CHI-CHIH WANGMING-CHANG TSAISHAO-CHUAN WANGCHENG-MING PENGHSIANG-LIN LEECHUN-CHE LINWEN-WEI SUNG2026-10-162026-10-162019-07-31Pure ID: 15024921Pure UUID: 47ab9f04-4a4f-4080-961a-aa501123fabd10.1186/s12889-019-7160-zhttps://www.scopus.com/pages/publications/85070888406https://scholars.csmu.edu.tw/handle/123456789/23546Background: The mortality-to-incidence ratio (MIR) is a marker that reflects the clinical outcome of cancer treatment. MIR as a prognostic marker is more accessible when compared with long-term follow-up survival surveys. Theoretically, countries with good health care systems would have favorable outcomes for cancer; however, no report has yet demonstrated an association between gallbladder cancer MIR and the World's Health System ranking. Methods: We used linear regression to analyze the correlation of MIRs with the World Health Organization (WHO) rankings and total expenditures on health/gross domestic product (e/GDP) in 57 countries selected according to the data quality. Results: The results showed high crude rates of incidence/mortality but low MIR in more developed regions. Among continents, Europe had the highest crude rates of incidence/mortality, whereas the highest age-standardized rates (ASR) of incidence/mortality were in Asia. The MIR was lowest in North America and highest in Africa (0.40 and 1.00, respectively). Furthermore, favorable MIRs were correlated with good WHO rankings and high e/GDP (p = 0.01 and p = 0.030, respectively). Conclusions: The MIR variation for gallbladder cancer is therefore associated with the ranking of the health system and the expenditure on health.enjournal article