Socioeconomic characteristics, cancer mortality, and universal health coverage: A global analysis

Achieving universal health coverage (UHC) involves all individuals attaining accessible health interventions at an affordable cost. We examined current patterns and temporal trends of cancer mortality and UHC across sociodemographic index (SDI) settings, and quantified these association. We used data from the Global Burden of Disease Study 2019 and Our World in Data. The UHC effective coverage index was obtained to assess the potential population health gains delivered by health systems. The estimated annual percentage change (EAPC) with a 95% confidence interval (CI) was calculated to quantify the trend of cancer age-standardized mortality rate (ASMR). A generalized linear model was applied to estimate the association between ASMR and UHC. The high (EAPC = −0.9% [95% CI, −1.0%, −0.9%]) and high-middle (−0.9% [–1.0%, −0.8%]) SDI regions had the fastest decline in ASMR (per 100,000) for total cancers from 1990 to 2019. The overall UHC effective coverage index increased by 27.9% in the high-SDI quintile to 62.2% in the low-SDI quintile. A negative association was observed between ASMR for all-cancer (adjusted odds ratio [OR] = 0.87 [0.76, 0.99]), stomach (0.73 [0.56, 0.95]), breast (0.64 [0.52, 0.79]), cervical (0.42 [0.30, 0.60]), lip and oral cavity (0.55 [0.40, 0.75]), and nasopharynx (0.42 [0.26, 0.68]) cancers and high UHC level (the lowest as the reference). Our findings strengthen the evidence base for achieving UHC to improve cancer outcomes. This work is funded by the China National Natural Science Foundation and Chinese Academy of Medical Sciences Innovation Fund for Medical Science. [Display omitted] •Inequality in UHC persists but has been decreasing globally•High UHC level plays an active role in reducing mortality for some specific cancers•Our findings highlight improving access to targeted and effective cancer care The role of universal health coverage (UHC) in reducing cancer deaths has been identified. However, the socioeconomic inequality in cancer mortality and its relationship with UHC on a global scale, has not yet been quantified. In this study, researchers show that the fastest decline in cancer mortality occurs in regions with high UHC and sociodemographic index. While the socioeconomic disparity in UHC persists, there has been a decrease globally over the past 30 years. High UHC level plays an active role in reducing mortality for all-cancer, stomach, breast, cervical, lip and oral cavity, and nasopharynx cancers. The findings provid