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Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 563-570
Epidemiology, incidence, and mortality of gallbladder cancer and its relation with development in the world


1 Health Promotion Research Center, Department of Epidemiology and Biostatistics, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran
2 Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
3 Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
4 Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
5 Zabol University of Medical Sciences, Zabol; Department of Epidemiology and Biostatistics, School of public health, Tehran University of Medical Sciences, Tehran, Iran

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Date of Web Publication21-Aug-2017
 

   Abstract 

Introduction: Gallbladder cancer is the sixth gastrointestinal cancer and one of the most common cancers of the biliary tract. Awareness about the incidence and mortality of this disease and its distribution in terms of geographical areas for further study and better planning is essential for prevention gallbladder. Therefore, this study was performed with the aim of determining the incidence and mortality of gallbladder cancer and its relationship with the Human Development Index (HDI) in the world in 2012. Methods: The study was conducted based on data from the world data of cancer and the World Bank (including the HDI and its components). Data about the age-specific incidence and mortality rate (ASR) for every country in 2012 were getting from the global cancer project. To analyze data, correlation tests between incidence and death rates, and HDI and its components were employed with a significance level of 0.05 using SPSS software. Results: In 2012, 178101 cases of gallbladder cancer had occurred in the whole world that 76844 cases of them were men and 101257 were women (Sex Ratio = 0.75). In 2012, 142823 deaths from gallbladder cancer had occurred in worldwide that 60339 cases were men and 82484 cases were women (Sex Ratio = 0.73). A positive correlation of 0.402 was seen between gallbladder cancer standardized incidence rate and the HDI that this correlation was statistically significant (P < 0.001). Also, a positive correlation of 0.261 was seen between the standardized mortality rate of gallbladder cancer and the HDI that this association was statistically significant (P = 0.001). Conclusion: Countries with high incidence of gall bladder carcinoma have higher mortality rates too. A significant correlation was seen between the standardized incidence and mortality rate of gallbladder cancer and the HDI and its dimensions (life expectancy at birth, average education). Further studies about the causes of this disease can be useful.

Keywords: Epidemiology, incidence, gallbladder cancer, mortality, world

How to cite this article:
Mahdavifar N, Pakzad R, Ghoncheh M, Gandomani HS, Salehiniya H. Epidemiology, incidence, and mortality of gallbladder cancer and its relation with development in the world. Ann Trop Med Public Health 2017;10:563-70

How to cite this URL:
Mahdavifar N, Pakzad R, Ghoncheh M, Gandomani HS, Salehiniya H. Epidemiology, incidence, and mortality of gallbladder cancer and its relation with development in the world. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Nov 15];10:563-70. Available from: http://www.atmph.org/text.asp?2017/10/3/563/213176

   Introduction Top


Nowadays, noncommunicable diseases are rising severely in the world. Among these diseases, cancer is the second cause of mortality in developed countries and is the tenth leading cause of death in developing countries. One of these important cancers is gallbladder cancer that first raised in 1777 and more than 200 years later, the characteristics of this disease, late diagnosis, and lack of effective treatment for many patients were announced.[1],[2] Gallbladder cancer is the sixth cancer of gastrointestinal system and is one of the most common cancers of biliary tract. As it is rare among different gastrointestinal cancers and has variety in incidence with the reported rate of 2.2 per hundred thousand people annually all around the world.[3],[4]

The incidence of gallbladder cancer has a variable geographical pattern around the world. As the highest incidence has been reported in India, Asia, Europe, and South America.[5],[6] The incidence of gallbladder cancer is rising because of the time of diagnosis in advanced stage in recent years. Often treatment is not beneficial and despite the progression of information and diagnostic techniques, the disease still remains as a deadly disease.[7]

The incidence of the disease increases with aging and the probability of women catching is 2-6 folds more than men.[8] We can point out to a history of gallstones or gallbladder disease,[9] food diet, tobacco usage, exposure to wood, coal dust, long interval between meals, obesity, use of oral contraceptives, number of deliveries and family history of gallbladder disease,[10] and genetic factors,[11] as risk factors of this disease. According to the studies, gallstone has existed in 70%-94% of patients with gall bladder cancer.[12],[13]

Despite the great progress that has been made in the field of diagnostic technology, due to the anatomical location of the gallbladder and nonspecificity of symptoms, gallbladder cancer diagnosis is often in late stages and with poor prognosis with the amount of less than 10% in the patients. So that the 5-year survival has been reported less than 5% in many studies.[7],[14] This is while 5-year survival can be different from 60% to 1% for the stages of 0-IV of this cancer.[5] Recently, in one study, the 5-year survival rate has been reported as 12%, reflecting the aggressive nature of the disease with extensive local invasion and metastasis early stages. The patients being under operation have shown the survival rate of 19%-26% percentages for 5-year survival with the tendency to get better more than two past decades.[15]

Some of the causes of differences in incidence and mortality of cancers in different regions are socioeconomic status, education level, and life expectancy which are introduced by the Human Development Index (HDI). So the HDI is a useful classification for comparison between the incidence and mortality of cancer in the world [16] and is one of the indicators that is used for checking the status of illnesses and deaths between countries.[17],[18] In fact, this index is associated with the incidence and mortality of many diseases and is an appropriate indicator for knowledge about the status of countries in terms of a specific disease. The relation between the HDI and some cancers has been studied and checking this relationship can lead to a more accurate understanding of the distribution of cancer and its risk factors.[19],[20],[21] Because the knowledge about the incidence and mortality of gallbladder cancer can be useful for health programs and research activities, and with the regard to the possible role of the HDI, this study has been performed with the aim of determining the incidence and mortality of gallbladder cancer and its relationship with development index and its components in the world in 2012.


   Methods Top


This study was an ecologic study in the world for assessing the correlation between age-specific incidence and mortality rate (ASR) with HDI and its details, including life expectancy at birth, mean years of schooling, and gross national income (GNI) per capita. Data about the ASR for every country in 2012 were gotten from the global cancer project that is available in http://globocan.iarc.fr/Default.aspx [22] and HDI from Human Development Report 2013[23] that includes information about HDI and its details for every country in the world in 2012.

Method for estimating the age-specific incidence and mortality rates in global cancer project by international agency for research on cancer

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 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 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 the 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:

1- Rates projected to 2012 (38 countries)

2- Most recent rates applied to 2012 population

(20 countries)

3- Estimated from national mortality by modeling, using incidence mortality ratios derived from recorded data in country-specific cancer registries (13 countries)

4- Estimated from national mortality estimates by modeling, using incidence mortality ratios derived from recorded data in local cancer registries in neighboring countries (nine European countries)

5- Estimated from national mortality estimates using modeled survival (32 countries)

6- Estimated as the weighted average of the local rates (16 countries)

7- One cancer registry covering a part of a country is used as representative of the country profile (11 countries)

8- Age/sex-specific rates for “all cancers” were partitioned using data on relative frequency of different cancers (by age and sex) (12 countries)

9- The rates are those of neighboring countries or registries in the same area (33 countries).[22]

Age-specific mortality rate estimate

Depending on the degree of detail and accuracy of the 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 (one country)

4- Estimated from national incidence estimates by modeling, using country-specific survival (two countries)

5- Estimated from national incidence estimates using modeled survival (83 countries)

6- The rates are those of neighboring countries or registries in the same area (three countries).[24]

Human Development Index (HDI)

HDI is a composite measure of indicators along three components, including 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 the North and the South, and income inequality within and between many countries has been rising. According to HDI, countries in the world are divided into four categories as follows: countries with very high HDI (HDI ≥0.80), countries with a high HDI (0.80 > HDI > 0.710), medium HDI countries (0.710 ≥ HDI ≥ 0.535), and countries with a low HDI (HDI < 0.535).[23]

Statistical analysis

In this study, we used correlation bivariate method for assessment of the correlation between ASR with HDI and its details, which include life expectancy at birth, mean years of schooling, and GNI per capita. Statistical significance was assumed if P < 0.05. All reported P-values are two-sided. Statistical analyses were performed using SPSS (Version 15.0, SPSS Inc.).


   Results Top


Incidence number of gallbladder cancer

In 2012, 178101 gallbladder cancer cases occurred in the whole world that 76844 cases of them were men and 101257 were women (Sex Ratio = 0.75). Of all the occurred cases, 67077 cases were in countries with very high HDI, 20281 cases in countries with high HDI, 79990 cases in countries with medium, and 10726 cases in countries with low HDI. Five countries that the most numbers of gallbladder cancer had occurred in them included China with 51463 cases, Japan with 21417 cases, India with 18787 cases, America with 9431 cases, and Germany with 5340 cases. Five countries that had the most numbers of gallbladder cancer in men were China with 23764 cases, Japan with 10818 cases, India with 7615 cases, America with 4181 cases, and the Republic of Korea with 2718 cases, respectively. Five countries that had the highest number of gallbladder cancer cases in women included China with 27699 cases, India with 11172 cases, Japan with 10599 cases, America with 3495 cases, and Bangladesh with 5250 cases.

The age-standardized incidence of gallbladder cancer

The standardized incidence rate of gallbladder cancer was 2.2 per hundred thousand people that was 2.1 per hundred thousand people in men and 2.3 per hundred thousand people in women in the world. The standardized incidence rate of gallbladder cancer was 2.6 per hundred thousand people in countries with very high HDI, 1.7 per hundred thousand people in countries with high HDI, 2.2 per hundred thousand people in countries with an average HDI, and 1.4 in countries with low HDI. Five countries that had the highest age-standardized incidence rate of gallbladder cancer included Chile with 9.7 per hundred thousand people, Bolivia with 8.1 per hundred thousand people, Republic of Korea with 6.5 per hundred thousand people, Lao PDR with 4.8 per hundred thousand people, and Japan with 4.7 per hundred thousand people, respectively. Five countries that had the highest age-standardized incidence rate of gallbladder cancer for men included Republic of Korea with 7.8 per hundred thousand people, Lao PDR with 6.5 per hundred thousand people, Chile with 7.8 per hundred thousand people, Japan with 5.8 per hundred thousand people, and Bolivia with 4.7 per hundred thousand people. Also five countries that had the highest age-standardized incidence rate of gallbladder cancer for women included Chile with 12.8 per hundred thousand people, Bolivia with 10.9 per hundred thousand people, Bangladesh with 6.2 per hundred thousand people, Ecuador with 5.7 per hundred thousand people, and Peru with 5.5 people per hundred thousand people [Figure 1].
Figure 1: Distribution of the standardized incidence rate gallbladder cancer in the world (extracted from GLOBOCAN 2012).

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The number of deaths from gallbladder cancer

In 2012, 142823 deaths due to gallbladder had occurred worldwide that about 60339 cases of them related to men and 82484 cases related to women (Sex Ratio = 0.73). The number of deaths from cancer in very high HDI countries was 48958 cases, 17213 cases in countries with high HDI, 66571 cases in countries with average HDI, and 66571 cases in countries with 10067 cases. Five countries that had the highest number of gallbladder cancer death included China with 41973 deaths, Japan with 19309 deaths, India with 15866 deaths, Bangladesh with 4412 deaths, and Republic of Korea with 4176 cases. Five countries that had highest number of gallbladder cancer with the most deaths in men included China with 19498 deaths, Japan with 9282 deaths, India with 6416 deaths, Republic of Korea with 3515 deaths, and America with 2059 deaths. Also, five countries that had the highest number of gallbladder cancer death in women included China with 22475 deaths, Japan with 10027 deaths, India with 9450 deaths, Bangladesh with 3259 deaths, and America with 2310 deaths.

The age-standardized mortality rate of gallbladder cancer

The standardized mortality rate of gallbladder cancer was 1.7 per hundred thousand people in the world that this rate was 1.6 in men and 1.8 in women. The standardized mortality rate of gallbladder cancer was 1.7 per hundred thousand people in countries with very high HDI, 1.4 per hundred thousand people in countries with high HDI, 1.8 per hundred thousand people in countries with an average HDI, and 1.4 per hundred thousand people in countries with low HDI. Five countries that had the highest standardized mortality rate of gallbladder cancer were Chile with 7.8 per hundred thousand people, Bolivia with 7.5 per hundred thousand people, Republic of Korea with 4.8 per hundred thousand people, Lao PDR with 4.7 per hundred thousand people, and Nepal with 4.1 per thousand people, respectively. Five countries that had the highest standardized mortality rate of gallbladder cancer for men were Lao PDR with 6.3 per hundred thousand people, Republic of Korea with 5.8 per hundred thousand people, Chile with 5 per hundred thousand people, Japan with 4.7 per hundred thousand people, and Bolivia with 4.5 per hundred thousand people, respectively. Also five countries that had the highest standardized mortality rate of gallbladder cancer in women were Chile with 10.3 per hundred thousand people, Bolivia with 10.1 per hundred thousand people, Bangladesh with 5.9 per hundred thousand people, Peru with 5 per hundred thousand people, and Nepal with 4.7 people per hundred thousand people [Figure 2].
Figure 2: Distribution of the standardized mortality rate of gallbladder cancer in the world (extracted from GLOBOCAN 2012).

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[Figure 3] shows the standardized incidence and mortality rate of gallbladder cancer in different parts of the UN. As it is clear, the standardized incidence and mortality rate of gallbladder cancer in developed and developing countries is more than in other countries [Figure 3].
Figure 3: Standardized incidence and mortality rate in different regions of UN (extracted from GLOBOCAN 2012).

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The relationship between age-standardized incidence of gallbladder cancer and the HDI

A positive correlation of 0.402 was seen between the standardized incidence rate of gallbladder cancer and the HDI that this association was statistically significant (P < 0.001). Also, a positive correlation was seen between the components of HDI with the standardized incidence rate of gallbladder cancer. As, the positive correlation of 0.459 (P < 0.001) between the standardized incidence rate and life expectancy at birth, a correlation of 0.307 with mean education years (P < 0.001), and a correlation of 0.206 with income level per person of the population (P = 0.007). All cases were statistically significant [Figure 4] and [Table 1].
Figure 4: The relation between the standardized incidence rate and the HDI.

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Table 1: Correlations between ASIR, ASMR with HDI and its component

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The relationship between the ASMR of gallbladder cancer and the HDI

In 2012, 178101 gallbladder cancer cases had occurred in the world that 76844 numbers of them were men and 101257 were women (Sex Ratio = 0.75). In 2012, 142823 numbers of deaths from gallbladder cancer had occurred worldwide that 60339 cases related to men and 82484 cases related to women (Sex Ratio = 0.73). A positive correlation of 0.402 was observed between the standardized incidence rate of gallbladder cancer and the HDI that this association was statistically significant (P < 0.001) as well as the positive correlation between components of the HDI and the standardized incidence rate of gallbladder cancer. A positive correlation of 0.261 was observed between the standardized mortality rate of gallbladder cancer and the HDI that this association was statistically significant (P = 0.001). Also, a positive correlation was observed between the components of the HDI and the standardized mortality rate of gallbladder cancer, as the positive correlation of 0.341 between the standardized mortality rate and life expectancy at birth (P < 0.001) and a correlation of 0.176 with mean education years (P = 0.022) which was statistically significant. Also, a positive correlation was of 0.073 was seen between the standardized mortality rate and income level per person of the population which was not statistically significant (P = 0.347) [Figure 5] and [Table 1].
Figure 5: The relation between the standardized mortality rate and the HDI.

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   Discussion Top


Generally in 2012, 178101 new cases and 142823 deaths from gallbladder cancer were recorded in the world that the sex ratio of catching (male to female) was 0.75 and death ratio of gallbladder cancer was 0.73

The highest incidence and mortality is related to countries with very high and medium HDI. Morbidity and mortality of this cancer is widely different and is variable in geographical areas and different tribes and different ethnic groups [25],[26] that this is caused by differences in risk factors related to progression in gallbladder cancer and clinical protests at the time of diagnosis in different areas.[25],[27]

In this study, the countries that have the highest standardized incidence rate of gallbladder cancer in terms of the HDI exist in the rank of very high HDI countries (Chile, Japan, and Republic of Korea) and countries with average HDI (Bolivia and Lao PDR). In the recent report of epidemiology in the world, the highest mortality rate of this cancer has been in Chile and the main cause of death from cancer among women in this country.[6],[28] Also, Japan with rather high frequency is responsible for 3.5% of deaths from this cancer in women and 1.25% in men.[29] The lowest incidence is related to North America, with about 1-2 cases per hundred thousand people. This is while that the indigenous population of America, especially in the southwest and immigrants, are more at the risk of this cancer and it has been known as the sixth gastrointestinal common malignancy in the United States.[5] The basis of the difference in incidence is due to differences in the distribution of risk factors such as the environment of living, genetic predisposition,[30],[31] food diet, fertility, age, and differences in gender (four to seven times more in women than men). Also, red meat and tobacco have caused increase in the risk of suffering from this cancer. While, fruits and vegetables have a protective role and exact effect of smoking and alcohol use have not been detected well in the etiology of this cancer.[32],[33] According to the study of Weiderpass et al., body weight gain reduces the risk of gallbladder cancer catching significantly.[34]

In this study, the countries that have the highest standardized mortality rate of gallbladder cancer are also countries with very high HDI (Chile and Republic of Korea), medium HDI (Bolivia and Lao PDR), and low HDI (Nepal). The prognosis of gallbladder cancer is too weak. In childhood, these tumors remain asymptomatic until the disease is not aggressive. In fact, after the invasion of the disease, the survival rate of patients with gall bladder cancer is 6 months and generally considering that the 5-year survival rate of this cancer is 5%, related mortality rate of this cancer is high.[35] From an epidemiological perspective, the incidence of gallbladder cancer is near to its mortality rate; so that countries with the highest incidence experience the highest mortality rates. Lack of access to health care in some parts of the world helps to increase these rates.[27] Mortality is declining in some countries such as the United States of America, Canada, Australia, and parts of Europe (England and Hungary). But it is increasing in some areas such as Chile and Japan.[31] The population-based data of United States in cancer recording confirm that the incidence and mortality rate of gallbladder cancer is higher among women than men. Although, the incidence has increased among some of the small groups, this is while the overall rate of incidence and mortality has decreased during the period of 1999-2011 years.[36] As well as differences in the trend of incidence and mortality among women and men need better understanding of causes of gallbladder cancer, which is not well known.[27]

In this study, a significant relationship was observed between the standardized incidence and mortality rate of gallbladder cancer and HDI. Also, the standardized incidence and mortality rate of gallbladder cancer had a significant relationship with components of the HDI (life expectancy). According to previous studies in recent years, primary tumors of this cancer have mostly increased due to the increase of life expectancy and improved detection methods.[37],[38] Also, the gallbladder cancer has been reported as a disease of older women, with the peak of incidence in the seventh and eighth decades of life. However, a study in India showed that this disease occurs mainly in women in the fourth decade of life and later due to the lower life expectancy.[8] Low age of onset of gallbladder cancer may indicate a genetic predisposition in this population. Genetic risk factors for this cancer are largely unknown. As reported, genetic factors are different in variable ethnic communities.[39],[40]

Also in this study, a significant relationship was seen between the incidence and mortality of gallbladder cancer and another component of the HDI (level of literacy or average years of education). The results of the studies express less than 4 years education as one of the main risk factors for this cancer.[41],[42],[43] As in countries with high education, people generally have healthier habits and more appropriate behaviors about the incidence and mortality in involving with risk factors of this cancer like smoking and appropriate food diet, in comparison with people in lower education level countries.[44],[45]

In this study, a significant relationship was observed between the standardized incidence rate of gallbladder cancer and another component of the HDI income levels (Gross Domestic Product, GDP), while a significant relationship was not observed between the standardized mortality and income levels (GDP). According to previous studies, an inverse relationship has been noted between socioeconomic status and gallbladder disease.[46],[47] Also, the delay in the treatment of gallstones and long-term inflammation caused by gallstones in the low socioeconomic levels may be among contributing factors for early onset, high incidence, and mortality of gallbladder cancer.[48],[49],[50] Low socioeconomic status affects indirectly on poor education and illiteracy and causes unemployment and inability to meet the cost of living and prevention aspects of the gallbladder cancer.[33] Totally, improvement of socioeconomic status along with the control of environmental pollution and education in order to raise awareness plays an important role in preventing the incidence and mortality of gallbladder cancer.[51]


   Conclusion Top


Countries with high incidence of gallbladder carcinoma have higher mortality rates too. A significant correlation was seen between the standardized incidence and mortality rate of gallbladder cancer and the HDI and its dimensions (life expectancy at birth, average education). Further studies about the causes of this disease can be useful.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

 
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Correspondence Address:
Hamid Salehiniya
Department of Epidemiology and Biostatistics, School of public health, Tehran University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.213176

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