Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Med. 2024 Aug 9;5(8):926-942.e3. doi: 10.1016/j.medj.2024.04.002. Epub 2024 May 17.
Achieving universal health coverage (UHC) involves all individuals attaining accessible health interventions at an affordable cost. We examined current patterns and temporal trends of cancer mortality and UHC across sociodemographic index (SDI) settings, and quantified these association.
We used data from the Global Burden of Disease Study 2019 and Our World in Data. The UHC effective coverage index was obtained to assess the potential population health gains delivered by health systems. The estimated annual percentage change (EAPC) with a 95% confidence interval (CI) was calculated to quantify the trend of cancer age-standardized mortality rate (ASMR). A generalized linear model was applied to estimate the association between ASMR and UHC.
The high (EAPC = -0.9% [95% CI, -1.0%, -0.9%]) and high-middle (-0.9% [-1.0%, -0.8%]) SDI regions had the fastest decline in ASMR (per 100,000) for total cancers from 1990 to 2019. The overall UHC effective coverage index increased by 27.9% in the high-SDI quintile to 62.2% in the low-SDI quintile. A negative association was observed between ASMR for all-cancer (adjusted odds ratio [OR] = 0.87 [0.76, 0.99]), stomach (0.73 [0.56, 0.95]), breast (0.64 [0.52, 0.79]), cervical (0.42 [0.30, 0.60]), lip and oral cavity (0.55 [0.40, 0.75]), and nasopharynx (0.42 [0.26, 0.68]) cancers and high UHC level (the lowest as the reference).
Our findings strengthen the evidence base for achieving UHC to improve cancer outcomes.
This work is funded by the China National Natural Science Foundation and Chinese Academy of Medical Sciences Innovation Fund for Medical Science.
实现全民健康覆盖（UHC）需要所有个人以可负担的成本获得可及的卫生干预措施。我们研究了社会人口指数（SDI）设定下癌症死亡率和 UHC 的当前模式和时间趋势，并量化了这些关联。
我们使用了 2019 年全球疾病负担研究和 Our World in Data 的数据。使用 UHC 有效覆盖指数来评估卫生系统提供的潜在人群健康收益。计算了估计的年百分比变化（EAPC）及其 95%置信区间（CI），以量化癌症年龄标准化死亡率（ASMR）的趋势。应用广义线性模型来估计 ASMR 与 UHC 之间的关联。
高（EAPC=-0.9%[95%CI，-1.0%，-0.9%]）和高-中（EAPC=-0.9%[-1.0%，-0.8%]）SDI 地区的总体癌症 ASMR（每 100,000 人）从 1990 年到 2019 年下降最快。高 SDI 五分位数的 UHC 有效覆盖指数增加了 27.9%，而低 SDI 五分位数的 UHC 有效覆盖指数增加了 62.2%。观察到所有癌症（调整后的比值比[OR]=0.87[0.76, 0.99]）、胃癌（OR=0.73[0.56, 0.95]）、乳腺癌（OR=0.64[0.52, 0.79]）、宫颈癌（OR=0.42[0.30, 0.60]）、唇和口腔癌（OR=0.55[0.40, 0.75]）和鼻咽癌（OR=0.42[0.26, 0.68]）的 ASMR 与高 UHC 水平呈负相关（最低作为参考）。
我们的研究结果为实现 UHC 以改善癌症结局提供了证据支持。
本工作由国家自然科学基金和中国医学科学院医学与健康科技创新工程资助。
