Quantifying the Health Lost Due to Oral Cancer in Latin America

Objectives: To assess the burden of oral cancer and its main risk factors in Latin American (LA) countries from 1990 to 2017.
Methods: A secondary analysis of the Global Burden of Disease 2017 Study results was performed. Disability-adjusted life years (DALYs) estimates due to lip and oral cavity cancer (ICD10: C00-C08.9, D10.0-D10.5, D11-D11.9) as oral cancer (OC) by year, sex and country were reported. DALYs were computed as the sum of years-lived with disability (YLDs) and years of life-lost (YLLs). YLDs were estimated as the product of the prevalence and the disability weights for health states of each mutually exclusive sequela, adjusted for comorbidity. Then, YLLs were calculated as the sum of each death multiplied by the standard life expectancy at each age. For risk factors (RF), using counterfactual scenarios, the attributable burden was computed by multiplying the risk and cause-specific population attributable fraction by cause-specific DALYs. The effect size of each RF-OC pair was obtained based on meta-analysis of prospective observational studies and randomized control trials. Additionally, expected burden were estimated adjusting by sociodemographic index.
Results: For all ages and both sexes combined, in LA -2017, OC was responsible for 68,001.1 DALYs (95% uncertainty-interval [UI]: 60,649.6-75,673.7) for females and 165,007.9 DALYs (95%UI: 151,236.4-179,415.6) for males. From total female-DALYs, 27.2%, 21.9% and 4% were attributable to alcohol use, tobacco and diet, respectively. From male-DALYs, 63.4%, 36.7% and 4% were attributable to alcohol use, tobacco and diet, respectively. Brazil-(57.8), Uruguay-(50.9) and Honduras-(39.6) have the highest age-standardized rate (per 100,000 inhabitants) (Figure 1). In contrast, Mexico-(20.9), Chile-(18.1) and Uruguay-(14.5) had the lowest rates. Honduras (females) and Brazil (males) have 33% and 9.3% more burden than the expected respectively (Figure 2). From 1990 to 2017, the decrease of OC rate in LA countries (except for Honduras) ranged from 3.2% to 43 %.
Conclusions: OC has a higher impact on males. These results allow the design and target of interventions to the main RF for OC. Additionally, it reveals the need to have a regional OC monitoring system.