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Screening, Salt Iodization and the Epidemic of Thyroid Cancer in China: An Analysis of National Inpatient and Commercial Insurance Databases

22 Pages Posted: 27 Sep 2018

See all articles by Sui Peng

Sui Peng

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit; Sun Yat-Sen University (SYSU) - Department of Gastroenterology and Hepatology

Haibo Wang

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit

Yihao Liu

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

Jianyan Long

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

Qian Zhou

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

Bin Li

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit

Lei Su

Sun Yat-Sen University (SYSU) - First Affiliated Hospital

Lanxia Gan

China Standard Medical Information Research Center

Ying Shi

China Standard Medical Information Research Center

Weiming Lv

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

Yanbing Li

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

KK Cheng

University of Birmingham - Institute of Applied Health Research

Haipeng Xiao

Sun Yat-Sen University (SYSU) - Institute of Precision Medicine

More...

Abstract

Background: Reasons behind the rapid increase of thyroid cancer (TC) in China are uncertain. Using two national databases, we assessed the burden of TC and the role of access to screening and salt iodization.

Methods: We analyzed data from Hospital Quality Monitoring System (HQMS) with 76,263,617 class 3 hospital inpatients in 2013-2017 and China Reinsurance Company (CRC) database with 93,123,018 clients in 2000-2016. Level of access to screening was assessed by the type of medical insurance of individuals and provincial Per Capita Disposable Income (PCDI). Iodine status of provinces was estimated by median urinary iodine (MUI). The proportion of TC inpatients among inpatients in HQMS and TC incidence in CII buyers were used to evaluate the association with screening and iodine status. We used the HQMS to estimate TC incidence in the general population.

Findings: Between 2013 and 2017 the proportion of TC patients in HQMS with urban employee medical insurance increased sharply while there was little change among those with the other two forms of medical insurance. The estimated incidence increased by 39.7% (23.9/100,000 to 33.4/100,000), with 1.98m new cases in class 3 hospitals. In CII buyers, the incidence increased by 57.2% (17.3/100,000 to 27.2/100,000) in 2013-2016. Across provinces, there was positive correlation between the proportion of TC inpatients in HQMS and PCDI. We found no association between the proportion of TC inpatients in HQMS in 2013-2017 and MUI in 1999 and 2005, but a negative correlation with MUI in 2011. Similar findings were observed in the CRC database. Interpretation: The epidemic of TC in China was substantially underestimated. It was associated with access to screening but not with salt iodization. In the absence of a very sharp reduction in screening activities, we forecast that 5.8 million healthy individuals would become TC patients unnecessarily between 2019 and 2030.

Funding: The World Health Organization (WHO Reference 2016/648722-0 and 2017/722356-0 for the China-World Health Organization Biennial Collaborative Projects 2016-2017) and National Natural Science Foundation of China (81772850).

Declaration of Interest: We declare no competing interests.

Ethical Approval: The ethics committee of the First Affiliated Hospital of Sun Yat-sen University approved the study.

Suggested Citation

Peng, Sui and Wang, Haibo and Liu, Yihao and Long, Jianyan and Zhou, Qian and Li, Bin and Su, Lei and Gan, Lanxia and Shi, Ying and Lv, Weiming and Li, Yanbing and Cheng, KK and Xiao, Haipeng, Screening, Salt Iodization and the Epidemic of Thyroid Cancer in China: An Analysis of National Inpatient and Commercial Insurance Databases (August 17, 2018). Available at SSRN: https://ssrn.com/abstract=3235644 or http://dx.doi.org/10.2139/ssrn.3235644

Sui Peng

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit ( email )

China

Sun Yat-Sen University (SYSU) - Department of Gastroenterology and Hepatology

135, Xingang Xi Road
Guangdong, Guangdong 510275
China

Haibo Wang

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit

China

Yihao Liu

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

China

Jianyan Long

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

China

Qian Zhou

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

China

Bin Li

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit ( email )

China

Lei Su

Sun Yat-Sen University (SYSU) - First Affiliated Hospital

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Lanxia Gan

China Standard Medical Information Research Center

China

Ying Shi

China Standard Medical Information Research Center

China

Weiming Lv

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

China

Yanbing Li

Sun Yat-Sen University (SYSU) - Fifth Affiliated Hospital

China

KK Cheng

University of Birmingham - Institute of Applied Health Research

Birmingham, B15 2TT
United Kingdom

Haipeng Xiao (Contact Author)

Sun Yat-Sen University (SYSU) - Institute of Precision Medicine ( email )

Guangzhou, Guangdong
China

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