Burden of cancer in children and adolescents in the Americas

 

Cancer is treatable and curable for the vast majority of children and adolescents when essential diagnostic, therapeutic, and supportive care services are accessible. However, substantial inequalities exist across countries of the Americas in terms of individual access to health care and high-quality treatment and supportive care services. For instance, while in high-income countries (HIC), such as Canada and the United States of America, the survival cancer rate is above 80%, in low- and middle-income countries is lower than 30%.

Monitoring the level and trends of cancer in children and adolescents is an essential function in evaluating programmatic interventions and informing policy development. This topic aims to provide an interactive data visualization that presents the main epidemiological measures of mortality and burden of disease caused by cancer in children and adolescents aged 0-19 years in countries of the Region of the Americas from 2000 to 2019.

Data source: WHO Global Health Estimates 2000-2019: Life Expectancy and leading causes of death and disabilty. Global Health Observatory. [Internet] Available online.

Cancer mortality

In 2019, regionwide cancer (all malignant neoplasms combined) in children and adolescents (aged 0-19 years) accounts for:

  • 12 thousand deaths, 7 thousand deaths in boys, and 5 thousand deaths in girls.
  • 83% (10 thousand out of 12 thousand deaths) of childhood and adolescent deaths from all cancers occurred in Latin America and the Caribean countries
  • The age-specific death rate due to all cancers combined was 4.0 deaths (95% UI: 2.8 to 5.6) per 100,000 population.
  • The death rates from all cancers combined vary across countries from a high in Honduras (9.9 deaths per 100,000 population) to a low in Antigua and Barbuda (0.1 deaths per 100,000 population).
  • For most countries, age-standardized death rates from cancer are higher in men than women, except in Bolivia, Guyana, and El Salvador.

Countries with the highest level of childhood and adolescent death rates from all cancers combined are:

  1. Honduras
  2. Saint Vincent and the Grenadines
  3. Peru
  4. Guyana
  5. Ecuador
  6. Nicaragua
  7. Venezuela

In the Region of the Americas, childhood and adolescent cancer mortality decreased by 20% from 5.1 deaths/100,000 in 2000 to 4.0 deaths/100,000 in 2019, with similar reduction rates from boys and girls. However, there are important variations in the rate of change from 2000 to 2019 across countries and subregions. 

The top three cancer types in children and adolescents in 2019 are:

  1. Leukaemia
  2. Brain and nervous system cancer
  3. Lymphomas, multiple myelomas

Mortality and the burden of disease caused by cancer

Using data from the WHO Global Health Estimates 2000-2019 (GHE), Cancer mortality was quantified using the number of deaths and deaths per 100,000 population. Deaths per population by age, sex, location and year was computed using population estimates from the UN World Population Prospects 2019. The absolute measures of burden of disease, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to premature death were also extracted from the GHE. Each epidemiological measures were disaggregated by cause-of-death, including Malignant Neoplasms (All cancers), and 28 types of cancers in children and adolescents aged 0-19 years. Annual rates per 100,000 population are presented as age-specific rates for the age groups <1 year, 1-9 years, 10-19 years, 20-24 years, and 0-19 years by sex, cause, and location for the period 2000 to 2019.

DATA CLASSIFICATION

The data is presented in five discrete classes created using the quantile classification method in the map and horizontal bar chart. Each class contains 20% of countries, which is easy to interpret. The quintile classes are labeled sequentially from Quintile 1 as the first quintile including the lowest fifth (0 to 20%) of the data to Quintile 5, the fifth quintile representing the class with the highest fifth (80% to 100%) of the data.

INDICATOR DEFINITION

Measure: Death, Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs), and Years of Life Lost (YLLs) due to premature death.  

Metric: Rate.

Unit of measurement: For mortality measures: deaths per 100,000 population. For measures of burden of disease: years per 100,000 population. 

Topic: Mortality and burden of disease.

Rationale: Measuring how many people die each year and why they die is one of the most important means – along with gauging how diseases and injuries affect people–to assess the effectiveness of a country’s health system. Statistics of causes of death and disease burden help health authorities focalize and prioritize public health actions.

Definition: Death rates due to all cancer, and cancer types were calculated as the number of deaths due to cancer in a year, sex, and location divided by the total population in the given year, sex, and location and multiplied by 100 000.  

Cancer types and ICD-10 codes:

The full list of cause categories and corresponding ICD-10 codes is included in the WHO methods and data sources for country-level causes of death 2000-2019, Annex A, page 62.

The cause list is organized hierarchically with four levels of aggregation. The cause list is mutually exclusive and collectively exhaustive at every level of aggregation; causes not individually specified are captured in residual categories, such as “Other malignant neoplasms”.  

Disaggregation: Age, Sex, Country, and Year.

Method of estimation: Mortality estimates by cause, age, sex, location (countries, and the region) were extracted from the WHO Global Health Estimates (GHE) 2019. These estimates represent WHO's best estimates, computed using standard categories, definitions, and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to input data and methods changes, these estimates are not comparable to previously published WHO estimates.

Methodological details:

Data sources and methods for estimating causes of death and burden of diseases are described in the following documents:

As part of the estimation methods, deaths due to cancers with unspecified sites (ICD10 codes C76, C80, C97) were distributed pro-rata to all sites excluding liver, pancreas, ovary, and lung. Additionally, deaths coded as cancer of the uterus, part unspecified (C55) are distributed pro-rata to cervix uteri (C53) and corpus uteri (C54). 

Method of estimation of global and regional aggregates: Computed by aggregating both the absolute measure (number of deaths, DALYs, YLDs, YLLs) as the numerator and population estimates from the World Population Prospect 2019, produced by the UN Population Division, as denominators for all countries included in the region.

Preferred data sources: Civil Registration and Vital Statistics (CRVS) system with complete coverage and medical certification of cause of death.

Suggested citation

Childhood and adolescent cancer in the Region of the Americas. ENLACE data portal. Pan American Health Organization, 2023. [Internet] Available online: https://www.paho.org/en/enlace/burden-disease-caused-childhood-and-adolescent-cancer-americas

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