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Abstract
Cancer can have profound social and economic consequences for people in India, often
leading to family impoverishment and societal inequity. Reported age-adjusted incidence
rates for cancer are still quite low in the demographically young country. Slightly
more than 1 million new cases of cancer are diagnosed every year in a population of
1.2 billion. In age-adjusted terms this represents a combined male and female incidence
of about a quarter of that recorded in western Europe. However, an estimated 600,000-700,000
deaths in India were caused by cancer in 2012. In age-standardised terms this figure
is close to the mortality burden seen in high-income countries. Such figures are partly
indicative of low rates of early-stage detection and poor treatment outcomes. Many
cancer cases in India are associated with tobacco use, infections, and other avoidable
causes. Social factors, especially inequalities, are major determinants of India's
cancer burden, with poorer people more likely to die from cancer before the age of
70 years than those who are more affluent. In this first of three papers, we examine
the complex epidemiology of cancer, the future burden, and the dominant sociopolitical
themes relating to cancer in India.
Much has been written about the relationship between high medical expenses and the likelihood of filing for bankruptcy, but the relationship between receiving a cancer diagnosis and filing for bankruptcy is less well understood. We estimated the incidence and relative risk of bankruptcy for people age twenty-one or older diagnosed with cancer compared to people the same age without cancer by conducting a retrospective cohort analysis that used a variety of medical, personal, legal, and bankruptcy sources covering the Western District of Washington State in US Bankruptcy Court for the period 1995-2009. We found that cancer patients were 2.65 times more likely to go bankrupt than people without cancer. Younger cancer patients had 2-5 times higher rates of bankruptcy than cancer patients age sixty-five or older, which indicates that Medicare and Social Security may mitigate bankruptcy risk for the older group. The findings suggest that employers and governments may have a policy role to play in creating programs and incentives that could help people cover expenses in the first year following a cancer diagnosis.
At the present stage of India's health transition, chronic diseases contribute to an estimated 53% of deaths and 44% of disability-adjusted life-years lost. Cardiovascular diseases and diabetes are highly prevalent in urban areas. Tobacco-related cancers account for a large proportion of all cancers. Tobacco consumption, in diverse smoked and smokeless forms, is common, especially among the poor and rural population segments. Hypertension and dyslipidaemia, although common, are inadequately detected and treated. Demographic and socioeconomic factors are hastening the health transition, with sharp escalation of chronic disease burdens expected over the next 20 years. A national cancer control programme, initiated in 1975, has established 13 registries and increased the capacity for treatment. A comprehensive law for tobacco control was enacted in 2003. An integrated national programme for the prevention and control of cardiovascular diseases and diabetes is under development. There is a need to increase resource allocation, coordinate multisectoral policy interventions, and enhance the engagement of the health system in activities related to chronic disease prevention and control.
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