Effects of screening and universal healthcare on long-term colorectal cancer mortality
Journal
International Journal of Epidemiology
Journal Volume
48
Journal Issue
2
Pages
538-548
Date Issued
2019
Author(s)
Hsu C.-Y.
Chen S.L.-S.
Yen A.M.-F.
Chiu S.Y.-H.
Fann J.C.-Y.
Chuang S.-L.
Abstract
Background: To evaluate the time trends of colorectal cancer (CRC) affected by a Nationwide Colorectal Cancer Screening (NCCS) programme with biennial faecal immunochemical testing (FIT) and Nationwide Healthcare Insurance (NHI). Methods: Data from the national registries on cancer and death in Taiwan were separated into years 1984-1993, 1994-2003 and 2004-2013 based on the implementations of NHI (starting 1995) and NCCS (starting 2004). The adult population was divided into three age groups (young, 30-49; middle-aged, 50-69; and old, 70-84 years); only the middle-aged were eligible for NCCS. Crude and adjusted effects of NCCS and NHI were quantified by percentage change and 95% confidence interval (CI) with respect to CRC mortality, according to the attributions from incidence and survival. Results: Within 335 million person-years of follow-up, 204 362 incident CRCs and 80 771 CRC-related deaths were identified. Increasing mortality trends were noted for 1994-2003 (post-NHI) vs 1984-1993 due to remarkable increasing incidence trends that could not be offset by improved survival as a result of NHI. During 2004-13 (post-NCCS), mortality continued to increase by 15% (95% CI: 10-21%) in young adults (30-49 years) and 8% (95% CI: 6-11%) in older adults (70-84 years), whereas middle-aged adults (50-69 years) had a reduction of 7% (95% CI: 5-9%) due to a remarkable stage shift and subsequent improvement in survival. In the middle-aged adults, increased incidence was less but survival improvement was more compared with other age groups. Conclusions: Whereas universal healthcare insurance led to improvement in CRC survival, FIT-based screening has made an even greater contribution to reducing CRC mortality. ? The Author(s) 2018. Published by Oxford University Press on behalf of the International Epidemiological Association.
SDGs
Other Subjects
cancer; confidence interval; disease incidence; health care; health insurance; mortality; quantitative analysis; survival; adult; aged; Article; cancer incidence; cancer mortality; cancer patient; cancer registry; cancer screening; cancer staging; cohort analysis; colorectal cancer; confidence interval; controlled study; female; follow up; groups by age; health care; health care disparity; health insurance; human; major clinical study; male; middle aged; mortality rate; occult blood test; priority journal; risk factor; sex difference; survival rate; Taiwan; trend study; very elderly; young adult; age distribution; colonoscopy; colorectal tumor; early cancer diagnosis; epidemiology; forecasting; incidence; mass screening; mortality; multivariate analysis; occult blood; procedures; register; regression analysis; sex ratio; Taiwan; Adult; Age Distribution; Aged; Aged, 80 and over; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Forecasting; Humans; Incidence; Male; Mass Screening; Middle Aged; Multivariate Analysis; Occult Blood; Registries; Regression Analysis; Sex Distribution; Taiwan; Universal Health Care
Publisher
Oxford University Press
Type
journal article