Urban-Rural Disparity in Cancer Incidence, Mortality, and Survivals in Shanghai, China, During 2002 and 2015

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Abstract

Introduction: Disparities in the incidence, mortality, and survival of cancer types between urban and rural areas in China reflect the effects of different risk factor exposure, education, and different medical availability. We aimed to characterize the disparities in the incidence, mortality, and survivals of cancer types between urban and rural areas in Shanghai, China, 2002-2015.

Materials and Methods: The incidence and mortality were standardized by Segi's world standard population. Trends in the incidence and mortality of cancers were compared using annual percent change. The 5-year observed and relative survivals were calculated with life table and Ederer II methods.

Results: Age-standardized incidences and mortalities were 212.55/10 ⁵ and 109.45/10 ⁵ in urban areas and 210.14/10 ⁵ and 103.99/10 ⁵ in rural areas, respectively. Female breast cancer and colorectal cancer occurred more frequently in urban than in rural areas, quite in contrast to liver cancer and cervical cancer. Cancers of lung and bronchus, liver, stomach, and colon and rectum were the leading causes of cancer death in both areas. Age-standardized incidence of female breast cancer and colorectal cancer in urban areas increased while gastric cancer and liver cancer decreased in both areas. Age-standardized mortalities of cancers of breast, esophagus, stomach, colon and rectum, liver, and lung and bronchus decreased in both areas. For all cancers combined, the 5-year observed and relative survivals of cancer patients were higher in urban than in rural areas. The 5-year observed and relative survivals of cancers of liver, pancreas, stomach, brain and central nervous system (CNS), and prostate were higher in urban than in rural areas. The 5-year observed and relative survivals of cervical cancer were higher in rural than in urban areas.

Conclusions: Factors promoting female breast cancer and colorectal cancer in urban areas and liver cancer and cervical cancer in rural areas should be specifically intervened in cancer prophylaxis. Improved medical services can greatly prolong the survival of major cancers in rural areas.

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Most cited references 31

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Overdiagnosis in cancer.

H. Welch, William C Black (2010)

This article summarizes the phenomenon of cancer overdiagnosis-the diagnosis of a "cancer" that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer overdiagnosis to occur: the existence of a silent disease reservoir and activities leading to its detection (particularly cancer screening). We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen-detected prostate cancers. We also review data from observational studies and population-based cancer statistics suggesting overdiagnosis in computed tomography-detected lung cancer, neuroblastoma, thyroid cancer, melanoma, and kidney cancer. To address the problem, patients must be adequately informed of the nature and the magnitude of the trade-off involved with early cancer detection. Equally important, researchers need to work to develop better estimates of the magnitude of overdiagnosis and develop clinical strategies to help minimize it.

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Urbanisation and health in China

Peng Gong, Song Liang, Elizabeth J. Carlton … (2012)

Summary China has seen the largest human migration in history, and the country's rapid urbanisation has important consequences for public health. A provincial analysis of its urbanisation trends shows shifting and accelerating rural-to-urban migration across the country and accompanying rapid increases in city size and population. The growing disease burden in urban areas attributable to nutrition and lifestyle choices is a major public health challenge, as are troubling disparities in health-care access, vaccination coverage, and accidents and injuries in China's rural-to-urban migrant population. Urban environmental quality, including air and water pollution, contributes to disease both in urban and in rural areas, and traffic-related accidents pose a major public health threat as the country becomes increasingly motorised. To address the health challenges and maximise the benefits that accompany this rapid urbanisation, innovative health policies focused on the needs of migrants and research that could close knowledge gaps on urban population exposures are needed.

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Epidemiological serosurvey of hepatitis B in China--declining HBV prevalence due to hepatitis B vaccination.

Xiaofeng Liang, Shengli Bi, Weizhong Yang … (2009)

To determine the prevalence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core anti-body (anti-HBc) in a representative population in China 14 years after introduction of hepatitis B vaccination of infants. National serosurvey, with participants selected by multi-stage random sampling. Demographics and hepatitis B vaccination history collected by questionnaire and review of vaccination records, and serum tested for HBsAg, antibody to anti-HBc and anti-HBs by ELISA. The weighted prevalences of HBsAg, anti-HBs and anti-HBc for Chinese population aged 1-59 years were 7.2%, 50.1%, 34.1%, respectively. HBsAg prevalence was greatly diminished among those age <15 years compared to that found in the 1992 national serosurvey, and among children age <5 years was only 1.0% (90% reduction). Reduced HBsAg prevalence was strongly associated with vaccination among all age groups. HBsAg risk in adults was associated with male sex, Western region, and certain ethnic groups and occupations while risk in children included birth at home or smaller hospitals, older age, and certain ethnic groups (Zhuang and other). China has already reached the national goal of reducing HBsAg prevalence to less than 1% among children under 5 years and has prevented an estimated 16-20 million HBV carriers through hepatitis B vaccination of infants. Immunization program should be further strengthened to reach those remaining at highest risk.

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Author and article information

Contributors

Xiaopan Li: URI : http://loop.frontiersin.org/people/647696/overview

Yang Deng: URI : http://loop.frontiersin.org/people/615439/overview

Weina Tang: URI : http://loop.frontiersin.org/people/647746/overview

Shuo Wang: URI : http://loop.frontiersin.org/people/647738/overview

Fan Yang: URI : http://loop.frontiersin.org/people/647758/overview

Yibo Ding: URI : http://loop.frontiersin.org/people/647759/overview

Genming Zhao: URI : http://loop.frontiersin.org/people/647697/overview

Guangwen Cao: URI : http://loop.frontiersin.org/people/618593/overview

Journal

Journal ID (nlm-ta): Front Oncol

Journal ID (iso-abbrev): Front Oncol

Journal ID (publisher-id): Front. Oncol.

Title: Frontiers in Oncology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2234-943X

Publication date (Electronic): 03 December 2018

Publication date Collection: 2018

Volume: 8

Electronic Location Identifier: 579

Affiliations

[1] ¹The Key Laboratory of Public Health and Safety of Education Ministry, School of Public Health, Fudan University , Shanghai, China

[2] ²Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University , Shanghai, China

[3] ³Department of Epidemiology, Second Military Medical University , Shanghai, China

Author notes

Edited by: Tianhui Chen, Zhejiang Academy of Medical Sciences, China

Reviewed by: Kun Chen, Zhejiang University, China; Ni Li, Chinese Academy of Medical Sciences and Peking Union Medical College, China

*Correspondence: Genming Zhao gmzhao@ 123456shmu.edu.cn

Guangwen Cao gcao@ 123456smmu.edu.cn

This article was submitted to Cancer Epidemiology and Prevention, a section of the journal Frontiers in Oncology

†These authors have contributed equally to this work

Article

DOI: 10.3389/fonc.2018.00579

PMC ID: 6287035

PubMed ID: 30560091

SO-VID: 7f0cd6dd-4ed7-4d96-adfa-ba40e1cbf85c

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 24 September 2018

Date accepted : 19 November 2018

Page count

Figures: 2, Tables: 4, Equations: 3, References: 41, Pages: 10, Words: 6879

Funding

Funded by: Ministry of Science and Technology of the People's Republic of China 10.13039/501100002855

Award ID: 2015CB554000

Funded by: National Natural Science Foundation of China 10.13039/501100001809

Award ID: 91529305

Award ID: 81520108021

Award ID: 81673250

Funded by: Natural Science Foundation of Shandong Province 10.13039/501100007129

Award ID: ZR2017PH012

Funded by: Foundation of Shanghai Municipal Commission of Health and Family Planning 10.13039/501100010032

Award ID: 201540407

Funded by: Health and Family Planning Committee of Pudong New Area 10.13039/501100011488

Urban-Rural Disparity in Cancer Incidence, Mortality, and Survivals in Shanghai, China, During 2002 and 2015

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Karger: Oncology

Most cited references 31

Overdiagnosis in cancer.

Urbanisation and health in China

Epidemiological serosurvey of hepatitis B in China--declining HBV prevalence due to hepatitis B vaccination.

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