Abstract
BackgroundGlobally China has the largest urban-rural disparity in socioeconomic development, and the urban-rural difference in upper gastrointestinal cancer (UGIC) is similar to the difference between developed and developing countries. ObjectivesTo describe urban-rural disparity in UGIC and to emphasize prevention by socioeconomic development and urbanization in China. MethodsAge-standardized incidence rates (ASRs) of cancers in 2012 were compared between urban Shijiazhuang city and rural Shexian County, and trends from 2000-2015 in Shexian County were analyzed. FindingsCompared with urban Shijiazhuang city, the ASR of gastroesophageal cancers in rural Shexian County was 5.3 times higher in men (234.1 vs 44.2/100,000, P < .01) and 9.1 times higher in women (107.7 vs 11.8/100,000, P < .01). This rural-urban disparity in UGIC is associated with differences in socioeconomic development in annual gross domestic product (GDP) per capita of US$2700 vs US$6965, in urbanization rate of 48% vs 100%, and in adult Helicobacter pylori infection prevalence of 75% vs 50%. From 2000-2015, the GDP per capita in Shexian County increased from US$860 to US$3000, urbanization rate increased from 22.4% to 54.8%, and prevalence of H pylori infection among 3- to 10-year-old children decreased from 60% to 46.1% (P < .01). Meanwhile, the biennial ASR of esophagogastric cancer decreased 42% in men, from 313.5 to 182.1 per 100,000 (P < .01), and 57% in women, from 188.6 to 80.4 per 100,000 (P = .00). However, lung, colorectal, and gallbladder cancers and leukemia in both sexes and breast, ovary, thyroid, and kidney cancer in women increased significantly. Despite this offset, ASR of all cancers combined decreased 25% in men (from 378.2 to 283.0/100,000, P = .00) and 19% in women (from 238.5 to 193.6/100,000, P = .00). ConclusionsUrban-rural disparity in UGIC is related to inequity in socioeconomic development. Economic growth and urbanization is effective for prevention in endemic regions in China and should be a policy priority.
Highlights
In China, the former Soviet Union–style central economy planning system implemented from 1949 until 1980 had invested more in urban industry development than in rural living condition improvement
Using age-standardized incidence rates by population-based tumor registration, this paper describes the urban-rural disparity in H pylori infection–related cancers in relation to unfair distribution of social determinants of health and examines the hypothesis that a decreasing trend of these cancers is associated with socioeconomic development and urbanization in an endemic region
In China, urban-rural inequity in socioeconomic development is so large that the urban-rural difference in cancer distribution is similar to the difference between developed and developing countries.[7,8,19]
Summary
In China, the former Soviet Union–style central economy planning system implemented from 1949 until 1980 had invested more in urban industry development than in rural living condition improvement. Using age-standardized incidence rates by population-based tumor registration, this paper describes the urban-rural disparity in H pylori infection–related cancers in relation to unfair distribution of social determinants of health and examines the hypothesis that a decreasing trend of these cancers is associated with socioeconomic development and urbanization in an endemic region. FINDINGS Compared with urban Shijiazhuang city, the ASR of gastroesophageal cancers in rural Shexian County was 5.3 times higher in men (234.1 vs 44.2/100,000, P < .01) and 9.1 times higher in women (107.7 vs 11.8/100,000, P < .01) This rural-urban disparity in UGIC is associated with differences in socioeconomic development in annual gross domestic product (GDP) per capita of US$2700 vs US$6965, in urbanization rate of 48% vs 100%, and in adult Helicobacter pylori infection prevalence of 75% vs 50%. Economic growth and urbanization is effective for prevention in endemic regions in China and should be a policy priority
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