A health systems analysis of global head and neck cancer outcomes.

Abstract

e18092 Background: Head and neck cancers (HNC) remain a major global cause of cancer morbidity and mortality, with disproportionately poor outcomes in low- and middle-income countries. Marked cross-national disparities suggest an important role for health system strengthening. We evaluated associations between national health system characteristics and global HNC outcomes. Methods: We conducted a cross-sectional ecological analysis of 185 countries using sex-stratified, age-standardized incidence and mortality estimates from the International Agency for Research on Cancer (IARC) GLOBOCAN 2022 database. The primary outcome was the composite mortality-to-incidence ratio (MIR) for aggregated HNCs, including cancers of the lip and oral cavity, oropharynx, larynx, nasopharynx, hypopharynx, and salivary gland. We evaluated 11 national health system indicators spanning health financing, workforce density, service availability, socioeconomic development, and gender equity. Univariable linear regressions identified candidate variables using Bonferroni correction (P<0.0045), followed by multivariable modeling with assessment for multicollinearity using variance inflation factor analysis (VIF>10 prompting removal). Results: All 11 health system indicators were significantly associated with HNC MIR in univariable analyses (P<.001 for all). In multivariable analysis restricted to countries with complete covariate data (n=123), higher Universal Health Coverage (UHC) service coverage index and higher gross domestic product (GDP) per capita were independently associated with lower (improved) HNC MIR. The model demonstrated strong predictive power (model R²=0.70; VIF for all <10). On analysis stratified by sex, UHC index and GDP per capita were similarly independently associated with improved MIR for HNCs. Conclusions: Our global cross-national analysis demonstrates that universal health coverage and national economic capacity are independently associated with improved head and neck cancer mortality-to-incidence ratios, underscoring the central role of health system strength in shaping outcomes. These findings highlight how investments in healthcare access, financial protection, and resource availability may help narrow global disparities in HNC.