The impact of national health systems on lung cancer mortality.

Cancers of the trachea, bronchus, and lung represent the leading cause of cancer death globally; therefore, understanding the levers that are associated with outcomes of patients with lung cancer may inform health system planning and investment. We used global health system data from the World Health Organization (WHO), the World Bank, the Directory of Radiotherapy Centres (DIRAC), the United Nations Development Programme (UNDP), and the International Agency for Research on Cancer (IARC) to evaluate predictors of improved global outcomes for cancers of the trachea, bronchus, and lung. In a multivariable model, health spending, nurse/midwife density, universal health coverage index, and radiotherapy center density were independently associated with lower mortality-to-incidence ratio for cancers of the trachea, bronchus, and lung, whereas physician density had a small positive adjusted association. These findings may be of particular utility for countries facing a high or increasing burden of lung cancer.