Tsutsui Anna, Ohno Yuko, Hara Junichi, Ito Yuri, Tsukuma Hideaki
Department of Mathematical Health Science, Course of Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka, Japan.
Jpn J Clin Oncol. 2009 Feb;39(2):127-31. doi: 10.1093/jjco/hyn138. Epub 2008 Dec 5.
To analyze the tendency to centralize childhood cancer treatment among cancer treatment hospitals in Osaka, Japan over a 28-year period.
The subjects were patients under the age of 15, newly diagnosed with cancer in Osaka between 1975 and 2002 (n = 4738). They were categorized into three groups by the time diagnosed (1975-84, 1985-93 and 1994-2002). The International Classification of Childhood Cancer was used as the disease classification. The degree of centralization was examined using a Pareto analysis, the Gini coefficient and the annual average number of cases per hospital.
During this period, the number of children with cancer in Osaka has decreased by nearly half, from 2.1 to 1.2 million and the number of hospitals treating childhood cancer decreased from 37 to 20. However, the Pareto curve and Gini coefficient were almost constant (0.747, 0.737, 0.756 in Gini coefficient for the three diagnosed periods). The annual average numbers of cases per hospital were much low and marginally increased from 5.6 during 1975-84 to 6.1 during 1994-2002 in the hospitals that treated 90% of all cancers.
The degree of centralization appeared to be almost constant from 1975 to 2002 regardless of the decrease in hospitals treating cancer patients.
分析日本大阪癌症治疗医院在28年期间儿童癌症治疗的集中化趋势。
研究对象为1975年至2002年在大阪新诊断为癌症的15岁以下患者（n = 4738）。根据诊断时间（1975 - 1984年、1985 - 1993年和1994 - 2002年）将他们分为三组。采用国际儿童癌症分类作为疾病分类。使用帕累托分析、基尼系数和每家医院的年平均病例数来检查集中化程度。
在此期间，大阪患癌症儿童的数量减少了近一半，从210万降至120万，治疗儿童癌症的医院数量从37家减少到20家。然而，帕累托曲线和基尼系数几乎保持不变（三个诊断时期的基尼系数分别为0.747、0.737、0.756）。在治疗所有癌症患者90%的医院中，每家医院的年平均病例数很低，仅从1975 - 1984年的5.6例略微增加到1994 - 2002年的6.1例。
从1975年到2002年，尽管治疗癌症患者的医院数量减少，但集中化程度似乎几乎保持不变。
