LANCET: Cancer Incidence in Children and Adolescents in China Exposed!

Cancer is one of the leading causes of
death in children and adolescents worldwide.

On September 24, 2022, the National Childhood Cancer Surveillance Center (NCPCS) assessed the differences in cancer incidence in children and adolescents in China from the
perspective of socioeconomic inequality 。 The findings were published in "The Lancet" under the title "Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study.

In this nationwide cross-sectional study, the researchers used data from the National Children's Cancer Surveillance Center, the National Hospital Quality Monitoring System and public databases to cover 31 provinces, autonomous regions and municipalities
directly under the Central Government of mainland China.

Use the Human Development Index (HDI) to classify
areas by socioeconomic status.

Results of the study

1.

Leukemia (42.

3.

4.

5.

1.

From January 1, 2018 to December 31, 2020, an estimated 121145 children and adolescents in China have been diagnosed with cancer, and the average incidence of the world standard age standardization is 126.

Leukemia (42.

Malignant epithelial tumors and melanoma, leukemia, and central nervous system tumors are the three most common cancer types
among adolescents.

Neuroblastoma and ganglion neuroblastoma are the most common types of cancer in girls and boys under 1 year of age, accounting for 15.

In people aged 1 year and older, the incidence of precursor cell leukemia was highest in all groups, with the exception of adolescent girls, with the highest
incidence of thyroid cancer.

3.

Although there are some fluctuations between different age groups, the overall incidence of childhood cancer increases with increasing HDI (p<0.
0001
).

In different HDI regions, the rate of change is greater for girls than for boys
.
Data on the total incidence of cancer in adolescents also increased with increasing HDI levels (p<0.
0001), but fluctuated greater
.

In children, a clear trend
was observed in which the incidence of lymphoma, central nervous system tumors, neuroblastoma, retinoblastoma, malignant bone tumors, and soft-tissue sarcoma increased with increasing HDI levels.

4.
Population and geographic density in most health services are also significantly positively correlated with HDI levels

The geographical density of all health services (Gini coefficient 0.
32–0.
47) is more unequal than population density (Gini coefficient 0.
05–0.
19).

The geographical density of all health services increased significantly with the increase in HDI (diagnostic and therapeutic institutions p=0.
012, pediatric beds p=0.
0050, pediatric oncologists p=0.
012, pathology p=0.
0060 labour), while population densities of only pediatric oncologists (p=0.
049) and pathological labour (p=0.
0090) were significantly positively correlated
with HDI levels.

In the areas with the highest geographical and population densities in almost all health services, the incidence of cancer among adolescents has dropped
dramatically.

5.
The overall proportion of patients with cancer in children and adolescents across regions was 22.
16%, of which retinoblastoma (56.
54%) and low HDI regions (35.
14%) had the highest proportion

The overall proportion of patients with cross-regional patients in new cases of cancer in children and adolescents was 22.
16%, with retinoblastoma (56.
54%) and low HDI region (35.
14%) having the highest
proportion.
HDI levels declined in the 11 major cancer groups, but with the exception of central nervous system tumors, kidney tumors, liver tumors, and soft-tissue sarcomas, there were some fluctuations between most groups, but a clear trend
towards an increase in the proportion of patients across regions was observed.

Conclusion of this article

In conclusion, this paper reveals the heavy burden
of cancer in children and adolescents in our country by combining cancer incidence and data obtained by health services.
As a social determinant of health, the distribution of access to health services may play a significant role in the socio-economy
.
To achieve the Sustainable Development Goals, policies should prioritize increasing access to early diagnosis health services to improve outcomes and subsequently reduce the burden of disease, and reduce socioeconomic inequalities in
childhood and adolescent cancer.