Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study

Ni, Xin; Li, Zhe; Li, Xinping; Zhang, Xiao; Bai, Guoliang; Liu, Yingying; Zheng, Rongshou; Zhang, Yawei; Xu, Xin; Liu, Yuanhu; Jia, Chenguang; Wang, Huanmin; Ma, Xiang; Zheng, Huyong; Su, Yan; Ge, Mingqiao; Zeng, Q.; Wang, Shengcai; Zhao, Junyang; Feng, Guoshuang; Yao, Xi; Guo, Yongli; Yang, Zhuoyu; Zhang, Jinzhe

doi:10.1016/s0140-6736(22)01541-0

Cited by 50 publications

(12 citation statements)

References 28 publications

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“…On the other hand, people with higher socioeconomic status might seek health services more frequently without worrying about medical expenditure, contributing to a lager molecule for calculating CHE. Several studies revealed that both health services distribution and utilization were concentrated among people with higher socioeconomic status [ 4 , 36 ]. These people were prone to overuse high-quality tertiary hospitals with poor quality primary health care, which are distributed mostly in urban areas and require higher costs with lower reimbursement ratios [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study

Wang

Qin

et al. 2023

BMC Health Serv Res

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Background Multimorbidity of non-communicable diseases (NCDs) is increasingly prevalent among older adults around the world, leading a higher risk of household catastrophic health expenditure (CHE). As current powerful evidence was insufficient, we aimed to estimate the association between multimorbidity of NCDs and the risk of CHE in China. Methods We designed a cohort study using data investigated in 2011–2018 from the China Health and Retirement Longitudinal Study, which is a nationally-representative study covering 150 counties of 28 provinces in China. We used mean ± standard deviation (SD) and frequencies and percentages to describe baseline characteristics. Person χ2 test was employed to compare the differences of baseline characteristics between households with and without multimorbidity. Lorenz curve and concentration index were used to measure the socioeconomic inequalities of CHE incidence. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between multimorbidity and CHE. Results Among 17,708 participants, 17,182 individuals were included for the descriptive analysis of the prevalence of multimorbidity in 2011, and 13,299 individuals (8029 households) met inclusion criteria and were included in the final analysis with a median of 83 (interquartile range: 25–84) person-months of follow-up. 45.1% (7752/17,182) individuals and 56.9% (4571/8029) households had multimorbidity at baseline. Participants with higher family economic level (aOR = 0.91, 95% CI: 0.86–0.97) had lower multimorbidity prevalence than those with lowest family economic level. 82.1% of participants with multimorbidity did not make use of outpatient care. The CHE incidence was more concentrated among participants with higher socioeconomic status (SES) with a concentration index of 0.059. The risk of CHE was 19% (aHR = 1.19, 95% CI: 1.16–1.22) higher for each additional NCD. Conclusions Approximately half of middle-aged and older adults in China had multimorbidity, causing a 19% higher risk of CHE for each additional NCD. Early interventions for preventing multimorbidity among people with low SES could be intensified to protect older adults from financial hardship. In addition, concerted efforts are needed to increase patients’ rational healthcare utilization and strengthen current medical security for people with high SES to reduce economic disparities in CHE.

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Section: Discussionmentioning

confidence: 99%

Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study

Wang

Qin

et al. 2023

BMC Health Serv Res

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“…Wenli Xiu 1,2 6A-C). 3D reconstruction suggested that the tumor originated from the posterior mediastinum and was closely adhered to the thoracic aorta and thoracic vertebra.…”

Section: Author Detailsmentioning

confidence: 99%

“…With decreasing mortality from infectious diseases and increasing cure rates for congenital malformations, pediatric tumors have become an important disease factor endangering the health of children, and their incidence continues to rise [1,2]. Surgical resection is the most effective and important treatment for the eradication of pediatric solid tumors, especially malignant solid tumors.…”

Section: Introductionmentioning

confidence: 99%

Application of Computer-Assisted Surgery System Based on Artificial Intelligence in Pediatric Precise Oncological Surgery

Xiu¹,

Hao²,

Xia³

et al. 2023

Artificial Intelligence

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Pediatric oncological surgery is difficult and challenging, especially in children with malignant solid tumors. Compared with adults, children have immature organs, thin blood vessels, and poor surgical tolerance. Moreover, pediatric malignant solid tumors are often huge, complex in location, fast-growing, and highly malignant. With artificial intelligence and machine learning breaking through many bottlenecks, computer-assisted precision medicine has also taken a quantum leap forward. Ten years ago, Professor Dong’s group invented the Computer-assisted Surgery System (Hisense CAS). Now, this three-dimensional (3D) visualization technology based on artificial intelligence has been used for pediatric precise oncological surgery and has been upgraded to version 5.0. Hisense CAS was developed based on enhanced pediatric CT data, so it has advantages in displaying pediatric solid tumors. CAS can display the adjacent relationships of the tumor with the surrounding tissues (especially the compressed blood vessels) in a 3D, dynamic, and complete manner through rapid and accurate 3D reconstruction of organs, tumors, and blood vessels. Then, precise preoperative evaluations and surgical planning can be carried out. This chapter focuses on individualized computer-assisted surgical planning and progress in common and complex pediatric tumors (such as malignant liver tumors, retroperitoneal tumors, and mediastinal tumors) and introduces experience in improving the resectability of tumors and reducing surgical complications.

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“…1 It represents 8%-10% of all pediatric tumors and up to 15.84% in infants, but accounts for 10%-15% of cancer-related deaths in children. 2,3 In order to compare the results of different clinical trials around the world, uniform risk classification approaches were applied according to the International Neuroblastoma Risk Group (INRG) classification system, which divides patients into very low-, low-, intermediate-, and high-risk groups. 4 More than half of patients were initially diagnosed with high-risk disease.…”

Section: Introductionmentioning

confidence: 99%

“…Neuroblastoma (NB) is the most frequent extracranial solid tumor, which arises from neural crest cells of sympathetic nervous system 1 . It represents 8%–10% of all pediatric tumors and up to 15.84% in infants, but accounts for 10%–15% of cancer‐related deaths in children 2,3 . In order to compare the results of different clinical trials around the world, uniform risk classification approaches were applied according to the International Neuroblastoma Risk Group (INRG) classification system, which divides patients into very low‐, low‐, intermediate‐, and high‐risk groups 4 …”

Section: Introductionmentioning

confidence: 99%

Combined analysis of PHOX2B at two time points and its value for further risk stratification in high‐risk neuroblastoma

Yue

Gao

Xing

et al. 2023

Pediatric Blood & Cancer

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Background Risk stratification of high‐risk neuroblastoma (NB) is crucial for exploring treatments. This study aimed to explore the value of minimal residual disease (MRD) based on PHOX2B levels for further risk stratification in high‐risk NB. Methods The expression of PHOX2B was monitored at two time points (after two and six cycles of induction chemotherapy, TP1 and TP2, respectively) by real‐time polymerase chain reaction (RT‐PCR). The clinical characteristics between groups and survival rates were analyzed. Results The study included 151 high‐risk patients. Positive expression of PHOX2B at diagnosis was seen in 129 cases. PHOX2B was mainly expressed in patients with high lactate dehydrogenase (LDH) and neuron‐specific enolase (NSE) levels (p < .001), bone marrow metastasis (p < .001), more than three metastatic organs (p < .001), 11q23 loss of heterozygosity (LOH) (p = .007), and when more events occurred (p = .012). The 4‐year EFS rate was significantly lower in patients with positive PHOX2B expression compared to the negative group at diagnosis (32.9% ± 6.2% vs. 74.5% ± 10.1%, p = .005). We stratified the 151 patients into three MRD risk groups: low high‐risk (low‐HR), with TP1 less than 10−4 and TP2 less than 10−4; ultra‐HR, with TP1 greater than or equal to 10−2 or TP2 greater than or equal to 10−4, and others classified as intermediate‐HR. Patients in ultra‐HR had the worst survival rate compared with other two groups (p = .02). In a multivariate model, MRD risk stratification based on PHOX2B levels at TP1 and TP2 was an independent prognostic factor for high‐risk patients (p = .001). Patients in ultra‐HR were associated with 11q23 LOH (p < .001), more than three organs of metastasis (p = .005), bone marrow metastasis (p < .001), and occurrence of more events (p = .009). Conclusions MRD risk stratification based on PHOX2B levels at two time points (after two and six cycles of induction chemotherapy) provided a stratification system for high‐risk NB, which successfully predicted treatment outcomes. Our results present an effective method for further stratification of high‐risk NB.

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Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study

Cited by 50 publications

References 28 publications

Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study

Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study

Application of Computer-Assisted Surgery System Based on Artificial Intelligence in Pediatric Precise Oncological Surgery

Combined analysis of PHOX2B at two time points and its value for further risk stratification in high‐risk neuroblastoma

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