Small-Area Lung Cancer Incidence and Mortality: Cross-Sectional Population-Based Study Using Hospital Discharge and...

Despite rapid development, cancer registries in low- and middle-income countries, such as China, have the persistent problems with up to 6-year delay and a lack of reported details about small areas.

This study aimed to develop an approach to provide more up-to-date localized cancer surveillance using linked administrative data. We used lung cancer as an example.

Based on data of hospitalization record front pages (HRFPs) between 2013 and 2022 from all the secondary and tertiary hospitals in Shandong Province, China, we identified incident cases of lung cancer in 2022 with 2013-2021 being the washout period. Deaths from lung cancer were ascertained for 2022 using linked HRFPs and death registration data. We estimated age-standardized incidence and mortality rates (ASIR and ASMR) of lung cancer in 2022 using Segi world standard population, age-specific incidence and mortality rates by sex, and county-level ASIR and ASMR to illustrate regional disparity. We grouped the counties by municipalities and calculated the Theil indices for within-municipality inequality and between-municipality inequality.

The HRFPs captured 79,672 incident cases of lung cancer in Shandong in 2022 (45,527 males, 34,145 females). The ASIR of lung cancer in Shandong was 42.46 per 100,000 in both sexes (49.19/100,000 in males vs 36.67/100,000 in females). A total of 40,626 lung cancer-specific deaths were ascertained (28,185 men and 12,441 women). The ASMR was 19.76/100,000 in both sexes, 26.29/100,000 and 11.38/100,000 in males and females, respectively. The IQR of county-level ASIR and ASMR were 17.13/100,000 and 10.41/100,000, respectively. The inequality was primarily due to within-municipality disparities, with within-municipality Theil T indices higher than between-municipality Theil T indices (0.0572 vs 0.0033 for ASIR, 0.0824 vs 0.0011 for ASMR).

The cancer surveillance approach based on linked administrative data could provide up-to-date small-area estimates of cancer burden, when cancer registry data are not yet reported and for areas not covered by cancer registries. It could reveal disparity of cancer epidemiology, which provides leads for further investigation into the underlying causes and potential solutions for equity improvement.