Takahashi Koshi, Nakamura Sho, Ogasawara Yu, Sakaguchi Masahiko, Watanabe Kaname, Narimatsu Hiroto
Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, Asahi-ku, Yokohama, Japan.
Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki-ku, Kawasaki, Japan.
Health Serv Insights. 2025 Aug 20;18:11786329251362381. doi: 10.1177/11786329251362381. eCollection 2025.
Improving cancer screening participation is increasingly important. However, insufficient medical and financial resources have been reported to hinder program implementation; therefore, enhancing program efficiency is crucial. Although demographic factors have been reported to correlate with public health program efficiency, it remains unclear whether this applies to cancer screening.
To evaluate the efficiency of cancer screening programs conducted in Japanese municipalities and analyze their relationship with demographic characteristics, including population size and aging rates.
A cross-sectional study using national open-source data from 2019.
We collected data from all 1741 Japanese municipalities in 2019 using a national open-source database. After applying inclusion criteria, 1593 municipalities were analyzed. Program efficiency was measured using Data Envelopment Analysis (DEA), with inputs including the number of public health nurses, medical institutions, and healthcare expenditure per target population. Outputs were cancer screening participation rates. Logistic regression was used to examine the relationships between efficiency, population size, aging rates, and their interaction.
Of the 1593 municipalities analyzed, 414 (26.0%) were deemed efficient. A statistically significant interaction between aging rates and population size was observed in the model predicting screening efficiency. In municipalities with aging rates above 31.4% (95% confidence interval [CI]: 29.2-37.1), larger target populations were associated with lower efficiency. Conversely, in municipalities with over 1075 screening targets (95% CI: 552-1381), higher aging rates were linked to lower efficiency.
This study suggests that aging rates and population size may be associated with municipal-level differences in the efficiency of cancer screening programs. Understanding the mechanism underlying this relationship could help inform resource allocation and program design. Further research is warranted to explore these relationships more deeply and to support the development of more efficient screening strategies, particularly in the context of ongoing demographic shifts.
提高癌症筛查参与率变得越来越重要。然而，据报道，医疗和财政资源不足阻碍了项目的实施；因此，提高项目效率至关重要。尽管据报道人口因素与公共卫生项目效率相关，但尚不清楚这是否适用于癌症筛查。
评估日本各市政当局开展的癌症筛查项目的效率，并分析其与人口特征（包括人口规模和老龄化率）之间的关系。
一项使用2019年国家开源数据的横断面研究。
我们使用国家开源数据库收集了2019年日本所有1741个市政当局的数据。应用纳入标准后，对1593个市政当局进行了分析。使用数据包络分析（DEA）衡量项目效率，投入包括公共卫生护士数量、医疗机构数量以及每目标人群的医疗保健支出。产出为癌症筛查参与率。使用逻辑回归来检验效率、人口规模、老龄化率及其相互作用之间的关系。
在分析的1593个市政当局中，414个（26.0%）被认为是高效的。在预测筛查效率的模型中，观察到老龄化率与人口规模之间存在统计学上显著的相互作用。在老龄化率高于31.4%（95%置信区间[CI]：29.2 - 37.1）的市政当局中，较大的目标人群与较低的效率相关。相反，在筛查目标超过1075个（95%CI：552 - 1381）的市政当局中，较高的老龄化率与较低的效率相关。
本研究表明，老龄化率和人口规模可能与癌症筛查项目效率的市级差异有关。了解这种关系背后的机制有助于为资源分配和项目设计提供信息。有必要进行进一步研究，以更深入地探索这些关系，并支持制定更有效的筛查策略，特别是在当前人口结构变化的背景下。
