GLOBAL AND TURKİYE QUALITY OF CARE INDEX (QCI) IN TRACHEAL, BRONCHUS, AND LUNG CANCER

Year 2026, Volume: 11 Issue: 1 , 74 - 86 , 28.02.2026

Arzu Yiğit

https://doi.org/10.33457/ijhsrp.1861508

https://izlik.org/JA87UM84XL

Abstract

According to GLOBOCAN 2022 data, Tracheal, Bronchus, and Lung (TBL) cancer continues to pose a critical threat to public health, ranking at the peak of global cancer mortality with 2.48 million new cases and 1.82 million deaths. This study aims to systematically analyze the quality standards in TBL cancer management and the performance of health systems on a global scale and specifically for Türkiye between 1990 and 2023. To measure care quality from a multidimensional perspective, four fundamental secondary indicators consisting of Mortality-to-Incidence (MIR), DALYs-to-Prevalence, Prevalence-to-Incidence, and YLLs-to-YLDs ratios were synthesized using Principal Component Analysis (PCA) to derive normalized Quality of Care Index (QCI) scores on a 0-100 scale. The analyses were deepened along the axes of the Socio-demographic Index (SDI) indicating the development levels of countries, gender, and age groups. Research findings reveal that while the global TBL cancer burden (DALY) decreased by 27.5% during the 1990-2023 period, the global QCI score increased from 64.24 to 81.74, indicating a significant improvement in treatment processes. When gender dynamics were examined, it was observed that the QCI score of women (87.28) was systematically higher than that of men (78.71) globally, and the "female advantage" phenomenon in care quality became evident. Data specific to Türkiye presents a complex picture; in the same period, the disease burden (DALY) decreased by 23.1%, and the QCI score increased from 51.61 to 63.57. However, despite Türkiye raising its Socio-demographic Index (SDI) value from 0.59 to 0.80 and achieving a significant economic class upgrade, it was determined that the obtained QCI (63.57) and Healthcare Access and Quality (HAQI: 64.8) scores remained behind both the global average and countries with similar development levels. Furthermore, the Gender Disparity Ratio (GDR), which showed perfect equality (1.00) in 1990, evolved in favor of women to 1.07 in 2023, pointing to the intensity of risk factors in the male population. In conclusion, although TBL cancer care quality has increased on a global scale, inter-regional inequalities are deepening. Specifically for Türkiye, it is observed that the achieved economic development and infrastructure investments are not fully reflected in oncological care quality, creating a structural efficiency problem. For Türkiye to raise its clinical standards to global norms, it is necessary to prioritize the tightening of tobacco control policies, the management of environmental risk factors, and structural improvements targeting not only diagnosis but also post-diagnosis treatment and care processes.

Keywords

TBL Cancer , Quality of Care Index (QCI) , Gender Disparity , Global Burden of Disease

Ethical Statement

This study is based on an analysis of secondary data obtained from the GBD 2023 database. The datasets utilized were publicly available, aggregated, and anonymized. Since the research involved no direct interaction with human subjects and no access to identifiable personal data, written informed consent was not required.

References

• Kuang, Z., Wang, J., Liu, K., Wu, J., Ge, Y., Zhu, G., et al., "Global, regional, and national burden of tracheal, bronchus, and lung cancer and its risk factors from 1990 to 2021", eClinicalMedicine, 75, 102804, 2024.
• Sharma, R., Khubchandani, J., "Global, Regional, and National Burden of Tracheal, Bronchus, and Lung Cancer in 2022: Evidence from the GLOBOCAN Study", Epidemiologia, 5(4), 785–795, 2024.
• Fan, X., Yin, L., Hou, X., Zhou, Q., "Temporal trends in the burden of tracheal, bronchial, and lung cancer in China and globally: A comprehensive analysis from 1990 to 2021", Chinese Medical Journal Pulmonary and Critical Care Medicine, 3, 120–131, 2025.
• Liu, G., Liu, Y., Jing, H., Chen, T., Wang, H., Qiu, H., et al., "Global, regional, and national economic consequences of tracheal, bronchial, and lung cancer", Lung Cancer, 207, 108685, 2025.
• Cella, D. F., Tulsky, D. S., "Quality of life in cancer: Definition, purpose, and method of measurement", Cancer Investigation, 11(3), 327–336, 1993.
• Wang, C., Wu, Z., Xu, Y., Zheng, Y., Luo, Z., Cao, W., et al., "Disparities in the global burden of tracheal, bronchus, and lung cancer from 1990 to 2019", Chinese Medical Journal Pulmonary and Critical Care Medicine, 1(1), 36–45, 2023.
• Zhang, S., Yang, L., Xu, W., Han, L., Zhao, G., Cai, T., "Global, regional, and national burden of trachea, bronchus, and lung cancer among women of reproductive age, 1990–2019", Cancer Epidemiology, 91, 102585, 2024.
• Safiri, S., Sohrabi, M. R., Carson-Chahhoud, K., Bettampadi, D., Taghizadieh, A., Almasi-Hashiani, A., et al., "Burden of Tracheal, Bronchus, and Lung Cancer and Its Attributable Risk Factors in 204 Countries and Territories, 1990 to 2019", Journal of Thoracic Oncology, 16(6), 945–959, 2021.
• Nowroozi, A., Ghasemi, E., Keykhaei, M., Moghaddam, S. S., Mohammadi, E., Farzadfar, F., "Global, regional, and national burden and quality of care index of brain and other CNS cancers: a systematic analysis of the global burden of disease study 1990–2019", Scientific Reports, 13(1), 699, 2023.
• Mohammadi, E., Ghasemi, E., Azadnajafabad, S., Rezaei, N., Saeedi Moghaddam, S., Farzadfar, F., "A global, regional, and national survey on burden and quality of care index (QCI) of brain and other central nervous system cancers", PLoS ONE, 16(2), e0247120, 2021.
• Gorgani, F., Esfahani, Z., Ghamari, S. H., Ghasemi, E., Azadnajafabad, S., Shobeiri, P., et al., "Global, regional, and national burden and quality of care index of liver cirrhosis by cause from global burden of disease 1990–2019", Journal of Gastroenterology and Hepatology, 38(1), 119-128, 2023.
• Pan, Y., Liu, Q., Zhang, N., Peng, S., Li, X., Zhou, F., "Global assessment of leukemia care quality: insights from the quality of care index (QCI) from 1990 to 2021", eClinicalMedicine, 79, 102996, 2025.
• Keykhaei, M., Masinaei, M., Mohammadi, E., Azadnajafabad, S., Rezaei, N., Saeedi Moghaddam, S., et al., "A global, regional, and national survey on burden and quality of care index (QCI) of hematologic malignancies; global burden of disease systematic analysis 1990–2017", Experimental Hematology & Oncology, 10(1), 11, 2021.
• Zhu, Y., Cheng, S., Luo, Z., Shen, J., Cao, J., Yao, L., et al., "Global burden, quality of care, and cross-country inequalities in Alzheimer’s disease and other dementias from 1990 to 2021", Journal of Global Health, 15, 04269, 2025.
• Same, K., Shobeiri, P., Rashidi, M. M., Ghasemi, E., Saeedi Moghaddam, S., Mohammadi, E., et al., "A global, regional, and national burden and quality of care index for schizophrenia: Global burden of disease systematic analysis 1990–2019", Schizophrenia Bulletin, 50(5), 1083-1093, 2024.
• Yao, L., Cao, J., Cheng, S., Shan, S., Jiang, D., Luo, Z., et al., "Inequalities in disease burden and care quality of chronic obstructive pulmonary disease, 1990–2021", Journal of Global Health, 14, 04213, 2024.
• Rashidi, M. M., Saeedi Moghaddam, S., Azadnajafabad, S., Heidari-Foroozan, M., Haddadi, M., Farzadfar, F., "Burden and quality of care index of chronic kidney disease: Global Burden of Disease analysis for 1990–2019", Nephrology Dialysis Transplantation, 39(2), 317-327, 2024.
• Lin, X., Liu, S., Ding, Y., Zhao, J., He, F., Zhong, W., "Contrasting tracheal, bronchus, and lung cancer burdens and care quality: a comparative analysis of China and global trends", BMC Cancer, 25(1), 1298, 2025.
• Geng, J., Zhao, J., Fan, R., Zhu, Z., Zhang, Y., Zhu, Y., et al., "Global, regional, and national burden and quality of care of multiple myeloma, 1990–2019", Journal of Global Health, 14, 04033, 2024.
• Karimi, A., Shobeiri, P., Azadnajafabad, S., Masinaei, M., Rezaei, N., Ghanbari, A., et al., "A global, regional, and national survey on burden and Quality of Care Index (QCI) of bladder cancer", PLoS ONE, 17(10), e0275574, 2022.
• Azangou-Khyavy, M., Ghasemi, E., Rezaei, N., Khanali, J., Kolahi, A. A., Malekpour, M. R., et al., "Global, regional, and national quality of care index of cervical and ovarian cancer", BMC Women’s Health, 24(1), 69, 2024.
• Rencher, A. C., Methods of multivariate analysis, 2nd ed., Wiley-Interscience, 2005.
• Aghababaie-Babaki, P., Khademi, N., Ghanbari, A., Azangou-Khyavy, M., Keykhaei, M., "Social and demographic inequality in the global burden of ovarian cancer: A global burden of disease study 2019", Arhives of Gynecology and Obstetrics, 307(6), 1961–1971, 2023.
• Fullman, N., Yearwood, J., Abay, S. M., Abbafati, C., Abd-Allah, F., Murray, C. J., "Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories", The Lancet, 391(10136), 2236–2271, 2018.
• Rashidi, M., Keykhaei, M., Ghasemi, E., Saeedi Moghaddam, S., Farzadfar, F., "Global, regional, and national burden and quality of care index of nasopharyngeal cancer", Annals of Medicine, 55(1), 2206672, 2023.
• Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Murray, C. J., "Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019", The Lancet, 396(10258), 1204–1222, 2020.
• Huang, B., Hua, J., Liu, S., Wang, X., Sun, Z., Bai, R., Dong, W., "Temporal trends in disease burden and attributable risk factors for tracheal, bronchus, and lung cancer in Nepal, 1990–2019", Cancer Epidemiology, 88, 102497, 2024.
• Zhang, Y., Mi, M., Zhu, N., Yuan, Z., Ding, Y., Zhao, Y., et al., "Global burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens", Annals of Medicine, 55(1), 2206672, 2023.
• Rezaei, F., Mazidimoradi, A., Rayatinejad, A., Allahqoli, L., Salehiniya, H., "Temporal trends of tracheal, bronchus, and lung cancer between 2010 and 2019, in Asian countries", Thoracic Cancer, 14(18), 1668–1706, 2023.