealthier nations had greater morbidity and mortality due to CNS cancer. Lower reported morbidity and mortality in developing nations may be due to underdiagnosis or poverty-associated mortalities which forestall cancer related death. We expect that the burden of CNS cancer will continue to increase along with increasing global wealth and corresponding improvements in healthcare systems.
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