Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study

Background

Despite the considerable burden caused by childhood cancer worldwide, the incidence of childhood cancer obtained from a national childhood cancer registry and the accessibility of relevant health services are still unknown in China. We comprehensively assessed the most recent cancer incidence among Chinese children and adolescents, nationally, regionally and in specific population subgroups, and also examined the association between incidence cancer and socio-economic inequality in access to health services.

Methods

In this nationwide cross-sectional study, we used data from the National Pediatric Cancer Surveillance Center, the national hospital quality surveillance system, and public databases to cover 31 provinces, autonomous regions, and municipalities in mainland China. We estimated cancer incidence in children (aged 0-14 years) and adolescents (aged 15-19 years) in China by stratified proportional estimation. We ranked regions by socio-economic status using the Human Development Index (HDI). Incidence rates of 12 main groups, 47 subgroups and 81 subtypes of cancer were reported and compared by sex, age and socioeconomic status, according to the third edition of the International Classification of Cancer of the child. We also quantified the geographic and population density of pediatric oncologists, pathology workforce, pediatric cancer diagnosis and treatment facilities, and pediatric beds. We used the Gini coefficient to assess equity of access to these four health service indicators. We also calculated the proportions of cross-regional patients among new cases in our surveillance system.

Results

We estimated the incidence of cancer in children (ages 0-14) and adolescents (ages 15-19) in China from 1 January 2018 to 31 December 2020. An estimated 121,145 cancer cases have been diagnosed in children and adolescents. in China between 2018 and 2020, with global age-standardized incidence rates of 122 86 (95% CI 121 70–124 02) per million for children and 137 64 (136 08 –139 20) per million for teenagers. Boys had a higher incidence rate of childhood cancer (133 18 for boys versus 111 21 for girls per million) but a lower incidence of cancer in adolescents (133 92 for boys versus 141 79 for girls per million) than girls. Leukemias (42.33 per million) were the most common cancer group in children, while malignant epithelial tumors and melanomas (30.39 per million) exceeded leukemias (30.08 per million) in adolescents as the cancer with the highest incidence. Overall incidence rates ranged from 101 60 (100 67–102 51) per million in very low HDI regions to 138 21 (137 14–139 ​​29) per million in high HDI regions , indicating a significant positive association between childhood and adolescent cancer incidence and regional socioeconomic status (p

Interpretation

Our study showed that the cancer burden among children and adolescents in China is much higher than previously reported nationwide from 2000 to 2015. The distribution of health service accessibility, in as a social determinant of health, may have a significant role in socioeconomic status. inequalities in cancer incidence among Chinese children and adolescents. With regard to achieving the Sustainable Development Goals, policy approaches should prioritize increasing the accessibility of health services for early diagnosis to improve outcomes and subsequently reduce disease burden, as well as to reduce the socio-economic inequalities of childhood and adolescent cancer.

Funding

National Major Science and Technology Projects of China, National Natural Science Foundation of China, Chinese Academy Engineering Consulting Research Project, Wu Jieping Medical Foundation, Beijing Municipal Hospital Administration Incubation Program.

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