Cross-National Comparison of Divergence Between Long-term Incidence and Mortality Trends in Lip and Oral Cavity Cancer and Associated Health-System Factors: A Population-Based Paired-Trend Study
- 1College & Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, PR China; Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Nanning, Guangxi, PR China
- 2College & Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, PR China
Abstract
Background: Lip and oral cavity cancer varies markedly across countries. We examined long-term incidence–mortality trend divergence and its health-system correlates. Methods: We paired Lip and oral cavity cancer (LOCC) (ICD-10 C00–C06) incidence data from Cancer Incidence in Five Continents Plus (CI5plus) with WHO Mortality Database data over overlapping years. Joinpoint regression estimated average annual percent change (AAPC) in age-standardized incidence rates (ASIR) and mortality rates (ASMR). Delta AAPC (AAPC_ASMR − AAPC_ASIR) was negative when mortality trends were more favorable. Main analyses covered all ages, 20–44 years, and ≥45 years; secondary and sensitivity analyses assessed consistency. Spearman correlation and linear regression assessed ecological associations with the universal health coverage (UHC) service coverage index as the primary indicator and Human Development Index (HDI), health expenditure, dentist density, and death-registration completeness as exploratory indicators. Results: Among 14 countries in the all-age main analysis, 11 had negative Delta AAPCs (median −1.31%), most notably New Zealand (−3.55%), Iceland (−3.43%), and the Republic of Korea (−3.31%). Among 13 countries with estimable results for ages 20–44 years, 12 had negative values (median −3.24%). Most of 41 main-analysis age-specific paired estimates fell below the incidence–mortality equality line. Across 62 estimable pairs, 51 were negative (median −1.35%); 15 of 18 secondary multi-registry pairs were negative (median −1.21%), whereas regional sensitivity results were more heterogeneous. Higher UHC correlated with more negative all-age Delta AAPC (Spearman ρ = −0.570, P = 0.034; regression β = −0.196, P = 0.012; R² = 0.422). HDI and expenditure showed weaker inverse associations; dentist density did not, and death-registration completeness had limited discriminatory value. Conclusions: Mortality trends were generally more favorable than incidence trends in countries with comparable long-term paired data, particularly among young adults. Delta AAPC may complement cancer surveillance, but ecological associations do not establish causation.
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BibTeX
@article{wang2026crossnational,
title = {{Cross-National Comparison of Divergence Between Long-term Incidence and Mortality Trends in Lip and Oral Cavity Cancer and Associated Health-System Factors: A Population-Based Paired-Trend Study}},
author = {Xian Wang and Yuetong Wang and Zhengzhong He and Ziqi Liao and Huangjian Li and Qingtiao Xie and Xuanping Huang},
journal = {International Dental Journal},
year = {2026},
month = oct,
doi = {10.1016/j.identj.2026.111259},
url = {https://doi.org/10.1016/j.identj.2026.111259},
note = {CC BY},
}
RIS
TY - JOUR
TI - Cross-National Comparison of Divergence Between Long-term Incidence and Mortality Trends in Lip and Oral Cavity Cancer and Associated Health-System Factors: A Population-Based Paired-Trend Study
AU - Xian Wang
AU - Yuetong Wang
AU - Zhengzhong He
AU - Ziqi Liao
AU - Huangjian Li
AU - Qingtiao Xie
AU - Xuanping Huang
PY - 2026
DA - 2026/10/30
JO - International Dental Journal
DO - 10.1016/j.identj.2026.111259
UR - https://doi.org/10.1016/j.identj.2026.111259
AB - Background: Lip and oral cavity cancer varies markedly across countries. We examined long-term incidence–mortality trend divergence and its health-system correlates. Methods: We paired Lip and oral cavity cancer (LOCC) (ICD-10 C00–C06) incidence data from Cancer Incidence in Five Continents Plus (CI5plus) with WHO Mortality Database data over overlapping years. Joinpoint regression estimated average annual percent change (AAPC) in age-standardized incidence rates (ASIR) and mortality rates (ASMR). Delta AAPC (AAPC_ASMR − AAPC_ASIR) was negative when mortality trends were more favorable. Main analyses covered all ages, 20–44 years, and ≥45 years; secondary and sensitivity analyses assessed consistency. Spearman correlation and linear regression assessed ecological associations with the universal health coverage (UHC) service coverage index as the primary indicator and Human Development Index (HDI), health expenditure, dentist density, and death-registration completeness as exploratory indicators. Results: Among 14 countries in the all-age main analysis, 11 had negative Delta AAPCs (median −1.31%), most notably New Zealand (−3.55%), Iceland (−3.43%), and the Republic of Korea (−3.31%). Among 13 countries with estimable results for ages 20–44 years, 12 had negative values (median −3.24%). Most of 41 main-analysis age-specific paired estimates fell below the incidence–mortality equality line. Across 62 estimable pairs, 51 were negative (median −1.35%); 15 of 18 secondary multi-registry pairs were negative (median −1.21%), whereas regional sensitivity results were more heterogeneous. Higher UHC correlated with more negative all-age Delta AAPC (Spearman ρ = −0.570, P = 0.034; regression β = −0.196, P = 0.012; R² = 0.422). HDI and expenditure showed weaker inverse associations; dentist density did not, and death-registration completeness had limited discriminatory value. Conclusions: Mortality trends were generally more favorable than incidence trends in countries with comparable long-term paired data, particularly among young adults. Delta AAPC may complement cancer surveillance, but ecological associations do not establish causation.
SN - 0020-6539
SN - 1875-595X
ER -